Whitepaper: 11.18.2013

Case Study: Building a World-Class Children’s Hospital

by Michael Gritters, McCarthy Executive Vice President, Healthcare Services

Serving the sixth most populous county in the United States, Children’s Hospital of Orange County (CHOC Children’s) embarked on a monumental building expansion to meet the growing needs of their community. With a goal to become a “destination of choice” among the nation’s pediatric hospitals, CHOC Children’s envisioned a transformation that would: 1) Advance clinical excellence; 2) Attract and retain top-level medical staff; and 3) Enhance the patient and family experience. Delivered 64 days early, the new Bill Holmes Tower at CHOC Children’s Hospital is now providing children in Southern California with increased hope for a healthier tomorrow.

After eight years of planning, design and construction, CHOC Children’s vision became a reality with the completion of an eight-level, 425,524-square-foot inpatient tower. The new cutting-edge facility not only increases capacity, but also consolidates all formerly dispersed diagnostic and treatment functions into a self-sustaining, best-in-class facility committed to a culture of safety and family-centered care.

“CHOC, with the help of McCarthy and our other design and construction partners, has built one of the most advanced and safest children's hospitals in the world," said Kimberly Chavalas Cripe, president and CEO, CHOC Children's. “Within this beautiful tower, which triples the size of our existing inpatient facility in Orange, our team of clinicians and staff will employ cutting-edge science and technology to improve care and outcomes for our community’s children, making their futures brighter than ever.”

Building the Children’s Hospital of Tomorrow
Located on the south side of the existing north tower at the CHOC Children’s hospital site, the project included construction of the Bill Holmes Tower as well as a penthouse chiller room and helistop. Prior to construction, an office building and two-level parking structure were removed to make way for the new tower. McCarthy also renovated 50,000 square feet of the existing north tower and supporting central plant components in its basement.

Building a technologically advanced project of this complexity came with a multitude of challenges. By utilizing an integrated team approach and the latest building technology, the project team developed a variety of innovative solutions to successfully overcome all challenges encountered.

Many of the individuals on the CHOC building expansion construction team had children or grandchildren of their own who had been or were currently being treated at CHOC. With the promise of a healthier future for their own children and CHOC’s ambitious goals in mind, the entire design and construction team came to work every day knowing their efforts would ultimately impact and improve the quality of life for countless children and families, not only regionally, but also nationally.

The much anticipated pediatric patient tower was completed 64 days early, enabling children to receive advanced medical care in the new CHOC facility sooner than originally anticipated. All of this was accomplished on a fully functioning hospital campus, while achieving an outstanding safety record and the highest levels of quality.

Designing for Children, Families, Physicians and Staff
Based on valuable input from parent and youth advisory councils as well as physicians and staff, the design of the Bill Holmes Tower features a lively exterior highlighted by a multicolored glass skin, accented with colorful metal panels and a vertical beacon. At night, the façade transforms providing a playful change in appearance.

The public spaces inside the new tower are infused with fun and excitement while patient floors create a peaceful healing environment. Organized and consolidated for optimum efficiency, the diagnostic and treatment areas are planned around flexible room concepts that can adapt to future technologies and changes in treatment techniques.

The new tower houses the region’s only operating rooms dedicated to pediatrics, an emergency department, imaging department and laboratory. Enhanced patient and family amenities feature Seacrest Studios, a multimedia broadcast center; pre-teen and teen rooms; a patient outdoor play area; café and outdoor garden; family resource center; and meditation and prayer center.

Safety and Technology
Supporting the hospital’s expansive safety initiative, patient, exam and procedure rooms were built with common standardized components and layouts. New operational logistics for laboratory specimen collection and processing, medication preparation and delivery, and material stocking and distribution were integrated into the design as additional safety features to decrease staff travel distances and time away from patients. A state-of-the-art wireless communication system assists with locating physicians, nursing staff and patients as they are on the move.

Further technology features within the hospital include:

  • Surgery Wall of Knowledge – a large flat screen video monitor to provide essential patient information to the surgical team;
  • Emergency Department Patient Tracking System – tracking each patient from the moment of arrival, enhancing communications and workflow through automated notifications;
  • “Plug-and-Play” Medical Devices – including patient monitors, IV and medication pumps that stream patient information directly to the medical record;
  • Computerized Medication Safety System – scans patient ID bands at the bedside to ensure each patient receives the correct medication at the correct time; and
  • Advanced Nurse Call System – immediately connects patients and families to the nurses’ smart phones as well as the nursing stations.

Building in an Operational Healthcare Environment
Building the new tower in an active hospital environment required extensive preplanning to mitigate disruption to the existing hospital and to keep this complex project on schedule.

Built on a 2.39-acre site, the new tower connects to the existing north tower on the north elevation, has a zero lot line on the east elevation, and is five feet away from an existing parking structure on the west elevation. One of the greatest logistical challenges was coordinating deliveries of large structural members, mechanical equipment and miscellaneous bulk deliveries.

