www.enr.com/articles/9070-hospital-systems-continue-building-large-projects

Hospital Systems Continue Building Large Projects

November 7, 2011

University of California San Diego Health System

California Building The Jacobs Medical Center project will be the biggest in UCSDs history.

Construction is picking up in the health-care market, but renovations trump new building and raising capital is becoming more difficult. Unlike the boom decade of hospital construction prior to 2008, hospitals are now more constrained in their spending habits. Nonetheless, significant projects are under way, and interest in the health-care sector is growing.

The American Society of Healthcare Engineering says its latest survey, published in November 2010, reported that 26% of respondents had hospital projects currently under construction compared to 31% in 2009.

ASHE Executive Director Dale Woodin says, “We saw a lessening of construction from 2009 to 2010, with construction picking up on a limited basis in 2010. I expect a continuation of that trend.”

The La Jolla campus of the University of California San Diego Health System (UCSDHS) is bristling with building activity, with more than $1 billion in construction under way. The $663.8-million Jacobs Medical Center, a 10-story, 509,500- sq-ft addition to the La Jolla campus, “is the biggest construction project in [UCSDHS] history,” says Shawn Sheffield, chief strategy and business officer for the health system. The project will add 245 beds, doubling the center's size, by 2016. “This project has set us apart because of the size and scope of the hospital,” she says.

The medical center will include three hospitals: a hospital for advanced surgery, a cancer center, and a women's and infants' hospital. Other projects include the $280-million Clinical Translational Research Institute, also under construction, and the $200-million Sulpizio Cardiovascular Center, which recently opened its doors.

Kitchell Contractors, Phoenix, is UCSDHS's construction manager/general contractor for the project. The firm is using a version of integrated project delivery fashioned for public institutions and their unique purchasing/contracting requirements. “We are approximately 60% through [hiring] the many trade contractors on the project,” says Jim Cleaton, project director for the Jacobs Medical Center.

While the high level of construction indicates an owner's market, Sheffield says securing funding for expensive hospital projects is becoming more difficult. “We have historically had a large reliance on philanthropy, but that is getting harder.”

Further, health-care facility owners say construction funded by the American Recovery and Reinvestment Act, which is providing $2 billion in grants to more than 1,500 health centers nationwide, largely has run out. “This has forced us to look at how to grow business and volumes locally,” Sheffield says. “To fill the medical center's new bed tower, we will have to look beyond San Diego and consider how to affiliate with other … systems.”

However, strong activity is also evident at the North Shore-Long Island Jewish Health System (NS-LIJHS). The hospital, now in the second year of a five-year capital plan approaching $2.5 billion, is completing construction of the $40-million, 48,500-sq-ft Katz Women's Hospital Pavilion, scheduled to open in January at the Long Island Jewish Medical Center (LIJMC). The $121.5-million expansion of the 130,000-sq-ft Cohen Children's Medical Center, part of LIJMC campus in New Hyde Park, N.Y., will include construction of a new emergency-room department, an intensive-care unit and surgical suites. It also is spending $73 million to replace older portions of Zucker Hillside Hospital, a 114-bed psychiatric facility.

At the North Shore University West Wing, the NS-LIJHS is spending $400 million to add 16 replacement operating rooms and 44 intensive-care beds, with enough space to install interoperative imaging technology and robotics.

Turner Construction is providing integrated project delivery via a construction management contract that allows everyone to participate as a single entity, Maurice LaBonne, senior vice president of facilities services at the NS-LIJHS, says. “Integrated project delivery is not legally available for health-care projects in the state of New York, but we are adopting the processes,” he says. “We are among the first to adopt this type of delivery for a health-care project.”

New LEED Category

Since the U.S. Green Building Council this April added a special health-care category to its Leadership, Energy and Environmental Design (LEED) rating system, health-care developers have become more conscious of green design, Woodin says. “The rating system didn't work for years, with only one hospital becoming LEED-certified,” he says.

Hospitals have become more performance-driven with customers, clients, regulators and the general public demanding more operational statistics. “We have more high-performing hospitals with documented results,” Woodin says.

Sheffield says green initiatives are definitely more the norm for hospitals now than several years ago. “LEED is more rigorous for hospitals, with criteria for 24/7 operations, huge energy demand and the need for processed water and filtered air,” she says. “There is more of a drive to meet the challenges of the unique set of building requirements.”

The University of California required the Jacobs Medical Center to apply for LEED certification and incorporate many green features in the hospital design, such as a variable-air-volume air-distribution system, fritted glass to reduce heat gain and use of reclaimed water for water towers and irrigation. The project is on track for achieving LEED Silver, Cleaton says.

