Whitepaper: 01.25.2012

Impossible Project? Planning Makes Perfect

Ensuring Patient Care during Construction at The University of Texas MD Anderson Cancer Center
by Ben Johanneman, McCarthy Project Director

Limited by real estate constraints and focused on making the absolute most of their construction dollars, some hospitals choose (or are forced) to expand up rather than out. That’s what happened in the case of The University of Texas MD Anderson Cancer Center’s expansion of its Alkek Hospital, though by most standards, this situation was even more unique. This $240 million design-build project was not only a 12-story vertical expansion – it was also built on top of an operational 12-story hospital known as the best in the country for treating patients diagnosed with cancer.

Faced with numerous obstacles including extremely tight site space, noise and infection control, catastrophic weather conditions, shutdowns, demolition, vibration and ongoing active hospital operations, the McCarthy team had to think of absolutely everything in order to ensure that patient care would not be compromised during the two-year project.

Reflecting on this project, there are nine specific actions the team took to make this project a success. Many of those actions were proactive in nature – requiring more time and effort on the front end, but resulting in zero or minimal impact to patients.

Understand the Specific and Situational Needs of the Hospital Community – and Exceed Them
The team worked hard, with the MD Anderson team, to communicate with the patients and their families. It was clearly understood by all team members that this disease could strike any member of any of their own families and many of them knew people who had received treatment at MD Anderson.

Nobody ever lost sight of the fact that the experiences the patients and their families were going through were significantly more difficult than anything the team was taking on with this project. That was motivation enough to go above and beyond the call of duty to help the staff do what they do every day without having to deal with extraneous construction issues.

Hurricane Ike serves as an outstanding example of this approach. When the storm was approaching Houston, a ride-out team was assembled, consisting of a few people who were willing to stay at the hospital on the top floor to make sure that the partially constructed part of the hospital didn’t impact patients or staff in any way. The team knew that the hospital staff had enough to handle with a Category Five hurricane approaching as they were trying to manage and comfort patients.

The top floor had already been abandoned because the hospital knew it would be difficult to occupy with the vertical expansion work going on above, due to noise and vibrations and other possible impacts – so the team manned that floor and made sure any leaks that occurred didn’t get down past Floor 12 to any of the occupied floors below. This involved identifying and cleaning up any water and surveying the roof at different points during the storm to make sure the partially constructed formwork and other building materials stayed intact.

The effort was well worth it. There was virtually no impact whatsoever below the top floor. Not only was the team able to manage the construction, they were also able to assist MD Anderson by addressing a minor water intrusion not associated with the project but that resulted from the storm.

Manage MEP Shutdowns Systematically
With more than 750 shutdowns of electrical, plumbing, medical gas, HVAC, security and fire alarm systems, the team had to work swiftly to extend services to the new floors, but obviously had to do so in a way that did not impact hospital operations. Because of the complexity of the system integration and the potential impact to the hospital, the team opted to tackle this with many shutdowns, but in small spurts and doses. Though it was more work and scheduling for the team, this effort greatly minimized the disruptions to the hospital and left the owner and patients virtually unaware that anything was even taking place.

Develop Strong Relationships with Hospital Staff – They’re the Key to Success
Superintendents and managers on the project took time to get to know the nurses, visitors and maintenance staff, providing them with contact information and phone numbers, communicating with them about work planned during that day or shift, and ultimately engaging them in the process and helping them feel like they had some control.

Time Invasive Renovation Work Appropriately
For approximately two years, the team worked 24/7 to complete a large amount of renovation work inside the hospital that could not occur during the day.

Shorten Potential Disruption Duration
The project required a significant amount of demolition work in order to complete the vertical expansion; and it was the type of demolition that wouldn’t normally be done around a hospital with patients because it involved jack-hammering concrete. To minimize patient and staff disruption, the team worked for just 15 minutes at a time on noisy work and would then stop to let people recover before beginning again. 

Neighborhood Watch – Provide Details and Seek Solutions
The neighborhood watch meeting was an excellent resource for the project. The manager for the renovation work inside the existing hospital met with the MD Anderson staff every Monday morning. A representative from each internal department received a list of the work going on that week, looking ahead two weeks – then even further – to anything on the radar that could have a big impact on hospital operations.

Details were provided about what that work entailed and which operations might be affected. The MD Anderson team was then able to develop ways to mitigate the impact to their individual operations, making them feel like they were an integral part of the process. That information was sent out to the hospital staff on a regular basis to make sure everyone was aware of what was going on.

Temporary Partition Layouts and Sequencing – Be Thoughtful and Proactive
Temporary partitions around the construction area were laid out with more than just the construction in mind. The team worked with the operations team so that partitions were erected and staged in a manner that would not overly inhibit ongoing hospital operations. This involved dividing a corridor in half and then switching construction from one side to another overnight or during low-use times.

Routing of Concrete Slickline Outside of Existing Building – Reduce Vibration and Noise
In order to bring the concrete up to the vertical expansion, the team had to run the slickline pipe to the construction area. It could not run through the inside of the existing hospital as would normally occur so the team erected a tower crane mast alongside the existing building and attached the slickline pipe to that. This allowed for constant access to the pipe in case there was a problem and also separated the pipe from the existing hospital structure somewhat, so it reduced the vibration that would normally occur when pumping concrete through a pipe up to that height. It turned out to be the perfect solution for the challenge.

Crafty Tower Crane Placement – A Solution that Paid Off in Big Ways
As if this project was not complicated enough, the hospital was surrounded on all four sides by large buildings and bustling streets in the Texas Medical Center, the largest concentration of healthcare facilities in the world, leaving no place to position the size tower crane necessary to complete the vertical expansion without causing a two-year disruption to the hospital and normal flow of traffic in and around the area.

The team determined that the only way around this problem was to drop a crane down the elevator shaft of the existing building one section at a time, bolt it to the floor of the shaft, and essentially build the additional 12 floors around the crane. For 20 months, the crane swung back and forth, day in and day out, getting higher and higher as the building expanded upward.

Removing the crane from the elevator shaft took an enormous amount of coordination with MD Anderson, the Texas Medical Center, the city of Houston, and university and local police departments. The team had to think of everything that might happen in any situation, which meant hours of planning and scheduling, including an understanding of where 282' of main boom and 262' of luffing jib of the dismantle crane would rest in the event of a hurricane – which was a good thing because it actually happened in the middle of the project.

Interested in learning more?
Your hospital expansion project is bound to have its own unique complexities, but patient care during construction is always a top concern. To learn more, join McCarthy’s Ben Johanneman, LEED AP BD+C, CHC and MD Anderson’s Kelly T. Cuddeback, MBA, PMP; Robert Ray, PE, MBA and Pamela Redden, MS, BSN, RN, EDAC for a panel discussion entitled, Growing Pains: Safe Patient Care During Construction.

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