More "Home" for Holmes

Owner Expectations Drove $130 Million Project to a New Standard

By Scott Judy

For several years, hospitals in the Southeast have utilized cues from the hospitality industry to design and build facilities that are warmer and friendlier places that provide a more healing environment.

Of course, it's also big business, and updated facilities are seen as an investment in a hospital's future financial health.

In Melbourne, Fla., officials with Holmes Regional Medical Center pushed their design and construction team to go beyond even the latest trends on its $130 million addition of a heart hospital and emergency/trauma center. The facility has been operational since November, with final completion scheduled for March.

"They certainly wanted us to propose things that were unique or aren't normally seen in a patient room, in a nursing setting," says Gary Cox, vice president and project manager for HKS Inc. of Orlando, the project architect.

Tom Mills, vice president for facilities and planning at Holmes Regional, says the goal was definitely one of patient comfort.

"The expectations were that it be less intimidating to the patient and have the experience be as pleasant as possible," he says. "Within reason, we tried to bring in more residential and less institutional feel the best we could."

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One example was the inclusion of 27 private holding beds for catheterization preparation and recovery. Whereas in the past these accommodations have usually been ward-type settings of cubicles and curtains, and little privacy, these areas at Holmes will be small private rooms with walls and a closing French door, television sets - and even a ceiling painted with a scenic touch to help ease the minds of the patients about to undergo this procedure.

"It's a big move trying to satisfy patients and their families when they go in for something like a catheterization, which is a high-stress situation a lot of times," Cox says. "We were able to provide private rooms for all of those folks and achieve something special in terms of the finishes."

Mills said the inclusion of these cath prep and recovery rooms happened because the hospital's clinicians and physicians pushed for them.

Additionally, the original full-size mock-up of a patient room that HKS delivered to the owner for review prior to construction "wasn't at the level where they wanted it to be," Cox says.

While this resulted in major changes, Mills appreciated this step in the process. "We knew exactly like it would be," he says. "That helped a lot in making our decisions."

Patient rooms now feature custom cabinetry that can hide away much of the installed equipment, a full-size sleeper couch, plasma televisions with pay-per-view capability, computers with wireless Internet connections, high-end bathroom countertops, Italian marble tile finishes and works of art. Wireless systems enable patient care physiological monitoring and tracking of the nurses.

The Project

Bovis Lend Lease of Orlando started work in mid-2004 with foundation work and received the final building permit in November of that year.

The contractor held a $92 million construction management contract for the 402,000-sq-ft project, which entailed construction of an eight-story heart hospital with 108 new, all-private patient-room beds and a 43,000-sq-ft emergency/trauma center with 58 treatment beds.

The heart hospital includes four cardiovascular and two general operating rooms; a 14-bed cardiovascular intensive care unit; seven cardiac catheterization labs with 27 holding beds; three floors of patient rooms; an additional floor shelled in for 36 future patient beds; and a rooftop helistop. (Bovis had been involved with preconstruction since 2002, when the original vision for the project was much different: a medical office building with parking garages and connector bridges. Market demand for cardiac services forced the project's evolution.)

Karen Voit, senior project manager for Bovis, says the construction manager set a roughly two-year goal for the project-one year to erect the structure and another to complete the interior and exterior finishes. Luckily, that schedule had some extra time built into it, says Mike Cockman, senior superintendent for Bovis.

"We probably would have beaten that schedule by quite a bit had nothing changed," Cockman says. "But we were able to absorb all of the (design) changes and still maintain the original date." He adds that Bovis received approximately 32 sets of new drawings, revisions and other items after the start of construction that impacted the schedule.

The contractor also absorbed the close calls of two hurricanes in 2005, both of which required the lowering of the project's tower crane and had a significant impact to the job's progress, Cockman adds.

"It seems like we were either cleaning up after a storm or getting ready for the next one for about two months," he says.

The ability to withstand a hurricane would extend to the project's design and construction. Partly because Holmes is the highest-rated trauma center between West Palm Beach and Daytona Beach, the owner required enhanced hurricane criteria for all exterior envelope materials and systems, including the doors, windows, louvers and precast materials. The project was designed and built to remain structurally sound against wind gusts of up to 160 mph.

One method Bovis utilized to get the structure up as quickly as possible was the use of two separate crews to simultaneously erect the precast concrete panels on two opposite sides of the building. Voit says the contractor tried to gain as much time as possible during the first year, so it could have more flexibility during the second.

It would need it. In addition to the design changes to the patient rooms and related oversight of these upgraded finishes, Bovis also had to accommodate the installation of new equipment. Like other health-care providers, Holmes wanted to ensure it had the latest and best equipment available, so it held off on purchases until as late as possible.

While Voit says the pushed-back installation of equipment caused some level of "struggle" and "frustration" because of the need to put some construction on hold to accommodate this, Cox with HKS says it was well worth it.

"A lot of hospitals will sell themselves short in terms of being on the cutting edge of technology," he says. "This hospital has been far ahead on technology and has been able to incorporate that into the hospital design-not without pain."

Just as a new hospital is big business for the health-care providers, a quality end-product is good business for contractors. In the case of Holmes, Mills says the hospital based much of its original selection of Bovis and HKS on the individual personnel committed to the project.

"I can't imagine going through a big project like this without those people," Mills says. "We have other big projects on our agenda, and we're trying to keep the same team in place to continue to work with us."