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Streamlined Process Allows for Fast Hospital Opening in Boom Town
Within the last five years, the population of Gilbert, Ariz., has been exploding. Due to its appealing climate, setting and economy, the Phoenix suburb has expanded at an average rate of more than 1,000 new residents per month. In fact, Gilbert is one of the nation's fastest-growing cities, with a population that has tripled to more than 178,000 over the past 10 years.
However, until recently, the booming town lacked one vital resource: a hospital. That’s where San Francisco-based Catholic Healthcare West (CHW) came in. It recognized the community’s need and saw the competitive advantage gained from being the first to open a healthcare facility in Gilbert.
Then in June 2006, the not-for-profit health system opened the 92-bed Mercy Gilbert Medical Center. Mercy Gilbert Medical Center is a full-service, acute-care facility that provides comprehensive medical services. It is located on a 100-acre medical campus that includes 60 acres designated for the hospital and 40 acres for medical office buildings, according to a hospital press release. The hospital’s Celebration Center for Integrated Healing is scheduled to open in 2007 on five acres next to the hospital.
“We knew the competition was building,” says Laurie Eberst, R.N., chief executive officer of Mercy Gilbert in a January 2007 Health Facilities Management (HFM) article by Amy Eagle.
Eberst says CHW wanted to establish Mercy Gilbert before another hospital opened in town. She adds that the health system wanted to be prepared to serve patients before the winter season, a period which was typically plagued by shortages in bed and emergency department capacity.
An Efficient, Streamlined Process
To meet its ambitious goals, CHW worked quickly with Moon Mayoras Architects Inc., San Diego; engineering firm Syska Hennessy Group, Los Angeles; structural engineers Chavez-Grieves, Albuquerque, N.M.; and Kitchell Contractors Inc., Phoenix. In fact, the doors of the hospital opened just three months after it had purchased the land for the project.
“It’s probably been one of the smoothest opening and construction processes that I’ve ever heard of,” says Eberst.
The project’s efficiency was due, in part, to getting all the major parties involved as early as possible. Team members included the owner, architects, engineers and construction manager, as well as local government officials, subcontractors and the hospital’s future facilities manager. Collecting everyone’s input on the front end helped the design and construction team effectively merge all the pieces of the project.
For example, team members met with officials from the town of Gilbert for a preconstruction discussion about how to streamline the inspection process. The community was “a tremendous help,” says Dave McDermed, senior project superintendent for Kitchell. Consequently, the town hired representatives from Canadian design and consulting firm Stantec to conduct the project’s plan check and building inspections. In addition, early meetings with utility company officials helped ensure utilities would be operating when the hospital opened.
“We were fortunate that the building site was pretty wide open,” says McDermed. However, the openness of the site, posed a problem. Having been a former alfalfa field, the site would need sewer, water, power, telephone and gas lines to be brought in from a distance. “We worked with the local utility companies very early on to get us into their overall area plans,” McDermed says.
The design plan of Mercy Gilbert was originally based on two existing CHW hospital developments, which gave the new project a head start. Kitchell personnel were familiar with the overall building size and scale, as they had worked on two previous CHW hospitals. However, there was significant design work left to be done. The original plan was created for a split-level parcel of land, so major sections of the building had to be redesigned for the flat Gilbert site.
“[We] essentially redesigned the entire facility with the exception of the patient bed tower to accommodate that change,” says David N. Moon, AIA, FACHA, of Moon Mayoras Architects, in the HFM article.
To uncover any flaws in the schematic and enhance the design of the new hospital, the team consulted with the chief engineer at the first hospital built to this design. “[CHW] wanted to apply any lessons learned to this project,” says Paul Dong, P.E., a Syska Hennessy mechanical engineer.
CHW also took advantage of a process called design-assist for the mechanical, electrical and plumbing (MEP) portions of the project. They brought the general contractor and subcontractors in to collaborate with the architects and MEP engineers during the design phase, and this enhanced the process of selecting and sizing the building’s infrastructure components.
As another time-saving move, Mercy Gilbert’s facilities manager, Paul Lyons, was also conferred with early in the project. This not only facilitated equipment selection and systems design, but also helped iron out maintenance issues before the building opened, according to McDermed.
In addition, employing a design-build approach for the steel portion of the project helped the team to identify the proper sizes for steel supports and complete the structural steel design and procurement early. “It helped eliminate a lot of change orders throughout the process,” McDermed says. “When it came time for construction we could move fairly quickly.”
Periodically, modifications had to be made to the construction schedule to accommodate the accelerated pace. To make it possible for CHW staff to take advantage of the latest technologies in major medical equipment without delaying construction, Kitchell staff worked around rooms where that equipment was to be located. “We had empty shell rooms with dirt floors, where on the other side of the wall you had final finishes such as floor tiling and paint on the walls,” says Pat Watson, project director for Kitchell.
Efficiency Is Key
Not only was the hospital built with efficiency, but it was built to run efficiently. The hospital’s chilled water system, for instance, uses only one set of pumps. Normally, two sets are used, one to move water around a primary loop and another to pump the water between that loop and the building, as a secondary loop.
Instead of running circles in the building, we pump through the chiller, go into the building, and then come back directly,” says Dong.
The longer run enables the pumps to operate at more efficient variable speeds. This setup provides a major first-cost savings on equipment, as well as ongoing operational and maintenance savings, according to Dong.
Heating represents another area of operational efficiency. The hospital has a non-flashing high-pressure condensate return system that conserves the heat generally lost during the water return process. Likewise, the air flow system in the hospital’s operating rooms has an unoccupied mode setting that reduces the number of air changes that occur when the rooms are not in use. The system goes from 20 to six air changes per hour when it is in unoccupied mode. “We slow down the fans to save energy,” Dong explains.
In addition, the operating rooms also have both high and low air returns to minimize surgical infections. This is in accordance with new recommendations in the 2006 Guidelines for Design and Construction of Health Care Facilities, commonly known as the “AIA Guidelines.”
Adding Local Color
Even though speed and efficiency were imperative, these factors were not allowed to overshadow concerns over aesthetics. “We wanted [the hospital] to stand out, and not just be a big, white boxy building,” says Eberst. “We wanted it to complement the architecture around us.
To convey a visual consistency with the surrounding community, interpretations of some of the local structures were blended in the architects’ design of the hospital. For instance, the design references to the train station’s barrel vaulting, as well as other shapes from the downtown area.
Careful consideration was also given to the natural setting. Color selections for the building were aimed at reflecting the intensity of Arizona sunsets. Also, exterior windows and skylights pour sunlight into the building during the day. To conserve water, the hospital is surrounded by attractive plants that thrive under desert conditions. Consequently the hospital was honored with a 2006 beautification award.
The hospital’s attractive design, use of technology and healing culture have made the hospital easy to staff, Eberst says. Staffing was a major concern for facility because Arizona is second only to California in the lowest number of nurses per capita. The hospital had geared up to
recruit nurses from overseas, but a pre-opening job fair attracted plenty of candidates—more than 1,200 people. “It was phenomenal,” Eberst says. “I had full staff on opening.”
The town of Gilbert has welcomed the new hospital with “a tremendous amount of support and warmth,” as well as the resources to continue facility development, Eberst says. In the last year and a half, the hospital has collected $5.6 million toward a $10 million capital campaign to provide for future growth—which, for Gilbert, seems inevitable.
This article was reproduced for educational purposes from the January 2007 HFM Magazine article entitled “Staking Claim” by Amy Eagle.
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