To solve the challenges associated with the tight site, just-in-time delivery was employed during all phases of the project for all construction materials and for export of construction debris and dirt. Utilizing Building Information Modeling (BIM), the construction team prefabricated many of the building systems and delivered them ready for installation.

Providing MEP Solutions
Blending the mechanical, electrical and plumbing (MEP) systems in the new tower with systems in the existing facility was extremely chal­lenging and could have resulted in lost time and an increased budget if not coordinated and implemented correctly.

McCarthy’s Project Director Max Burcham explains the solution for one such instance. “The existing chillers could not be decommissioned until the new chillers were installed and commissioned. The increased size of the new boilers meant that the third boiler sat where the existing chillers were currently operating to feed the north tower. Through the collaborative design-assist phase of the project, we established a phasing plan allowing for early commissioning of the new mechanical systems in coordination with the Office of Statewide Health Planning and Development. This allowed the existing chillers to be demolished and the new third boiler installation to start ahead of schedule.”

Furthermore, a phased renovation required that all electrical and low voltage systems (such as fire alarm, lighting, emergency power, telecommunications and nurse call) remain active while each system was upgraded to new technology. Thousands of hours of research, sequence planning and development of innovative temporary solutions led to a successful phased transition with no interruption to the hospital’s services.

Meeting Sustainable and Environmental Health Principals
The project team recommended using several LEED construction practices on the Bill Holmes Tower project. As a result of these recommendations, the building incorporates environmental health principles and sustainable building guidelines as recognized by the Green Guide for Healthcare, United States Green Building Council and state of California energy mandates.

During construction, McCarthy implemented air quality and infection control protocols for the existing hospital, minimized unrecyclable construction waste and sediment runoff into storm draining systems, ground and recycled asphalt aggregate, and conserved power by reducing lighting in select areas during high-energy usage days.

Some of the building’s sustainable features include: recyclable materials; low-emitting insulating exterior glass panels; light-colored skin materials; green roofing; insulation isolation of skin materials; ozone protection/refrigerant selection; abundant use and optimization of natural light; increasing green space with healing gardens; low-emitting interior materials such as floor, wall and ceiling finishes; energy management technology; water-efficient landscaping; and irrigation management.

Delivering Increased Care Ahead of Schedule
At the project outset, the construction schedule was established at 42 months. However, given that CHOC was building the Bill Holmes Tower to bring core services under its own roof, the project team collaborated to complete the project as soon as possible. Ultimately, the team met this goal and completed the project 64 days ahead of schedule.

The use of the latest construction technology and project delivery techniques played a significant role in completing the project ahead of schedule. BIM technology in conjunction with the design-assist delivery method were used early in the design phases of the CHOC Children’s project to coordinate the tower’s intricate drawings for the MEP and other related systems.

“By using design-assist delivery and incorporating BIM technology, McCarthy and its team of subcontractors identified several critical discrepancies that could have been detrimental to maintaining the project schedule,” said Waldo Romero, CHOC Children’s vice president, facilities and support services. “Through this proactive approach, the project team was able to mitigate these discrepancies before construction began, ultimately beating the schedule and allowing CHOC to open its doors sooner to care for the children in our community.”

Though they have much to celebrate, the designers and builders of the new Bill Holmes Tower are most proud of creating a world-class healthcare facility that will greatly assist caring healthcare professionals and serve as a place of hope and healing to thousands of children and families for many years to come.

FKP Architects – design architect and architect-of-record
WBSA (Wood, Burghard & Swain Architects) – construction administration and associate architect

Project Personnel:
Project Executive: Greg Schoonover
Director: Max Burcham
Project Managers:
Kris Nordback, Eugenio Acosta
Asst. Project Managers: James Burggraf, Mike Engers, Brett Bickford
Project Superintendents: Lee Davis, John Moffatt, Jimmy Allman, Matthew Kelso, Gary Phillips
Asst. Superintendents: Zach Bowersox, Brandon Jennings, Keith Van Aalst
Quality Coordinators: Carlos Garcia, Yefim Portman
MEP Manager: Pete Plaza                    
Safety Coordinators: Basil Espinosa, Herb Sollars
Sr. Scheduler: Jamin Mehta                    
Sr. Project Engineer: Nadirah Tajuddin
Project Engineers: Austin Kettlewell, Yemi Alade, Ricardo Rivas, Trevor Lawton, Josh Finley
Project Administrators: Debby Dix, Preeti Patel, Stacy Peterman

About the Author
Michael Gritters, LEED AP BD+C, is Executive Vice President, Healthcare Services for McCarthy’s Southern California Division. In this role, Michael is responsible for supervising the delivery of preconstruction and construction services on all healthcare projects in Southern California, with a focus on bringing additional value to clients through the use of technology and collaborative building approaches. Throughout his more than 27 years with McCarthy, he has been involved with over $3 billion in healthcare work, aiding in all stages of the project from marketing and preconstruction through project closeout. Michael has served as a board member of the Associated General Contractors (AGC) of California Orange County District and is currently a member of the AGC Union Craft Committee. He holds a bachelor of science in construction engineering from Iowa State University. Michael can be reached at mgritters@mccarthy.com.


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