In 2018, the DHMC board approved the construction of a new, six-story 240,000 square foot Inpatient Tower, expanding services and capacity by adding 64 state-of-the-art inpatient beds and shell space for future flexible expansion.

The facility was designed with an interdisciplinary and “future-proof” approach. Patient rooms provide flexibility to serve as med/surg, step-down, or even critical care options, depending on need. Each room is private and offers space for visitors to be with their loved ones during their stay. And, technology is at the forefront, with integrated patient dashboards, MyChart Bedside, and telemetry units, allowing patients to interact with their provider teams at their fingertips.

The Challenge: Location-based Labor Shortages

The Upper Valley is a collection of small, quintessential New England towns along the Vermont/New Hampshire border. The area is large, but the population is low, and DHMC is the only hospital within many miles for these residents.

DHMC’s priorities and obligation to Upper Valley residents extended beyond the care they were providing. It was important to the hospital to put the Upper Valley to work through this significant construction project, and to the extent it was possible, keep the labor and vendor base local.

Consigli’s knowledge of the New Hampshire subcontractor market and capabilities informed a thoughtful strategy to do just that, ultimately keeping over 50% of the project spend with local firms.

The Solution: Thoughtful Procurement & Intentional
Pre-fabrication

Keeping the Work Local: The Consigli team took a holistic view of the planning and buyout for this project: identify which scope areas could be supported by local subcontractors and vendors, and then determine where there were opportunities to introduce creative solutions—like pre-fabrication and material pre-purchasing—that would infuse greater efficiencies into the project.

To start, the team mapped out all local subcontractors with the size, capacity, and experience to take on a project of this scale and complexity. The subcontractors were invited to an open house event where they could learn more about the project, meet the Consigli team, and get a sense of the expectations and timing for bidding.

“Our plan was to use local labor whenever we could, and when we maxed out that avenue, we explored creative solutions that could enhance the overall delivery of the project,” said Ricky Gala, Senior Project Manager.

Pre-purchasing Equipment for Schedule Certainty: During Design Development in February 2020, Consigli and designer HDR proactively mapped out decision deadlines for material purchasing, advising on workarounds wherever possible. This is a risk management strategy that Consigli employs on all projects, but it proved critically important and timely at DHMC as COVID hit.

As the world was facing unprecedented uncertainty in early 2020, Consigli’s DHMC team was preparing to break ground on the long-awaited (and much needed) Inpatient Tower. Instead, their focus shifted toward forecasting looming material shortages, supply chain issues, border shutdowns, and astronomical price increases.

“From the beginning of the project, well before COVID was ever heard of, we planned this project to be as schedule and labor-resilient as possible…and then the pandemic really stress-tested that approach,” said Consigli Director of Pre-fabrication Bill Seery.

Consigli secured steel prices before costs skyrocketed and bought from a New Hampshire-based steel mill to avoid potential U.S./Canada border issues. All M/E/P equipment was pre-purchased, locking in early pricing to avoid escalation and circumnavigating long equipment lead times, getting materials to New Hampshire well before they were needed.

It also provided other benefits, like allowing the M/E/P equipment to be designed into the building, and all structural slab requirements and electrical could be fully coordinated in advance, eliminating clashes and field re-work.

This proactive approach extended to commodity items, too. Piping, insulation, roofing, and drywall were prioritized; subcontractor onboarding was expedited, submittals and reviews were fast-tracked, and materials were ordered. Warehouse spaces in Nashua, Enfield, and Seabrook, NH as well as Windsor, VT were used to store the materials until they were needed much later in the project. This fast-tracked procurement approach proved critical as lead times increased nearly 500% on many commodity items during the pandemic.

By April 2020, the Consigli team had locked in its subcontractor and vendor base, pre-purchased materials, and had a solid plan going into the Inpatient Tower groundbreaking, set for July 2020.