As hospital owners look to the future they are focusing more on ambulatory rather than inpatient care, sources say. While the aging population ensures there will be more demand for services, hospital owners recognize that stays will be shorter. “Hospitals need to be outpatient- friendly for those coming in and out,” Woodin says. “Basic way-finding is important so patients can get to the right place quickly.” LaBonne says, by the end of the decade, 50% of income will come from ambulatory care. “As an integrated health-care system with 14 hospitals, we see the need to have more of a population-based strategy shift in health-care initiatives from treating sick and diseased people to preventive care,” he says.


1	Stanford Univ. Medical Center Expansion, Palo Alto, Calif.	New	3,500	Stanford University Medical Center, Palo Alto, Calif.
2	Medical LifeCare Campus, Riverside, Calif.	New	3,300	March Healthcare Development, Riverside, Calif.
3	Union Village, Henderson, Nev.	New	1,500	Haskell Company Corporate HQ, Jacksonville, Fla.
4	UNMH North Campus Hospital, Albuquerque, N.M.	New	1,000	UNM Hospital, Albuquerque, N.M.
5	New Orleans VA Medical Center, New Orleans, La.	New	800-845	Dept. of Veterans Affairs Medical Center, New Orleans, La.
6	Exempla St. Joseph Replacement Hospital, Denver, Colo.	New	623	Exempla St. Joseph Hospital, Denver, Colo.
7	RFQ/AE: Tricare Medical Facilities, Huntsville, Ala.	A/R, New, Additions	498	US Army Corps of Engineers, Huntsville, Ala.
8	CPMC Cathedral Hill Hospital, San Francisco, Calif.	New	450	California Pacific Medical Center, San Francisco, Calif.
9	Highland Hospital Acute Tower, Oakland, Calif.	New	431	County of Alameda General Services Agency, Oakland, Calif.
10	Children's Hosp. & Adult Critical Care Tower, Iowa City, Iowa	New	270	University of Iowa Hospital Architects, Iowa City, Iowa
11	UConn Health Center, Farmington, Conn.	A/R, New	258	University of Connecticut, Storrs Mansfield, Conn.
12	Jennie Sealy Hospital Replacement, Galveston, Texas	A/R, New	250	University of Texas Medical Branch, Galveston, Texas
13	North Alabama Medical Center, Huntsville, Ala.	New	250	RegionalCare Hospital Partners, Brentwood, Tenn.
14	Sacred Heart Medical Center, Springfield, Ore.	A/R, New, Additions, Int. Comp.	250	PeaceHealth Medical Group, Eugene, Ore.
15	St. Michaels Medical Emergency, Newark, N.J.	A/R, New, Additions	250	St Michael's Medical Center, Newark, N.J.
16	Ambulatory Services Expansion, Brooklyn, N.Y.	A/R, New	234	SUNY Downstate Medical Center, Brooklyn, N.Y.
17	Centegra Hospital, Huntley, Ill.	New	233	Centegra Health System, McHenry, Ill.
18	Suburban Hospital Expansion, Bethesda, Md.	A/R, New	230	Suburban Hospital, Bethesda, Md.
19	Advocate Christ Hosp. - Ambulatory Pav., Oak Lawn, Ill.	New	200	Advocate Christ Medical Center, Oak Lawn, Ill.
20	Emory Hospital Patient Tower/Garage, Atlanta, Ga.	New	200	Emory University, Atlanta, Ga.
21	Meadows Medical Center, Las Vegas, Nev.	New	200	JWM Ventures, LLC, Las Vegas, Nev.
22	Mercy Crystal Lake Hospital, Crystal Lake, Ill.	New	200	Mercy Hospital & Medical Center, Chicago, Ill.
23	New Holy Cross Hospital, Germantown, Md.	New	200	Holy Cross Hospital of Silver Spring, Silver Spring, Md.
24	Reading Hospital - Surgical Building, Reading, Pa.	New	189	Reading Hospital & Medical Center, West Reading, Pa.
25	Washington Hospital Building Replacement, Fremont, Calif.	New	150-180	Washington Township Healthcare System, Fremont, Calif.

Johanna Knapschaefer, ENR’s New England Special Correspondent, has been writing about trends in design and construction of buildings, bridges, tunnels and other infrastructure for more than a decade. She also profiles award-winning industry leaders and delves into broader construction issues such as workforce training, worker safety and health, climate change remediation and emerging offshore wind and tidal energy developments. Over the past two decades, her articles have appeared in Architectural Record, BusinessWeek, the Boston Globe, American Banker, Modern Metals, BusinessNH Magazine, Pittsburgh Magazine and many other publications. Johanna is fluent in Japanese, and taught English and academic writing in the Science and Engineering Department of Ritsumeikan University, Kyoto, while living in Japan for eight years.

When not writing, Johanna enjoys mountain climbing, singing and playing her Spanish guitar.