APPLETON, Wis.—Hospitals are increasingly finding ways to segregate patient space from operational space for safety and efficiency reasons, and one Wisconsin hospital took to the air to maintain that separation.

Marshfield Clinic Health System wanted a way to connect its existing hospital with an existing east wing building but building at ground level would have significantly disrupted daily operations. Instead, construction teams were tasked with building a “tunnel in the sky” to transport patients, linens, food, and supplies needed for everyday support.

The Boldt Company worked with HGA Architects to create a connector bridge 600 feet long that varied in height from 20 feet to 50 feet above the ground. The structure consisted of ten steel trusses, the longest of which was 70 feet weighing about 45 tons. The entire structure rested on helical piles screwed into the soil at least 30 feet to anchor the connector.

The thought of building the connector on site was immediately swapped for offsite prefabrication.

According to Boldt it was an issue of access. “If we had built on-site, the entire loading dock would have been shut down and the public road would have been closed for a long time,” said Heather Stoffel, senior director of healthcare for Boldt. “It was a timing issue, and time is money.”

To ensure the hospital continued to serve patients during construction, crews left access open to the loading dock and helipad. Patient transport from the helipad to the hospital was done through a tunnel of temporary shipping containers Boldt crews sourced and installed for safe access through the construction site to the facility.

“We first looked at the project and thought we couldn’t do it the conventional way,” said Bert Schmitz, Boldt project manager. “We had an active helicopter pad on-site and we also had to consider noise variances.” Construction teams working high above street level was also a safety concern for project managers.

The decision was made to prefabricate the trusses on an empty parking lot near the hospital.

“One of the small benefits of COVID was so many employees were working from home, it meant parking lots were less populated,” Stoffel said.

Structural steel was delivered to the staging area and crews built the trusses in a short timeline. For accuracy, crews used their own models to maintain tolerances of +/- ¼ inch so the preassembled sections would fit exactly into the existing structures.

Twelve weeks after construction started, crews were ready to lift the prefabricated truss sections into place. Starting at 5 a.m., crews used a self-propelled modular transport (SPMT) to move the giant sections into place. A 200-ton crane hoisted the sections in the air and crews started work to connect the trusses. The SPMT provided extreme maneuverability on the city street and transport time for each section was about 10 minutes. Once on site, traffic was only impacted for one day per truss section, rather than having a site-built approach tie up traffic for weeks.

“It required tons of pre-planning to move 45 tons of steel in 10 minutes,” said Linda Danielski, Boldt project manager. “We spent hours and hours in meetings between Boldt, the hospital, the city, and a nearby day care and it was amazing how all the planning paid off.”

Boldt project managers estimate costs were cut in half by prefabricating trusses versus building right on the job site and the overall production timeline was reduced by about 10%. Prefab building at ground level instead of 50 feet in the air also reduced the safety risk by almost 80%.

Daily planning sessions and extreme collaboration required teams to refine production schedules and ensure production costs kept pace with the budget. Boldt’s production process also managed the staging and timing of off-site prefabrication and on-site installation to compress the overall construction calendar. For healthcare, integrating preconstruction planning and prefabrication are the next generation of construction.

“There is opportunity to use prefab in the healthcare environment primarily where there’s a repeatable room or function such as exam rooms, hallways or patient rooms,” Stoffel said.

The connector project for Marshfield Hospital will be finished October 2022.

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Conversations — and aspirations — around high-performing buildings have evolved quickly. Ten years ago, we dreamed of achieving LEED certification on high energy building types such as hospitals and labs. Net zero energy buildings were a costly pipe dream, at best available to small buildings with low energy needs. In 2018, the New Buildings Institute lists 67 “verified” and 415 “emerging” zero energy (ZE) projects. It’s safe to say that net zero appears ready to take over the market much as LEED did a few short years ago.

This remarkable transformation can be attributed both to advances in technology and to a growing understanding of the integrated design process.

Net zero design depends on two key elements, the reduction of energy demands and the on-site production of energy. Successful projects strive to reduce energy use to the point that on-site production is feasible and cost-effective. With widespread acceptance of technologies that were previously viewed with suspicion — the use of radiant beams in laboratory or displacement ventilation in hospitals, for example — it becomes possible to reduce energy demands to the point that on-site production becomes viable. The precipitous drop in photovoltaic panel prices completes the picture; in many cases, it can be less expensive to buy solar panels than to invest in complicated HVAC systems.

Advances in technology alone do not explain this market change; the real source of change is the growing implementation of integrated design processes.

Integrated design demands an expansion of the project “team.” Rather than a linear process led by the architect, high-performance project teams expect continuous and proactive engagement not only from the full design team, including engineers and other consultants, but also from the contractor, owner and end users. The process typically proceeds as follows:

