Strong Pulse

Health-care construction remains robust throughout the region

By Debra Wood

Hospital work has proven to be a healthy market for contractors in the region in recent years, and it’s a trend that likely will continue.

Privately owned and public hospitals, including military health-care facilities, are upgrading their current facilities to meet the needs of a rapidly evolving marketplace and shifting demographics.

“The Mid-Atlantic market continues to be strong, and there are major projects in the planning stages,” says Joseph E. Kranz, health-care manager for Turner Construction Co. in Arlington, Va. “Most clients we talk to are planning an addition or new towers.”

The demands of aging baby boomers continue to drive much of the work, Kranz says. He adds that other factors are the surge of growth in the suburbs brought on by the housing boom and old facilities that cannot accommodate latest equipment and amenities.

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“The health-care market has been active at least the last five years in this region,” says Paul Reibel, senior director of business development for Skanska USA Building in Philadelphia. “Every health system has plans in place for expansion, moving or renovations.”

Skanska is working on an $80 million-plus expansion of Wilmington Hospital for Christina Care in Wilmington, Del.

Meanwhile, Dennis Curl, vice president of Gilbane Building Co. of Providence, R.I., says, “It was our strongest year in health care, and we don’t see any slowdown. “We’ve seen bigger projects [on the horizon].”

Gilbane, in a joint venture with Turner Construction, is building the $649 million, 1.1-million-sq-ft DeWitt Community Hospital replacement complex at Fort Belvoir, Va., as part of the Base Realignment and Closure process. Curl says the military used an innovative design-assist delivery system in which subcontractors are brought in early to consult. The project broke ground in November and is expected to complete in summer 2010.

HSMM of Roanoke, Va., also has BRAC-associated health-care work. The firm, in conjunction with HOK of St. Louis, is preparing the design-build documents and request for proposals for the replacement of the Walter Reed Army Medical Center at the National Naval Medical Center in Bethesda.

“It’s bullish—a good market up and down [the Mid-Atlantic],” says Doug Wignall, international health care director for HDR in Omaha, Neb. “We’re seeing more large projects. It wasn’t too long ago, $100 million to $200 million was considered large, and they didn’t happen often. [Now] we’re coming across $500 million to $1 billion projects on a monthly basis, and not just in this region.”

HDR of Omaha, Neb., is bullish on the Mid-Atlantic health-care market, regularly finding big-dollar projects. Among its recent successes, the company designed the $76.3 million, 339,000-sq-ft Sentara Williamsburg Regional Medical Center in Williamsburg, Va. (Photos courtesy of HDR).

HDR created the master plan for Sentara Princess Anne Commons Health Campus, a $162.4 million, 550,000-sq-ft health-care village with a 158-bed hospital, in Virginia Beach, Va. The company also designed the $76.3 million, 339,000-sq-ft Sentara Williamsburg Regional Medical Center in Williamsburg, Va.

Wignall says the University of Pennsylvania plans to build a new hospital campus, which is now in the architectural selection process.

“The Mid-Atlantic has a wealth of health-care institutions with facilities that are older—and they are looking for upgrades, expansions and renovations,” says Tom Forde, health-care principal with RTKL in Washington, D.C.

Chambersburg Hospital in Chambersburg, Pa., for example, was built in the 1950s with small, semiprivate rooms, Forde says. The firm is designing a new seven-story bed tower at the facility, which will allow Chambersburg to switch to all private rooms and “decompress” the existing building.

RTKL also designed a $212 million campus revitalization for St. Agnes Hospital in Baltimore. The work includes a 120-room bed tower, renovations and a master plan for a bed tower at Mercy Hospital in Baltimore.

“Master planning is a critical component in any hospital’s strategic vision,” Forde says. “The master plan sets the tone for the entire project over time.”

As more hospitals expand and upgrade, competition within the health-care field drives the need for even more construction activity. Wignall says every health system is trying to get a leg up, with demands of selective patients emerging as a true driver.

Wilmot/Sanz in Gaithersburg, Md., sees much of its work stemming from patients becoming choosier about what hospital to go to for certain procedures. The firm designed two the 299,000-sq-ft addition for Christiana Hospital in Delaware (top and middle) and a 43,000-sq-ft expansion and renovation at Shady Grove Adventist Hospital in Rockville, Md. (bottom). Images courtesy of Wilmot/Sanz.

“Health care has become more of a consumer market,” says Dwight Fincher, a partner at Wilmot/Sanz in Gaithersburg, Md. “[Patients] become more selective and choosier about what hospital to go to for certain procedures. In that sense, hospitals are starting to compete, not just for patients, but for top staff and physicians.”

