The $10.7 million, 44,390-square-foot project is being built in multiple phases to allow the cancer center to remain operational throughout construction and continue meeting the needs of its patients from northern Colorado and southern Wyoming.

“It has been a three-phase project and we’ve completed Phase I and Phase II, and Phase III began construction about a month ago,” said Mark Johnson, design vice president for Heery International, based in Atlanta, who planned, designed and oversaw the project. “Way out in the future they may choose to do other phases or additions. There is a master plan that can accommodate more phases beyond the first three.”

The project had many challenges, including site constraints, tight deadlines and the health system’s desire to remain open throughout construction, according to Johnson.

“We led an intense, interactive one-week LEAN 2P design process that involved all the stakeholders,” Johnson said. “The result is a state-of-the-art expansion and renovation that was delivered for a fraction of the cost of building new.”

The design 2P process generated not only the design and engineering concept plans and direction, but it also laid out a complex phasing and sub-phasing construction schedule.
Phase I consisted of a 4,400-square-foot renovation of the existing and fully operational radiation oncology suite. The second phase included construction of a 32,150-square-foot, two-story addition and interior renovation that converted the existing lobby into an area that connected different oncology departments with the cancer center addition. Design for Phase III phase started in August 2014. A 7,840-square-foot renovation, this phase will integrate a survivorship center, physical rehabilitation, alternative medicine department and flexible conference zone into the center.

“It’s a rather large clinic. The three-phase project is based on a true integrative way of delivering cancer treatment. Phase III is the rehabilitation area primarily. It’s where infusion used to be,” Johnson noted. “Plans for the renovation started back in 09’ or ‘10 for phase one. The reason is because this is an outpatient campus for Poudre Valley Health System, based in Fort Collins, which is now part of University of Colorado Health. The population in Fort Collins is aging, so aging resident demands started to increase along with the demand for outpatient cancer treatment, which has made great strides in being a very valid treatment. With that, growing along with the older population, the retirement community and the population growth in general, [Harmony Cancer Center] was bursting at the seams.”

Also part of the cancer center is a pharmacy project. Heery is providing design services for a new 30,000-square-foot addition on the Harmony Outpatient Campus. As part of the project a $280,000, 1,050-square-foot pharmacy is being built.

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When completed at the end of 2017, the hospital expects more than 24,000 patient visits. The hospital was originally constructed as an inpatient facility with minimal outpatient services and as a result, the outpatient areas were small, lacked sufficient storage and have small waiting areas.

With the completion of Phases III and IV, the hospital will be able to place the helipad on top of the building. It will also be able to better accommodate emergency admissions by ambulance, including patients in need of hazardous material decontamination and in the event of a mass casualty situation. The hospital will also better serve ambulatory emergency patients with a separate identifiable entrance and it will provide enhanced privacy and comfort during an emergency visit to the hospital.

The hospital is also aiming to enhance patient safety with space to accommodate multiple pieces of equipment and numerous staff representing various specialties during emergencies and surgeries. Additionally, the hospital is planning to provide adequate space for all diagnostic imaging modalities, many of which are new technologies added after the existing hospital was constructed in 1977.

The hospital wants to enhance patient care further by eliminating inappropriate interactions among patients and the general public and providing quiet, private spaces for families dealing with loss. The hospital is also going to provide medical office space to specialists from Glenwood Springs and Denver who consult with patients in Aspen on a regular basis.

On the administrative side, the hospital plans to register patients and discuss payment and billing in a private setting and will accommodate additional local medical practices to provide a health campus that addresses a full spectrum of care, including prevention, wellness, early detection, diagnosis and treatment.

Funding sources for the final phases of the project include philanthropy and hospital resources. A $60 million capital campaign is currently underway, spearheaded by the Aspen Valley Hospital Foundation. This funding allocation — like Phase II, which also included tax-supported general obligation bonds — does not place an undue burden on any one group of citizens and is consistent with the community’s philanthropic history for hospital construction.

