Uncovering Issues
Generally, the most common issues uncovered by the building investigation process include code compliance, deficiencies in power requirements, inaccuracies in ductwork and plumbing layouts, as well as the possibility of structural conflicts with proposed systems. Inevitably, as a building ages, technological advances are being made in construction materials and methodologies. Internal wall systems become incompatible with current building codes or fire-rating systems. Prior renovations may have included undocumented loads being placed on breaker boxes, resulting in the need to modify planned power distribution within the new project. When tasked with converting conventional spaces, like offices, to specialized uses, such as laboratories, there are frequently workarounds required to make specified ventilation equipment fit into the generally tight confines of the existing structure.
“It’s important to never give patients any sense they are being treated in a facility that is under construction. Whether they are in for preventative care or something serious, our presence should only be beneficially felt, when the work is done,” says Mark Stubits, AP Healthcare superintendent. With more than 28 years’ experience in renovation construction, Stubits has definitely encountered a few challenging health-care projects. For example, he has supervised countless, systematically sequenced, area-by-area transformations while working on the Franklin Medical Office Building. The 243,000-square-foot, 12-story building in downtown Denver has been under renovation for more than two decades. In the last 10 years alone, Stubits has renovated surgery centers; laboratory spaces; specialized care units, like oncology, neonatal and fluoroscopy; and even added an entire floor to the top of the high rise.
Infection Control
The possibility of construction-related infection risks literally magnifies the need for attention to detail while working in an occupied health-care facility. Maintaining maximum awareness to the control of debris, dust, noise, vibrations and other environmental contaminants is a conscientious focus of AP Healthcare’s preplanning process on renovations. As potential project impediments are identified during the discovery process, AP Healthcare takes a proactive approach in presenting issues to the owner and design team accompanied by thorough documentation of existing conditions and possible resolutions.
“It’s very important we collaborate with owners, architects and design consultants to really work through the details of every issue while solutions are still on paper rather than in the field,” Stubits states. “As the builder, we don’t want to simply expose unforeseen issues, we’ve got to propose possible solutions and plan implementation scenarios that consider construction costs, schedule impacts and functionality to lead decision-makers toward solutions that result in the most positive benefits and the least negative impacts.”
AP Healthcare worked closely with the Yampa Valley Medical Center, Steamboat Springs, Colo., to consider and preplan a 37,000-square-foot occupied renovation and addition, which involved changes to obstetrics and the surgical department. This included working with hospital staff to coordinate construction activities with scheduled surgeries to maintain the critical path construction schedule. The excellent communication and rapport between the onsite superintendent and the owner made for a smooth construction process.
It is in the benefits to owners, users and design partners that AP Healthcare really sees the extra effort pay off. A few hours of getting up into the ceilings during off-hours can pay huge dividends in terms of stronger, more reliable cost estimates; enhanced user-centric scheduling and construction sequencing; and the reduced need for value engineering or change orders once construction starts.
“The best example of the benefits of an integrated process can be found in the work on one of our more intense renovations,” Curtis says. “We worked with the client and design team for more than two years to plan a renovation of seven operating rooms. Those two years of planning came to fruition in just 21 days of construction.” AP Healthcare led three crews working in shifts, non-stop during a Christmas holiday break. The speed, efficiency and precision of the construction process were the result of a painstaking, calculated building investigation and test construction development process during preconstruction.
The focus of AP Healthcare’s preconstruction process is to develop a very detailed understanding of the client’s objectives and expectations. Exposing any and every incongruity between reality and the as-built documentation through a room-by-room/drawing-by-drawing building analysis is actually a lot easier than discovering an issue while the building is torn apart and the client and their patients are being inconvenienced. Health-care construction definitely has its complications but AP Healthcare’s committed building-investigation process goes a long way toward turning challenges into opportunities, and, in the end, the investigation process is a worthwhile investment.