A Comprehensive Building Investigation Enhances Health Care Renovations

The challenges of health care construction are always immense, yet when it comes to an occupied renovation of an active medical facility, the stakes are magnified exponentially. When undertaking a renovation or expansion, health care builders are faced with the possibility of several unforeseen conditions. Examples include inadequate or poorly coordinated documentation of previous facility improvement projects, continuously evolving code requirements and highly specialized equipment requirements related to power, space and ventilation. Combined with the critical need to minimize construction impacts to ongoing operations, the desire to maximize every dollar invested and the hypersensitive nature of infection control, it’s easy to understand why the renovation of an occupied health care facility is far more difficult than most commercial construction projects.
In response, Adolfson & Peterson Construction, a renovation contractor located in Aurora, Colo., formed AP Healthcare in 2011. Comprised of a specialized team of health care construction professionals, AP Healthcare provides clients with a proven process to enhance both value and overall client/design team satisfaction on health care construction while reducing the adverse impacts of construction. A key facet of AP Healthcare’s preconstruction methodology for any renovation is a discovery process designed to identify potential complications within the scope of work before they require non-budgeted expenditures to correct.
Design teams often work from a set of as-built drawings that are not always well-documented, and often times minor discrepancies between what is on a facility’s as-built drawings and the actual in-place conditions can have a substantial impact on constructability, costs, ties-ins and shut downs required to seamlessly transition spaces from one purpose to another.
“We believe it is in everyone’s best interest to take as-built documentation a significant step further by actually getting into the unseen spaces above ceilings and behind walls as much as possible,” said AP HealthCare Project Manager Matt Curtis.
Code compliance, deficiencies in power requirements, inaccuracies in duct work and plumbing layouts and the possibilities of structural conflicts with proposed systems are generally among the most common issues uncovered by AP Healthcare’s building investigation process. As the building ages and technological advances are made in both construction materials and methodologies, internal wall systems become outdated with fire rating systems and current building codes. Breaker boxes may be overloaded as the result of undocumented loads being placed on them during prior renovations. When tasked with converting conventional spaces like offices to specialized uses such as laboratories, there are frequently workarounds required to make specified ventilation equipment fit into the generally tight confines on the existing structure.
Avoiding Disruption of Patient Care
One key difference between the design team’s obligations and the contractor’s responsibilities is the fact that many of the potential construction hurdles that may be encountered on a job actually lie beyond the limits of the design documentation. While the architects’ work is largely concerned with resolving a scope of work within the parameters of cost and program, the contractor is challenged to consider the project’s interface with adjacent areas, frequently including the floors above and below the construction zone.
“It’s important to never give patients any sense that they are being treated in a facility that is under construction. Whether they are in for preventative care or something serious, our presence should only be beneficially felt, when the work is done,” said Mark Stubits, AP Healthcare superintendent.
Adding greatly to the complexity of working with an occupied health care facility, the possibility of construction related infection risks literally magnifies that need to a microscopic level. Maintaining maximum awareness and attention to the control of debris, dust, noise, vibrations and other environmental contaminants is a conscientious focus of AP Healthcare’s preplanning process on every project. As potential project impediments are identified during the discovery process, AP Healthcare takes a proactive approach in presenting issues to the owner and design team accompanied by thorough documentation of existing conditions and possible resolutions.
“It’s very important that we collaborate with owners, architects and design consultants to really work through the details of every issue, while solutions are still on paper rather than in the field,” said Stubits. “As the builder we don’t want to simply expose unforeseen issues, we’ve got to propose possible solutions and game plan implementation scenarios that consider construction costs, schedule impacts and functionality to lead decision makers toward solutions that result in the most positive benefits and the least negative impacts.”
It is in the benefits to owners, users and design partners that AP Healthcare really sees the extra effort pay off. A few hours of getting up into the ceilings during off hours can pay huge dividends in terms of stronger, more reliable cost estimates; enhanced user-centric scheduling and construction sequencing; and the reduced need for value engineering or change orders once construction starts.
“The focus of AP Healthcare’s preconstruction effort is to develop a very detailed understanding of the client’s objectives and expectations,” says Curtis. “Exposing any and every incongruity between reality and the as-builts through a room-by-room/drawing-by-drawing building analysis is actually a lot easier than discovering an issue while the building is torn apart and the client and their patients are being inconvenienced.”

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