“If we weren’t proactive about the way we approached procurement and pre-fabrication on this project, we would’ve been caught on our heels when COVID hit,” said Gala. “We weren’t reacting to a problem and trying to change course. We planned the project in the most efficient way possible, and when the pandemic hit, we were in the best possible situation to take it head-on.”

See how Consigli’s equipment and commodity pre-purchase strategy safeguarded the project when COVID hit, and lead times skyrocketed.

Pre-fabrication for Enhanced Delivery: “The way we go about pre-fab…it’s very systematic. We think from the site all the way through the M/E/Ps and finishes,” explains Brian Hamilton, Consigli’s Vice President of Healthcare & Life Sciences. “When you approach pre-fab as removing labor from a jobsite, it opens up people’s minds; they aren’t just thinking about the standard pre-fabrication elements.”

Every aspect of the DHMC pre-fabrication approach was deliberate. The selected scopes needed to add value to the finished project or the way it was delivered. From the smallest solutions like pre-installing hardware on doors, to large-scale improvements like a structural shift to bolted connections, or driving the exterior design for pre-fabrication, the decisions had to improve quality, increase speed of delivery, save money, or remove on-site labor to mitigate campus disturbances and make the jobsite safer.

“Consigli went into this project knowing the value and advantages that pre-fabrication would bring. When HDR had roughed out a conceptual massing diagram, the entire DHMC project team started collectively digging into the elements of the job that we wanted to pre-fab,” continues Hamilton. “It was really important that we started this out of the gate, because in some cases, it changed the way we approached the building.”

By pre-fabricating systems that directly impacted care delivery and the patient experience, items like headwalls, med gas racks, and wet walls, Consigli and the client team were able to inspect early and often, ensuring the assemblies met DHMC’s exact specifications and standards of care. It also helped keep the schedule in-line by reducing the risk of defects and non-compliance that would need to be repaired or replaced during punchlist.

“By going into the Inpatient Tower project aware of these potential delay ‘traps,’ pre-planning, pre-procuring, and pre-fabricating were all applied to mitigate and diminish these risks,” said Seery. “Our goal on every project is to eliminate risk through intensive pre-planning, and the results at DHMC showcase the fruits of that effort.”

Check out the video below to see what was pre-fabricated and the value it added to the DHMC Patient Tower project.

Turning Over the Tower

Three years after COVID called into question the feasibility of DHMC’s long-awaited project, the Inpatient Tower is opening its doors to the Upper Valley community, providing close-to-home care and a patient experience that rivals its neighbors in Boston and Portland.

Dartmouth Hitchcock Medical Center’s state-of-the-art tower has increased the hospital’s ICU capacity by 228%, with an additional two floors of shell space for a flexible expansion and space for 64 beds which could increase capacity by 356% when fit-out. The main entrance to the hospital is welcoming, with a comfortable lobby, beautiful chapel, easy-to-access amenities and services like food and beverage stations, a lactation room, and an expanded discharge lounge for DHMC patients.

The once too-small hospital is now a landmark for primary and specialty care in the Upper Valley.

The post Revolutionizing Healthcare Construction: The Power of Pre-fabrication & Pre-purchasing first appeared on Consigli Construction.

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While outpatient facilities are less expensive to build and operate than a traditional hospital and are often situated in suburban locations where real estate is more affordable, there are still significant cost factors that can easily tip the scales on your bottom line.

How does Consigli—which has built 40+ outpatient care centers—collaborate with owner and design teams to deliver high-quality, durable buildings in an efficient, cost-sensitive manner? Brian Hamilton, Consigli’s Director of Healthcare & Life Sciences, provides 3 Critical Insights to Consider When Planning Your Next Outpatient Facility.

Certainty of Cost

On any project, healthcare owners are looking for one thing—certainty. Certainty of first cost, first patient date and the long-term operational efficiency of the building they’re investing in.