Atlanta-headquartered Heery International is the architectural firm handling the third phase, which is expected to be completed by the end of 2017.

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The expansion for the hospital increased the number of beds from 35 to 65. The hospital has the busiest urgent care center in the Air Force based on the number of visits per day. The medical complex provides inpatient and outpatient services, intensive care, emergency room services, a dental clinic and health support services. Roughly 1,000 health care professionals serve a patient population of more than 60,000 active duty members, dependents and retirees.

Over a two-year process, Atlanta-based Heery International provided a team of integrated architects, engineers, interior designers and construction managers to wrap up the expansion project. The 160,000-square-foot renovation reconfigured and modernized the USAF 1st Medical Group facilities to support new technologies and equipment. The majority of the renovations occurred in the main hospital building, but also included two other ancillary buildings on the base. The project also included the design and construction of a 3,492-square-foot veterinary clinic to serve the military working dogs as well as the pets of base personnel. This could mean a boost in the number of vet jobs at the facility, as more vets and nurses will be required to run the clinic.

Key elements of the project included modernizing the life safety and mechanical systems throughout the buildings while replacing and upgrading exterior items including brick faades, windows and roofing.

All the work was completed through a phasing plan that allowed all departments to remain fully operational throughout construction, without the use of modular or temporary buildings. Building systems from security to HVAC and IT, as well as patient and staff access were maintained throughout the project.

Several clinics relocated to the hospitals main building, including the flight medicine, mental health and public health clinics. Virginia Air National Guard medical personnel have moved from the nearby Aerospace Medicine building into the newly renovated area of the main hospital. The migration project provided modernized work centers for the clinics.
All the work was completed through a detailed phasing plan that allowed all departments to remain fully operational throughout construction, without the use of modular or temporary buildings. Building systems, such as security, HVAC and IT, as well as patient and staff access were maintained throughout the project.

The new addition is a three-story steel frame structure, and the exterior was constructed of brick veneer with cast stone details over metal studs. Constructions such as this will require careful planning in which details such as the steel channel sizes will be decided on. The existing building has been refaced with a brick veneer and new window frames. The project also included a renovation of the central utility plant. The renovation replaced a 167-ton chiller, steam boilers and associated equipment.

Langley has experienced a lot of growth over the past few years and now has specialty clinics that were not available in a military treatment facility on the Peninsula, U.S. Air Force Maj. Jeffrey Chaperon told The Peninsula Warrior. Military patients living west of the tunnels now have a convenient location to receive care for those services.

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Atlanta-based Heery International, program manager for the new project, broke ground in mid-July. Dennis LaGatta, Heery’s project executive overseeing the work, said there would be three components to the construction process. First, the facility’s central plant is set to be replaced, then a new addition will replace the emergency and operating departments, and at the same time, the hospital’s nine-story patient tower will be revamped to give the 1950s exterior a more modern look.

“We anticipate that the central plant will be operational in November 2015, and that has to be done first so that we can connect to the new OR-emergency department expansion in December of 2015 to allow the completion and opening of the OR/ED in the winter of 2015,” LaGatta said.

The new central plant will serve as the hospital’s connection point for vital building services, so it’s important for it to be operational first. It also houses the hospital’s back-up generator system.

“The next phase would be, once we have the operating room and ED up and running, that we’ll go back and reconnect the rest of the existing hospital to the new central plant for the purposes of upgrading their emergency power system. Running concurrently will be the re-cladding of the [patient tower],” LaGatta added.

The transformed patient tower will be the most visible element of the process with a glass curtain wall and metal panel system. The prominent tower can be seen from Broward County’s Interstate 95, and it overlooks the hospital’s 35-acre campus.

Inside the hospital, the newly expanded 53,000-square-foot operating suite and emergency department will allow the hospital to continue as the only Level II trauma center in the north end of the county. The ER has 53 treatment spaces, and each treatment space is identical in room orientation and available medical equipment. A decentralized nursing station model allows for flexible treatment space utilization during peak and non-peak event time frames. The operating department will feature six new class-C operating rooms.