Wilmot/Sanz designed two additions – one 299,000 sq ft and the other 43,000 sq ft – for Christiana Hospital in Delaware, and an expansion and renovation at Shady Grove Adventist Hospital in Rockville, Md. Fincher says Wilmot/Sanz has also been designing a lot of replacement facilities because owners have found it’s just as expensive to renovate as to build new.

“Most hospitals, if given their preference, particularly with the cost of renovation and addition, would go for new,” Gilbane’s Curl says. “But most hospitals don’t have the land available, so they are forced to do renovations.”

Greg Smith, regional preconstruction manager for Turner Construction in Philadelphia, says his company has an abundance of rehab work, including at Pennsylvania Hospital and Shriners Hospitals for Children, both in Philadelphia.

The jobs are “to bring old facilities up to new health-care guidelines and the ability to provide private rooms for every patient,” says Smith, adding that the need to replace medical equipment with new technology and adding wireless capability also sparks projects.

Robert A. Strickland, director of health care design at HSMM, says new construction and renovation often go hand in hand, such as when hospitals build new outpatient facilities that free up space in the hospital and spawn renovation work.

General and specialty centers

The outlook on specialty facilities, such as stand-alone cancer centers, is mixed. Smith finds greater interest in full-service facilities, with the specialty trend limited to outpatient facilities being built by independent development companies. Skanska’s Reibel adds that developers are investing in medical office buildings and diagnostic centers near hospitals but not owned by the health-care system.

RTKL in Washington, D.C., is looking to give older facilities a fresh look. The firm designed a $212 million campus revitalization for St. Agnes Hospital in Baltimore. The work includes a 120-room bed tower, renovations and a master plan for a bed tower at Mercy Hospital in Baltimore.

RTKL’s Forde and Daniel J. DiMarco, health and sciences lead at HSMM, say they see fewer specialty hospitals, with more clients developing centers of excellence within their facilities. At Carilion Roanoke Memorial Hospital, HSMM consolidated two facilities into a new 300,000-sq-ft, 15-story tower and designed 150,000 sq ft of renovations. The hospital includes a center of excellence for women and children.

“People are searching for a certain market share within health care, and to do so you establish yourself as a center of excellence,” Strickland adds.

Curl, on the other hand, continues to see an interest for specialty hospitals. At the University of Virginia in Charlottesville, Gilbane is working on a stand-alone, 150,000-sq-ft, five-story cancer center and a 63,000-sq-ft bed expansion. Both projects are in design.

The company began building a six-story addition to Doctors Community Hospital in Lanham, Md., at the first of the year. It is scheduled for a fall 2009 completion.

Gilbane continues as project manager on the District’s $140 million, 438,000-sq-ft St. Elizabeth Psychiatric Hospital replacement project. Tompkins Builders of Washington, D.C., broke ground on the 290-bed, steel-frame structure in 2006. Occupancy is slated for 2009

Turner has begun preconstruction services for Washington Adventist Hospital in Bethesda, Md., for its new $250 million hospital. The company also is in preconstruction on a $140 million addition at Suburban Hospital in Bethesda. It began a $40 million emergency department and operating room addition and renovation at Inova Alexandria Hospital in Alexandria, Va., in May.

Taking the LEED

“Every hospital is looking at some element of LEED,” Curl says.

Melanie Townshend, Gilbane national sustainability coordinator and project executive for health-care practice, says the DeWitt Community Hospital project at Fort Belvoir and a $300 million-plus addition at Anne Arundel Medical Center in Annapolis, Md., are seeking LEED certification.

“Our buildings need to last a lifetime,” Townshend says. “Folks are tuned into energy and efficiency and durable materials.”

Kranz agrees there is a “huge interest” in sustainable design. He credits government placing a priority on LEED certification, and uses as an example Montgomery County, Md., which requires new structures to meet LEED standards.

DiMarco says it also helps attract patients and staff. The firm designed a new clinic for Carillon Clinic, which is aiming for LEED silver certification.

“If you create a more pleasing environment, one that people are interested in going to everyday, you are more likely to fill it with staff,” DiMarco adds.

Evidence-based design remains popular. Hospitals try to put into place features that studies have shown promote healing. One of those things is family-friendly environments. Rooms are bigger, with space for a family member to stay overnight. Jobs may include healing gardens or waterfalls.

For now, many firms see the surge of major health-care work continuing, but some weakening could be on the horizon. Turner’s Smith says he anticipates activity for replacement facilities to remain strong for about five years, but once hospitals’ new facilities and additions catch up with demand, he expects the number of projects will drop off. But he adds that renovation work will remain strong.

“The facilities will need to be renovated so that care can be provided more efficiently,” he says.