Target Value Design (TVD) is one of the best ways to control costs and get early budget certainty. It directs a design and construction management team toward a budget—not a blank check—by providing cost buckets for various building elements (i.e. building enclosure, M/E/P, finishes, etc.) that drive the cost of outpatient facilities. If costs need to be moved from one bucket to another, the value and impacts of that move need to be considered.

Consigli Tip: As a rule of thumb, outpatient care facility budgets typically follow a 30/30/40 rule: 30% on finishes, 30% on the building envelope and 40% on M/E/P systems. Traditionally, outpatient facilities have been significant consumers of energy due to the specialty equipment, lighting and HVAC controls (i.e. air exchange) required in the spaces. If you can gain efficiencies in the M/E/Ps, there can be significant long-term cost savings as a result (more on this later).

Leveraging Buying Power

Pre-fabricated mechanical penthouse at Dana-Farber Cancer Institute’s Merrimack Valley Cancer Center

Standardization of building systems and finishes over a multi-facility rollout will result in a cost savings and long-term ease of maintenance. When things like HVAC, heating, elevators, finishes, flooring, ceilings, generators and façade systems are uniform across multiple sites, there are opportunities that become available that can improve cost, schedule and long-term maintenance for the facilities.

Consigli Tip: There are three strategies that we’ve seen consistently lower costs by standardizing building design across multiple sites: (1) Designing for Pre-fabrication, (2) Opening Up the Competition and (3) Bulk Buying Through Standardization. Smart owners will push design and construction teams to creatively employ one, two or all three of these strategies on their projects:

• Designing for Pre-fabrication: Pre-fabrication is a proven strategy to accelerate schedules and reduce costs, while removing labor from the jobsite and assembling building components in a controlled, off-site environment. When cost certainty and speed are driving factors in a project—particularly a project that features repetitive elements like exam rooms—pre-fabrication should be a major topic of conversation.
• Opening Up the Competition: When building off-site from your primary hospital campus, the door is opened to utilize different vendors (i.e. elevators and building controls) than those embedded in the hospital itself, which can lead to more competitive pricing.
• Bulk Buying Through Standardization: By purchasing materials in greater quantities, there is an inherent cost savings. This approach also mitigates escalation in multi-building facility rollout that can span several years. Furthermore, your facilities staff will thank you because maintenance becomes easier and more predictable (i.e. attic stock is the same for all facilities).

The Right Site

On any ROI-driven project, site selection is a major deliberation and outpatient care facilities are no different. New construction typically presents a higher acquisition, development and construction cost, but lower existing building conditions risk. Renovations, on the other hand, can require months of enabling work and costs up to $50/SF before the building is even fit-out ready. Both scenarios come with their own set of advantages and risks that need to be thoroughly evaluated.

(L) Former grocery store transformed into Caremount Medical’s Rhinebeck, NY location (R) Kingston, NY Macy’s department store repurposed into a modern multi-provider outpatient facility

The trend of capitalizing on the increased vacancy of malls and shopping centers has presented opportunities for convenient, accessible care closer to where patients live—and more cost-effective developments for healthcare organizations. While building systems will likely require upgrades (and probably an outright replacement) and the façade may call for enhancements for energy performance and aesthetics, you’re starting with an existing building and a relatively blank canvas. This is a popular alternative to new outpatient construction and will continue to be for the foreseeable future.

Consigli Tip: Whether you’re building new, renovating or repurposing, site selection can easily tip the scales on what’s feasible and what isn’t. When choosing your site or building, keep in mind these three primary cost drivers: (1) Below-grade Conditions & Infrastructure Availability, (2) Heating & Cooling Method and (3) Sound Transmission.

