July 2018 — Health Care Properties Quarterly — Page 15 H ealth care is one of the most complex and challenging con- struction types, and the small number of contractors who excel seem to dominate the market, which can include half-billion- dollar, ground-up hospitals, medical office buildings and rehabilitation facili- ties all the way to skilled nursing wings of retirement communities. “Since the scope of work involves the integration of multiple systems includ- ing safety, comfort, security, medical equipment, food service and more, teams need to be flexible even dur- ing construction to accommodate for changes in direction and technologies,” said Charles Adkisson, AIA, inTre- anorHL’s Health studio. These requirements encompass all phases of a construction project, begin- ning with programming and continuing through closeout and warranty.Thus, it takes a strongly coordinated effort from an experienced project team to minimize or eliminate the myriad chal- lenges these highly technical projects present. “Strong collaboration, great technical expertise and meticulous execution are critical to success in health care construction,” said Pinkard President Tony Burke.That involves coordination with the many user groups involved in a health care project and needs to be grounded in the basic understanding that these many user groups – while all focused on the patient experience – may have diverse and sometimes con- flicting priorities. “Operations personnel typically enter a project with a long list of equipment and specifications,” said Burke. “Facili- ties managers are familiar with this equipment and usu- ally know exactly where this equip- ment should be installed. Clinicians and physicians, on the other hand, work with this equipment every day and fre- quently have either changing needs for the equipment, or new health care trends dictate replac- ing equipment that no longer serves patients in the best possible way.” Therefore, collaborative design, plan- ning and construction all play a crucial role in the project’s success. “When designing for health care, it’s critical that the program is clear, the needs are well communicated and that the hos- pital leadership team is involved,” said Associate Keyon Anderson, who repre- sentsTreanorHL’s Health studio. “When user groups and clients have conflict, architects can bridge the gap between the medical planning and project over- sight teams.” This type of planning is critical for all health care projects, but it isn’t just about programming. A contractor must understand how the complex systems function, their specific uses and ultimately how they affect the physicians and clinicians. All of this must be accounted for in preconstruc- tion to include procurement, long-term schedule and sequencing planning and meticulous design coordination. “You can’t wait until you’re in the field to consider all these issues,” said Pinkard Senior Superintendent Dale Young. “A highly qualified superinten- dent must be involved early in plan- ning to minimize the risk of surprises in the field, especially structural issues.” This technical knowledge – applied during the planning phase – can pre- pare a construction team for efficient scheduling and sequencing in the field. A good team’s value is not only in finding the best ways for the complex equipment and systems to fit together. Equally important is when they should fit together. “Med gas is a great example,” said Young. “You cannot install overhead oxygen lines for med gas until the walls are constructed, because zone valve boxes must go into the walls first to allow for purging and brazing of the lines. A scheduling novice might just include a line item in the schedule that says overhead med gas, but that is a trap a new team can fall into.” MRIs are another good example. An MRI can weigh up to 90,000 pounds, most of which is in the magnet. Slab thickness in just the right place is criti- cal to support it. “In addition to structural consider- ations such as slab thickness, it is nec- essary to understand the importance of the magnetic isocenter,” saidYoung. That might involve coordinating dis- tances from that center to certain size transformers, planning for procure- ment of stainless rebar and bolts, con- firming the required floor recess for the RF shielding and flooring, coordinating the quench vent with MEPFs from the magnet to a safe discharge point, coor- dinating penetrations in the RF shield- ing, procuring the RF shielding, under- standing and coordinating delivery of the MRI to coincide with the proper site conditions, and ensuring the fire protection system inside the room is nonmagnetic. Another scheduling consideration is inspection.The Colorado Department of Public Health and the Environment is the inspection agency responsible for health facility licensure, certification and registration, all of which are to be included in the master schedule. These critical, meticulous activities must have their own critical paths on the schedule, which can contain thousands of activities. And every sub- contractor, supplier and teammember must pull his or her own weight to stay on track. “Because so many of these types of projects are fast-tracked, there is no room for a weak teammember,” said Bokhoven. “Owners, designers and contractors must carefully choose their partners to ensure strong performances from all players.” In today’s health care environment, fast-tracking is due, in part, to the evolving field of health care.With the ever-changing government health care system, and hospital/health care companies merging or breaking apart, owners are faced with shrinking bud- gets and a greater need for fiduciary responsibility.This translates to owners doing all they can to put the right facil- ity into the right neighborhood as soon as possible and ultimately providing an exceptional patient experience within an efficiently operating facility. So how can a contractor succeed? It comes down to planning and having a strong team, as Anderson sums best: “Collaboration starts fromDay One – and extends beyond seeing the first patient.” ▲ Considerations for health care construction today Blending the Generations Experts in Design Mixology Tenant Planning Services 1660 Lincoln St, Ste100, Denver, CO 80264 303.861.4800 l Contact us to learn more Construction Ned Foster Performance insight, Pinkard Construction