Nemours Foundation's Vision Drives Design of Children's Hospital

The Nemours Foundation had a clear vision for its new children's hospital in Orlando: a world-class facility that would offer Central Florida a new level of pediatric specialty care, from minor injuries to the most complex of illnesses and conditions.

However, since Nemours had never built—nor operated—a full-service, in-patient pediatric hospital before, envisioning how to attain its goal was less clear. And from the beginning, complications would abound, starting with the fact that the new facility's location wasn't firmly set until the state of Florida authorized construction to begin in August 2009. Even then, only portions of the design had progressed to the point of being buildable. Other components would come into focus as Nemours brought the hospital's administrative and clinical leadership on board.

Despite these huge challenges, within 37 months, the Skanska USA-led design and construction team had birthed a $256-million, seven-story, 633,000-sq-ft hospital that was ready to serve. By overcoming so many unknowns while building a state-of-the-art health care facility—and for doing so with a stellar safety program and end results—ENR Southeast recognizes the Nemours Children's Hospital as its Project of the Year for 2013.

Impressive Achievement

ENR Southeast's judges were impressed with the Nemours project. Judge Howard Wertheimer, director of capital planning and space management at the Georgia Institute of Technology, Atlanta, called it a "very well-crafted facility with finely detailed and executed results."

The completed hospital's 400,000-sq-ft in-patient portion includes 95 private patient rooms; an operating-rooms suite; full radiology and nuclear medicine capabilities; and a pharmacy. The 200,000-sq-ft clinic includes 85 exam rooms, plus an education center with conference facilities and a 225-seat auditorium.

While some of the logistical hurdles could have been smoothed out over time, Nemours officials say the urgency to build wouldn't allow for that time.

"Greenfield projects such as these don't happen often and inherently have their own construction issues," says Nelson Roque, Nemours' director of planning and construction. "But we just couldn't afford to wait for everything to fall into place before getting started."

In fact, Nemours wanted to get started before it even had assigned staff to make key project decisions.

"We could get going on the core infrastructure, but things like the operating rooms, radiology labs and food service had to be deferred until Nemours could get clinical staff on board to make decisions," says Andy Allen, Skanska USA's project director.

The prospect of having design continually play catch-up with construction would test the patience of the project team. But for the most part, collaboration, rather than contention, won the day.

"Skanska went to great lengths to build relations with the design team, which was important with the changes coming in so fast," says Veronique Pryor, project manager for designer Stanley Beaman and Sears.

One certainty from the outset was the need to have the hospital's landscaping—which would ultimately include two therapeutic roof gardens—as well-established as possible by opening day to achieve the "Hospital in a Garden" design theme, which emphasizes nature's role in the healing process. That meant that landscaping was installed at the start of construction.

This was no small point, and caught the eye of ENR Southeast's judges. Georgia Tech's Wertheimer called it "a very forward-thinking and innovative approach."

Within the project's first five months, underground infrastructure in the outparcels had been installed, and 33 acres of the site were seeded with native Florida grasses. Skanska accelerated construction of the site's retaining walls so that they would be fully covered with creeping fig vines by the hospital's opening.

Another key performance requirement was ensuring that the hospital could withstand 150-mph winds—no easy task given that the design also called for extensive use of glass, including the custom aluminum unitized double low-E double-pane panels for the curtain wall. Pryor says having key subcontractors on board early expedited constructibility assessments and fabrication of the glass and other specially designed components.

"We couldn't have done it as fast otherwise," she says.

At other times, upfront planning would yield to quick reaction times—such as with timing the delivery of the radiology diagnostic equipment with completion of lab spaces. When equipment selections were made several months after established "drop-dead" dates, the team had to move fast. "We had to significantly accelerate the radiology area work in order to preserve the completion date," Allen says.

Project safety was another key emphasis noted by ENR Southeast's safety judges. Citing the Nemours project's more than 4.2-million man-hours with only one minor lost-time incident, judges recognized the results with an award of merit for safety.

And it was all possible, Allen says, because project team members committed themselves to trusting each other, and to putting the overall project's goals ahead of all others.

"If you spend time trying to make decisions work, rather than challenging why they were made," says Allen, "you can do great things."

Nemours Children's HospitalOrlando

Key Players

Contractor Skanska USA Building Inc., Orlando

Owner Nemours Children’s Hospital, Orlando

Lead Design Firm Stanley Beaman & Sears, Atlanta

Structural Engineer Simpson Gumpertz & Heger, Boston

MEP Engineer TLC Engineering for Architecture, Orlando