A new tilt on hospital construction

March 2015
By Gary S. Owens, FAIA , ACHA, LEED AP , Senior Principal / Senior Designer, FKP Architects

A challenging economy, emerging public policy and rapidly increasing patient demand requires that the healthcare industry rethink its conventional design and construction practices—and Memorial Hermann, the largest not-for-profit health system in Southeast Texas, is leading the way.

Evolving from the impact of the Affordable Care Act and the recent economic downturn, Memorial Hermann investigated new concepts to expand and build new facilities with greater economies in structure and form.

With a focus on speed to market, the owner and its design and construction team has begun adopting building assembly and construction techniques that deviate from the norm for typical hospital structures. Specifically, the team introduced a rapid building construction method—the concrete tilt wall system—as a key time and cost saving element of its new six-story patient tower for Katy Hospital. When complete, it will be the first multi-floor hospital tower in the Houston region to be designed and constructed using this construction method.

Katy Hospital Expansion

The currently in progress Memorial Hermann Katy Hospital expansion project includes the construction of a new 232,700 square foot, six-story tower and the renovation of 31,000 square feet within the existing building. The new tower will increase the campus’s patient bed count from 142 to 202 and includes neonatal intensive care beds, intensive care beds, intermediate care beds, women’s services beds and acute care beds. The new tower will also house expanded and relocated support services from the existing building including, laboratory, surgical pre-operative care, pre-admitting check-in and testing, and staff offices. Renovation within the existing building expands a variety of services such as operating rooms, special procedure rooms, post-anesthesia recovery care, sterile processing, labor delivery recovery rooms and emergency center exam rooms.

Time to market is critical in this rapidly growing community of Houston in order to meet the expanding demand for health care services. The use of concrete tilt wall construction—commonly used in the industrial market for warehouses and similar structures—will minimize the time for the construction of the exterior envelope of the building, thus reducing overall costs and time to occupy the building and providing a high quality, long-standing building.

With concrete tilt walls, the contractor can build multiple floors of the exterior wall. For each wall, the concrete is poured into formwork on site and then lifted vertically. The large, multifloor height panels form the exterior structural frame and the exterior finish wall. By adding glass and other details, the exterior envelope of the building rises rapidly. The process saves considerable construction time and costs without sacrificing quality.

The typical maximum height of concrete tilt wall construction is four stories. However, in order to meet the desired program, the Katy hospital tower needed to be six stories to provide the necessary space in proximity to the existing tower. Therefore, the design and construction project team will stack the concrete tilt wall panels atop one another to provide the additional height. Houston’s first multi-floor, concreted tilt wall fabricated hospital is expected to open this year.

Energy Emphasis

Beyond seeking economies in structure and form, Memorial Hermann is also continuing to invest in more efficient mechanical systems to support its 12 campuses, including the new Katy patient tower. This focus on energy efficiency has helped Memorial Hermann achieve Energy Star label for eight of its hospitals. They have also been recognized as Energy Star Partner of the Year for 2013 and 2014 and is the only healthcare system in the United States to have this designation.

Mandated by new energy codes, the mechanical systems for the new tower will prove to provide more efficient heating ventilation and air conditioning resulting in lower operating costs. The new systems in the campus central plant are an extension to the existing systems and will be connected to provide prime backup service to both major buildings.

The chilled water piping in the existing central plant was reconfigured to a variable primary flow system that is more efficient than the existing plants primary-secondary setup. The new tower was designed using dedicated outdoor air systems with efficient HVAC equipment that is based on using 100 percent outside air flow that is preconditioned with a heat recovery cycle before being delivered to the building air handling units.

This system saves on energy use and annual operating costs for the building, all reducing the cost of healthcare. Another economy was the design and installation of only the HVAC systems needed to support the opening day mechanical needs without installing large air handling units on shelled floors which is an initial cost savings for construction, but is designed to easily add units as unoccupied spaces get activated. This allows for these future air handling units to be right-sized to the program for each shelled space at the same time these programs are developed.

Designing an efficient mechanical system is the initial step toward visioning of cost savings throughout an annual cycle. This comprehensive system also will begin its start-up through a mandatory commissioning analysis when each component is checked to be operating at its best capacity and the energy saving sequences of operation that have been designed are verified to be functioning properly. The commissioning phase is the final tune-up for all systems and marks the beginning of efficiency and annual cost savings.

Streamlined Operations

To further address economies within the Memorial Hermann Healthcare System of 12 campuses, with its 5,500 affiliated physicians and its 21,000 employees, facility team leadership have incorporated means to streamline daily operations that impact patient care as well as operational costs.

A concise document of established Best Practices was compiled by Memorial Hermann to provide standards to guide the design and construction of new and renovated spaces. For instance, right-sized rooms in high-tech spaces (operating rooms, radiology rooms, exam rooms and patient rooms) and low tech rooms (offices, utility rooms and storage rooms) were created to provide common plan layouts that would support staff from the various campuses and to improve safety and patient outcomes. Standardization of medical equipment and the common location of equipment within rooms assist the clinical team in providing the best and convenient care for their patients. Department layouts were studied early in the design process to maximize flexibility to support changes in care models and healthcare technology.

As medical institutions seek ways to improve patient care, uncover new treatments and reduce costs, so must the design and construction profession seek to provide facilities that address the overall vision of the institution while meeting their needs for providing physical spaces that support care models with fiscal solutions. Facility longevity is also a key need and low core and shell maintenance costs are essential. The new Memorial Hermann Katy expansion tower was an engaged effort between representatives of the hospital, design team and construction team working in collaboration to create a new direction for hospital buildings.