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A Case Study in Construction Cost and Schedule Challenges

NEW YORK — When a shorter construction schedule was implemented for the Henry J. Carter Specialty Hospital and Nursing Facility in Harlem, it forced designers and contractors to re-evaluate their plans to overcome any potential delays.

The original objective was to relocate Coler-Goldwater Specialty Hospital and Nursing Facility (later renamed to Henry J. Carter Specialty Hospital and Nursing Facility) from Manhattan’s Roosevelt Island to the Harlem neighborhood of New York City. The $285 million project would be divided into two projects: renovating 270,000 square feet of the former North General Hospital in Harlem and building 185,000 square feet of space next door to accommodate a new, 164-bed nursing facility.

Had the original timeline been maintained, the hospital and separate nursing facility would still be under construction with a completion date set for March 2015. These plans were overhauled, however, when New York City’s mayor made a special announcement.

“We started schematic design and realized quickly that Mayor Bloomberg had announced that Cornell University and its partner, the Techion-Israel Institute of Technology, were going to be awarded an applied sciences technology school,” said Marsha Whitt, principal at Array Architects, based in King of Prussia, Pa., and project manager for the Henry J. Carter facility.

The technology school was set to build on the same Roosevelt Island site where the Coler-Goldwater hospital was located. The only problem was that the hospital needed to be demolished — quickly. The expedited demolition date moved the completion and patient-move date for Henry J. Carter up to November 2013 and shrank the schedule by 16 months.

“That’s when we had to back up and relook at the project and look at how we were going to approach it. How long was design going take? How long was construction going to take? How were the design team and the construction managers going to work together to meet these accelerated deadlines?” Whitt said.

A new time frame wiped out the design-development process. The solution was to regroup and implement integrated project delivery (IPD) strategies and a collocation system. Array went straight from schematic design to construction documents. This forced the project’s construction manager, Gilbane McKissack (a joint venture between Providence, R.I.-based Gilbane and Nashville, Tenn.-based McKissack & McKissack) to start looking at how they could quickly get resources on-site.

All stakeholders involved in the development process came together in full-team meetings. The strategy united the design team, construction manager and hospital owner in one location, and the collaboration accelerated the decision-making. Additionally, performance incentives that included shared cost and schedule metrics for both the contractor and design team helped to maintain the team effort.

“You’re joined at the hip by money, but since we were collocated, we put that piece aside and started to work as a cohesive team; we were all working toward the same goal,” Whitt said.

One critical component of adjusting to the tighter schedule involved dividing the two projects into multiple bid packages, which helped speed up information delivery, contract award and start of construction.

“Traditionally you may have a site package, an exterior package and a fit-out package. On this, we ended up with 20 packages because we broke it out by what could be purchased and when to get it on-site and get it installed,” Whitt said.

The client, contractor and design team worked side-by-side to review and approve packages. That process helped with getting parts of construction completed earlier — things such as elevators, major medical equipment and the mechanical, electrical and plumbing (MEP).

Just when the process was starting to go smoothly, the development process for the hospital and new nursing facility hit a new obstacle — Hurricane Sandy. Luckily, the Harlem site was not flooded, but it prompted a review of storm and flood elevations for the facilities. The project team included additional equipment protection and elevated electrical equipment on higher pads.

The Henry J. Carter Specialty Hospital and Nursing Facility opened on time, and Array is now involved in “Day 2” revisions, assessing what else is needed — or needs to be adjusted — after occupant move-in.

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Comforts of Home: Furnishing a Health Care Setting

NEW YORK – In every space people use, furniture is needed and creates an impression. For a space to be functional as well as healing, furniture needs to function in more ways than might be expected in a hotel or office. Patient room chairs may be used for rehab or used overnight by a loved one. The low tables in a waiting room might be used for a coffee break while waiting for a parent in surgery or for a child to do his homework while waiting for his annual physical.
When Array Architects sat down with the user groups of the Henry J. Carter Specialty Hospital and Nursing Facility to determine the furnishings of each space at the new 302-bed long-term care and skilled nursing facility, there were many features to consider. Varied patient acuity and mobility levels needed to be taken into account. Public spaces with many planned uses had to accommodate community members, patients, visitors and staff. Budget and durability for this public hospital were also key factors.
The owner, Health and Hospitals Corporation, dictated that a Culture Change Initiative was to accompany the move to a new facility. For many residents, this facility is their permanent home – their neighbors make up their community. To this end, it was essential that the furnishings not feel institutional. Array selected furniture and finishes that are of a residential scale, with a modern and urban aesthetic. Furniture features include warm woods and textiles with vibrant colors and patterns, which balances the desire for beautiful furniture and the ability to withstand heavy daily use for years to come. Inspiration came from the surrounding sight and sounds of the East Harlem neighborhood. In keeping with the neighborhood theme, each floor has a distinct signature color and vibe, which is reinforced through a rich art program.
To achieve consensus, weekly committee meetings were held with facility leaders with regular input from the focus groups that included a cross section of residents. The Array team conducted detailed reviews, selecting and approving furniture for all facility areas including lounges, dining rooms, long-term care patient units, skilled nursing resident units, clinical areas and offices. Unique program elements included worship spaces, a teaching kitchen, rich library and art rooms and finally a performance space used by patients, residents and the East Harlem community at large. These meetings allowed the clinicians who work in the spaces each day to express their wishes, concerns and experience with furniture, finishes and their impressions of what does and doesn’t work for the patient population in a long term health care environment.
Safety was paramount when considering patient and resident needs. Mobility limitations were accommodated and ergonomic features ensure comfort and reduce fall risk. For those patients and residents ambulatory enough to take advantage of the communal living and dining spaces, therapeutic gardens, worship spaces, etc. – their comfort must be maintained as they enter and leave their bedrooms. A safe route to the common areas must also be maintained. Array’s designers chose slip-resistant flooring in a low-contrast pattern to prevent patient falls as well as to prevent their “eyes playing tricks on them” with a busy floor pattern that those with impaired vision could perceive as uneven.
Variety and flexibility were key factors in the communal living room and dining spaces. Residents are empowered to engage with others in a generative setting or to have quiet moments of solitude with an expansive view of the surrounding community.
Resident living rooms were designed to accommodate different size groups with different interests. Game tables with chairs light enough for the residents to move independently were included alongside space for an electric hearth and sofas gathered around for reading and socializing. Game tables accommodate both chairs and wheelchairs comfortably. Computer stations are included in each Living Room for resident use. Large windows invite natural light and sight and sound from the adjacent train line, which serves as an animated distraction. Furthermore, having a conservatory with things like cosy conservatory panels, allows for a wide-open space, with lots of natural light but still the luxury of being in a sturdy building. This creates a comfortable and relaxing space for anyone who enters this area.

A thoughtful and studied approach to comfort, safety, durability, flexibility and context ensure that caregivers, patients and residents have a beautiful and equitable environment that delights the senses every day.
Patricia Malick, AAHID, EDAC, LGB is a principal and practice area leader at Array Architects. She can be reached at pmalick@array-architects.com and on Twitter @patmalick. To read more thoughts on health care design, please visit www.array-architects.com/author/patmalick/.

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