When Broward Health hired Heery, the hospital system asked the program manager to use an integrated project delivery-lite (IPD-lite) approach. The traditional IPD delivery method creates a single team of project participants that are uniformly responsible for completion. IPD-lite uses some elements of traditional IPD, but there are still incentives to collaborate.

Heery then reached out to Dallas-based HKS Architects and Chicago-based Perkins + Will as well as Skanska USA Building in Parsippany, N.J., as the construction manager at-risk, to create a four-company team throughout the planning, design and construction phases.

“Our IPD-lite approach allowed our team to focus on meeting Broward Health’s needs in the most cost-effective and time-efficient way possible,” LaGatta said in a press statement. “The creative thought process yielded innovations in our approach to the program as a whole and substantially reduced the construction schedule timeline, which means these new facilities will be operational and supporting the hospital conservatively 12 months earlier than initially projected.”

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Q: Why were renovations needed at these two bases?

Tomy: DOD (Department of Defense) health care has been evolving to a great degree over the past decade based on U.S. force commitment to new theaters of operation and our returning servicemen. There has also been a parallel emphasis based on our aging and retired service personnel. There has been a decision made that the existing health care facilities as well as replacement facilities need to be state-of-the-art in order to properly care for our service community. More specifically as it relates to these projects, Heery International’s integrated design-build team was hired to replace a 50-year old health care facility for Seymour Johnson Air Force Base in North Carolina and to fully renovate the health care facility at Robins Air Force Base in Georgia. Both existing clinics were very dated and needed major improvements to meet the bases’ as well as our stated national health care needs.

Q: What kind of renovations/updates is most sorely needed in the current facilities?

Tomy: Both clinics needed major redesigns and construction upgrades to provide for all the new technologies that changed the health care landscape over the past generation. Heery also addressed the clinics’ overall layout to help make the departments’ functional relationships more flexible and efficient. We also created environmental designs to enhance the patient experience. On a more practical level, both facilities needed to be brought up to code, including ordinances to comply with building safety as well as for seismic requirements.

Q: What are some of the benefits and challenges in working with the U.S. Army? The project?

The greatest benefit is that the Army Corps of Engineers has a professional team that is familiar with construction, that is their job and business. The Corps has the staffing required to manage the project as the owner’s representative, to help guide and oversee the work done by the designers, constructors and multiple consultants.

The greatest challenge of the project is completing the work while allowing the medical professionals to continue its ongoing health care service for the bases. It is critical for the bases to continue providing medical care even while we are taking down buildings or bringing in temporary modular buildings. The other challenge is working on an active secured military base and maintaining all the necessary security protocols that are required for a project like this.

Q: Could you describe a few features that you believe are the most beneficial to your sustainable goals?

There are many sustainable features that we were required to meet to achieve LEED Silver certification. Examples include:
• A two-foot height reduction of the finish slab height of the Seymour Johnson medical clinic, reducing the impact of this new clinic on the neighboring buildings while providing an architecturally significant building to the Air Force base master plan:
• Seymour Johnson’s Vegetated Roof System, whose benefits include improved working life span of the underlying roof membrane system;
• Storm water retention/detention that provides lower operating fees for water

At Robins we added additional natural light to the new public corridors through vertical glazing and skylight systems, enriching the patient and staff experiences of the building with increased daylight.

Q: How do these sustainable features assist in the healing process?

Tomy: Heery used Evidence-based Design (EBD) to create a healing environment – one that is safe, comfortable, and that supports the patient and reducing the stress experienced by patients and the teams caring for them.

Heery’s design contains design solutions that are in line with EBD recommendations. For example, physical therapy’s entrance at Seymour Johnson reduces the travel distance that may be required of mobility-impaired patients. This orientation allows the PT department to take full advantage of the healing effects of natural light and views.

The light well will be utilized as an extension of the exercise area with the incorporation of a climbing wall, a therapeutic stair, and other possible modalities.