• Below-grade Conditions & Infrastructure Availability: On new buildings, below-grade conditions (i.e. ledge and hazardous soils) and infrastructure availability are critical considerations. Sites requiring soil abatement, significant earthwork and new utility infrastructure will pinch costs from the beginning, and on building components that won’t enhance patient services.
• Heating & Cooling Method: Remember, mechanical, electrical, plumbing and fire protection systems are going to make up approximately 40% of your budget, so decide early if you’re designing your facility to run more like a hospital or more like an outpatient facility. If it’s a 10-hour per day building, system functionality needs are different than that of a 24/7 hospital environment. As such, systems can be simplified, which also means less steel, less screen wall and therefore, less cost.
• Sound Transmission: Sound transmission is always a major concern when designing and building healthcare facilities, with a justified focus on patient confidentiality and the overall patient experience. Privacy from exam room-to-exam room and corridors-to-exam rooms is a non-negotiable, and there are multiple ways to mitigate noise transfer using different structural elements and building systems, at varying price points. The most common systems include demountable partitions, ducted returns, sound masking and walls-to-deck construction. Consider all four systems and how they can work together—not each individually—to determine the best combination for your facility.

 In-House Expertise

Project Executives Charles Canepa and Vincent Fiorillo have experience with all the major hospital systems in the New York Region. If you are planning a renovation or expansion of your outpatient facility in the five boroughs, Long Island, Westchester or New Jersey, Charles and Vincent can assist you to ensure the success of your next project.

The post 3 Things to Consider Before Building Your Next Outpatient Facility first appeared on Consigli Construction.

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The post Consigli’s Brian Hamilton Talks Healthcare Design in a Post-COVID World first appeared on Consigli Construction.

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“Darrin is a seasoned construction professional who has extensive knowledge and has overseen complex construction projects for major life science users, academic institutions and owners,” said Brian Hamilton, Director of Healthcare & Life Sciences for Consigli. “He will be an integral part of our efforts as we look to expand our market presence.”

Ball comes to Consigli with 30 years of diverse construction industry experience ranging from heavy civil to large scale pharmaceutical manufacturing projects that include renovations, new construction and significant infrastructure projects. Ball received his Bachelor of Science in Building Construction from Wentworth Institute of Technology.

Consigli’s life science team had completed in excess of 2.5 million square feet of projects over the last five years and has extensive experience working both within occupied R&D facilities as well as new construction. The team has completed several significant projects for some of the most prestigious research institutions in the New England and Mid-Atlantic regions. The group has worked on cGMP facilities, research laboratories and in-depth infrastructure projects to support laboratory operations.

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“Stephanie brings a tremendous amount of experience to our team on both laboratory and medical facilities,” said Brian Hamilton, Director of Healthcare & Life Sciences for Consigli. “Her background and leadership skills will be a tremendous asset to expand our presence in these markets.”

O’Brien comes to Consigli with more than 25 years of industry experience with an extensive background in overall project management and oversight. Her expertise includes being the primary contact for all project procurement, subcontract administration, scheduling, as well as ensuring overall job-site safety and quality control. O’Brien received her Master’s Degree in Civil Engineering from Worcester Polytechnic Institute as well as a Bachelor of Science in Civil Engineering from Bucknell University.

Consigli’s healthcare and life sciences team has completed several significant projects for some of the most prestigious healthcare and research institutions in both New England and the Mid-Atlantic regions. The group has worked on emergency departments, patient rooms and surgical facilities; as well as GMP facilities, research labs and in-depth infrastructure projects to support laboratory operations. Most recently the team received the prestigious American Society for Healthcare Engineering (ASHE) Vista Renovation Award for the UMass Memorial Health Care MC 2020 Memorial Campus Refresh. The award recognizes significant collaboration and outstanding teamwork in creating optimal health care environments.

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With a goal of being “The best place to give care and the best place to get care,” UMass Memorial Health Care executive leadership set out to plan and implement transformative upgrades and improvements at the academic medical center’s campuses in Worcester, Massachusetts.  The resulting modernization has increased the number of private patient beds, transitioned Nurses Stations into collaborative Team Stations, increased learning and discovery space, and created a more standardized person-centered experience at the campus.

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