• Architect and engineers determine appropriate energy-use goals for the project. These are typically described in terms of Energy Use Intensity (EUI).
• Engineers determine the parameters for net zero design for the given project. How much power can be provided on site? Most projects carry certain limitations related to available site or roof area, and so the energy use reduction goals for a project are directly related to the ability to produce power. In other words, if a project is able to generate power adequate for 50 EUI, then the energy-use goals for that project are now 50 EUI. This simple formula can be very effective; design teams perform well in the face of hard targets.
• The entire team — owners, users, designers and contractors — comes together to work through the many elements that contribute to energy-use reduction.
  • Passive Design: Passive architectural design comes first as building massing, zoning, envelope and orientation are fine-tuned to enhance building performance. Key foci include the use of natural daylight and ventilation and the protection of interior spaces from direct solar gain.
  • Active Design: Heating, cooling, lighting and ventilation systems are designed to work with passive design elements. HVAC systems are reduced in size and cost, offsetting added costs for passive design elements.
  • Occupant Behavior: Ten years ago, a team might focus on the first two steps above. However, as project teams squeeze every opportunity to reduce energy out of architecture and building systems, the role of end users and building managers becomes crucial. In many high-performing projects, plug loads become the single biggest use of energy. Successful teams engage occupants to find ways to reduce ongoing energy use on multiple levels. Some solutions involve technology such as the use of sensors to turn equipment off when not in use. Others go back to the layout of the building. Can lab users be persuaded to share high-energy equipment such as freezers? Procurement comes into play; the design team for the Net Zero Packard office in Palo Alto, Calif., recommended that the owners buy Apple screens for their low-energy use. In response, Hewlett-Packard came out with its own low-energy screens.
  • Design Process: The above steps are taken in tandem, not sequentially. Models are built of energy, water, daylight, comfort and cost, and constantly updated to test technologies and strategies in relation to one another. Real-time analysis replaces historical data and formulas, allowing teams to adjust to the specifics of the project at hand; no cookie-cutters allowed.
  • Ongoing operations. Finally, and perhaps most importantly, zero energy requires that a building actually operate at net zero for a certain period of time, typically two years, before being declared successful. This requirement highlights the need for users and designers to work together; one cannot succeed without the other, and it turns out that connection and buy-in are crucial.

Ultimately, the trend towards net zero energy will yield tremendous results across the industry because the goals are aggressive, strictly defined and ultimately require true collaboration across all members of the team.

Lisa Matthiessen is the national sustainable design director at HGA, an architecture firm with locations across the country.

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PALO ALTO, Calif. – The main building at the Lucile Packard Children’s Hospital in Stanford is now open. The impressive hospital has been a work in progress for over ten years, making its completion a cause for true celebration for all of those involved in the extensive project, as well as those who will benefit from its services.

The building was designed by Perkins+Will out of its New York office, in conjunction with Hammel, Green and Abrahamson Architects, Inc. (HGA), headquartered out of Minneapolis, Minn. DPR Construction served as the general contractor on the project, headquartered out of Redwood City, Calif.

The main building of the new hospital was officially opened on Dec. 9, 2017, after the hospital was given its licence by the California Department of Public Health on Dec. 4, just five days before. An official ribbon-cutting ceremony took place on November 30 which included approximately 300 leaders from the hospital and Stanford University, as well as elected officials, community partners and members of the donor community.

“Hundreds of staff prepared for months and months for this day, when this new building became part of our working hospital,” said Christopher G. Dawes, president and chief executive officer at Lucile Packard Hospital and Stanford Children’s Health in a recent statement.

The new 521,000-square-foot building increases the original pediatric and obstetric hospital size by more than double. Expansion of the new building meant the addition of 149 patient beds, bringing the total bed count to 361 on the Palo Alto campus.

While the main building of the new hospital is open for business, more construction remains to be accomplished on the West building over the next few years. Construction will include a new surgery center with six new operating suites, as well as intraoperative MRI technology and angiography equipment in the neuro-hybrid surgery suite that will be constructed.

Amongst many other exciting features, the new main building at Lucile Packard is the anticipation of LEED Gold certification, which, when achieved, will make the new hospital one of the most sustainable children’s hospitals in the country, according to Robin Guenther, principal at Perkins + Will in a recent statement.  

The new building features sustainable features such as water-efficient landscaping and water collection systems. These features are projected to save 800,000 gallons of water annually. In addition, ventilation and shading systems have been installed that will mean reducing thermal energy usage by 60 percent, as compared to other similar hospitals in the area.

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Hammel Green and Abrahamson (HGA) Architects, headquartered in Minneapolis, is the architect on the project, with New York-headquartered Skanska serving as the general contractor. The new building will be approximately 46,300 square feet, with a budget of $35 million. Samaritan Health Services is paying for the new hospital through the issuance of bonds, while Samaritan North Lincoln Hospital itself will pay for medical equipment and furnishings with support from contributions to the North Lincoln Hospital Foundation (currently estimated at an additional $7 million).

Design plans are still a work in progress, with a vision of a one-story building from the design team. Frontline employees of the hospital have been involved in the planning and design process from the beginning, brainstorming ideas to improve processes in terms of how care is delivered to patients. The staff is currently participating in a series of space-planning meetings to discuss where related departments should be located and how workspaces can be flexed and shared, according to Lesley Ogden, CEO at Samaritan North Lincoln Hospital in a recent interview with The News Guard.

“We want our new hospital to represent big, bold and innovative ideas for delivering health care to our community,” said Ogden. “By designing a hospital with flexible spaces and collaborative services, we can continue to offer inpatient and outpatient services, but in a more efficient patient- and family-centered atmosphere. This is an exciting opportunity for hospital staff to participate in a major project that will impact our community for decades to come.”

The new hospital will be located on the site of the current main parking lot on the east side of the campus and near the helipad, which will remain in place due to the expense and regulatory logistics of relocation. A portion of the existing hospital building will likely be demolished this winter to allow site preparation to begin for the new facility. Once the new hospital is constructed, the old hospital building will be demolished entirely, with a parking lot constructed in its place at that location.

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