Heery also designed walled rooms for examination and treatment spaces rather than open-plan rooms with curtains that divide separate patient spaces to improve patient privacy and confidentiality. This included individual screening and exam rooms are permanent drywall partition walled rooms.

Heery maximized natural light throughout the building to decrease patient stress and reduce staff fatigue by designing windows and glazing systems that provide natural light for the main public corridor and offices/exam rooms located on the perimeter.

Q: How will this project benefit from the integrated project design methodology?

Tomy: Heery, along with the U.S. Army Corps of Engineers in Little Rock, Ark., helped pioneer an innovative and comprehensive approach to health care renovations for the Air Force across the United States.

This $800 million Multiple Award Task Order (MATOC) program, for which Heery was awarded almost $200 million, substantially reduced project delivery and set cost limitations that couldn’t be exceeded. It integrated all user groups and provided a seamless delivery method for the owner.

Integrated project design methodology creates an interactive environment that promotes creativity and innovation for all parties involved in the process.

Heery is a true integrated project delivery company; our health care design-build team develops solutions that are prepared with a level of integration that is quite unique to the industry.

The Heery team, both design and construction is located in the same office, on the same floor and in the same team studio, creates a truly interactive environment that promotes creativity and innovation.

Additionally, Initial Outfitting and Transition planning is used to ensure that the building occupants have everything they need from the day they move in. For example, for ambulatory clinics like these, not only is the furniture, furnishing and medical equipment in place on day one, but so are rubber gloves, tongue depressors, and sterile medical instruments.

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The hospital unveiled a newly updated design for the $292 million facility, which broke ground in June 2013, at an open house Monday. Officials have placed special emphasis on patient and family involvement in the design due to the hospital’s strong philosophy on patient- and family-centered care. Visitors to the open house viewed the latest renderings, interactive displays and interior design elements.

New features include a movie theater and playground that will add to the list of kid-friendly amenities at the hospital aimed at preventing children from becoming bored during the healing process.

“Children’s health care is becoming increasingly specialized. We want to continue meeting the needs of children throughout Iowa, in conjunction with community pediatricians, family practitioners and other providers. This partnership between community-based providers and UI Children’s Hospital is a major factor in Iowa’s ranking as the top state in the nation from a child health perspective,” said Dr. Thomas Scholz, interim director of the division of pediatric hematology and oncology, in a statement.

The 134 private patient rooms at the 480,000-square-foot children’s hospital will include state-of-the-art technology for programs that will range from promoting wellness to the care of general childhood illness, surgery, traumatic injuries chronic illnesses and developmental disabilities. The building will also feature pediatric imaging, pharmacy, pediatric surgery, cancer care, a pediatric intensive care unit, neonatal intensive care unit, acute care and shelled space to be made available for future expansions. Each room was designed specifically for young patients with space for homework and ample room for family visitation.

“Building the new University of Iowa Children’s Hospital is a critical step in advancing the strategic master facilities plan that will meet the health care needs of our patients and families in the 21st century,” said Jean Robillard, UI vice president for medical affairs, in a statement. “We must be able to accommodate the projected growth in the number of patients, surgeries, diagnostic and therapeutic procedures, and imaging and laboratory analyses, as well as meeting increased space requirements for teaching and clinical research.”

The 14-story hospital, which has 12 floors above ground and two floors below ground, will consolidate the children’s hospital services that are currently housed in a variety of buildings on the medical campus. In the 2013 fiscal year, the hospital treated 57,872 patients, and officials are expecting this number to grow. Administrators believe the centralized facility will significantly improve operations.

With more than 40 pediatric specialties, the UI Children’s Hospital will employ more than 170 pediatric physicians and surgeons, as well as 500 specially trained pediatric nurses.

Heery International’s Iowa City office is the architect of record for the project and Stanley Beaman & Sears, based in Atlanta, is the architect. Gilbane Building Co., with offices in Chicago, is the project contractor. The project, which is funded completely by revenue bonds, hospital funds and donations, is aiming for a 2016 completion date.

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