Making Phased Renovations Work

The variety and complexity of unknowns in existing health care facilities means careful planning is required when phased renovations are undertaken

More than half of all laboratory space in use is housed in health care facilities that are more than 20 years old. Over time, changes in process, workflow, technology, consolidation or business strategy render older lab space outdated. It is often more cost effective to renovate than to build new, but remodeling occupied laboratory facilities requires a carefully staged process that minimizes downtime. Most laboratory functions cannot be duplicated elsewhere, making continuous operation paramount.

A lack of other available space means that phasing is frequently the only option to reprogram existing space allocations and functions. The variety and complexity of unknowns in an existing building makes planning for phased implementation difficult. However, phased renovation entails real costs that need to be captured in the budgeting phase. In addition to extra design and construction costs for temporary spaces, detailed design studies should be used to avoid moving staff and equipment more than once.

To control these costs, it is essential that the design team investigate conditions early on and develop preliminary phasing plans as part of the programming process. Doing so helps address construction costs as well. Good planning can reduce construction time and facilitate measures to increase productivity by foreseeing and dealing with potential bottlenecks, such as contractor and staff access, construction staging areas, and staff turmoil and confusion about work areas. Dust, debris and noise from construction should also be considered so that they are factored into temporary construction requirements, hours of work and limitations on the use of certain types of equipment. Maintenance of life safety systems, including existing alarms, emergency lighting, emergency power and all other issues required during construction should also be addressed upfront to ensure seamless operation during renovation.

Many existing laboratories present unknown conditions that are difficult to determine without extensive field verification. Routine upgrades, equipment replacement and partial renovations are frequently undocumented by as-built drawings. The more extensive the upfront analysis, the better the chances of avoiding costly changes during construction. Environmental issues such as maintaining ongoing operations and handling or removing asbestos and other hazardous materials frequently encumber field investigations.

A critical part of any investigation is identifying impacts and risks to adjacent areas and to floors above and below the area to be renovated. For example, during one recent pathology lab renovation project, the main surgery center was located above the laboratory renovation. As a result, it was necessary to specify some work, including demolition and core drilling, before or after normal surgery hours of 7:30 a.m. to 5 p.m. Understanding these conditions from the outset made it possible to forecast any additional costs, which helped keep the project within budget.

Code considerations

Laboratory areas to be remodeled should be investigated to see if they conform to codes. While essential, this endeavor opens up potential issues far beyond the scope of a single project. On many projects, there are code deficiencies that require work outside of the project area or extensive negotiations with code authorities to limit the scope. When discovered during construction, such code deficiencies can have a dramatic effect on cost and schedule.

Do not underestimate the level of detail required during these early field investigations. A typical task, such as replacement or upgrade of existing electrical panels, can quickly spiral out of control during construction without upfront investigation of terminations, routings and the like through circuit tracing in the field.

Infection control is important in any health care renovation. Typically, medical centers have policies and procedures for infection control that must be specifically addressed for every renovation. An infection-control plan, along with details for temporary partitions, is an important part of the planning process and should be incorporated into construction documents to establish these requirements as part of the project.

Frequently, facility executives expect that most renovation issues can be addressed by scheduling additional labor during construction to limit the expected impact on the operations of the hospital. In reality, however, second-shift work is rarely the answer. Most complex medical renovations are simply too congested to allow much opportunity to share work among trades. Moreover, the size of the project generally limits the crew size, eliminating any economy from second-shift work. While this should be investigated on a case-by-case basis, experience shows that either the entire project should be specified to be done outside of normal hours or provisions should be made for access on a limited basis for overtime work. In this way, the general contractor may schedule demolition, drilling and large equipment installation on a case-by-case basis with a better estimate of actual costs.

Another essential task in this planning process is to communicate with staff and users early on. This helps establish acceptance for the plan and lessen staff turmoil. Once the general framework of the project is established, it is useful to conduct a work session to gather information about the project and initiate discussion on how best to implement it. Publishing the phasing plan early in the process to the building owner, the users and the entire design team helps to ensure buy-in and understanding that extend far beyond construction. This support is invaluable in minimizing complaints and lost workdays and in overcoming the general turmoil associated with any complex renovation.

Planning for temporary space

The availability of swing space is critical to any renovation in an occupied facility. Frequently, additions may precede renovation. Alternatively, in some projects, under-used space allows a short-term consolidation to free up space in the remodeled area. Temporary labs require additional planning to save time and money during the setup, operation and takedown phases. Modeling multiple scenarios, including cost and duration, is the best way to find the most economical solutions. This model can be taken to staff and users to elicit comments and establish communication channels before proceeding further.

It is important to describe the proposed phasing plan fully, but concisely, to enable general contractors and subcontractors to estimate accurately how these conditions will affect their work. The development of specific phase plans, as opposed to a descriptive narrative, is an important tool to describe the work. Providing specific phase plans early in the design process allows the design team to capture these conditions in the preliminary cost model, translating to a higher likelihood of predicting more accurate construction bids. The phasing methodology should be refined as a project progresses. New ideas can surface from staff and users. An inventory of equipment and other systems upfront will provide sufficient detail to the team.

Finding the best approach to phasing

Phased implementation can take several forms. Determining the best approach requires a thorough understanding of building systems and how they are structured. In some cases, existing laboratories use stacked systems that require taking out whole blocks or vertical sections of the building if one part is to be taken out of service. Examples of this are vertical distribution of plumbing, electrical risers, HVAC ducts, and low-voltage systems such as telephone and data. In other instances, services are aligned back to back, which means that taking one area out of service may affect an adjacent area where no work is being considered.

Careful investigation of distribution systems is essential to developing sound phasing plans. In general, wherever possible, it makes sense to take out as large an area as possible, including full floors if feasible. In either case, the goal of the phasing plan is to minimize impacts to adjacent areas and to localize and compartmentalize work so that other areas are not unexpectedly affected. It is useful to look for logical breaks in work, such as intersecting corridors, zones and solid walls, such as shear walls or fire partitions as opposed to more easily demolished partitions. In doing this it is important to consider workflow and process. This means designing to the use, not the building.

That good planning can save money is an axiom in the design industry. This is particularly true when it comes to establishing phasing plans for complex projects.

The first thing to consider is establishing enough work area to provide sufficient room for trades to work. Phases that require heavy scheduling to get everyone in and out are more expensive than larger ones where trade work can overlap. Imagine two scenarios where the mechanical-electrical-plumbing (MEP) rough-in is completed and now the laboratory casework is being installed. In one scenario, enough area is allowed in the phase that each trade can work side by side; as one installs the cabinets, the other trades complete the MEP connections and final finish to the casework. In the other, only one trade can work at a time, with each day having to be rescheduled as work progresses ahead of or behind schedule. Which one gets the better pricing? Obviously, the one where there is an even flow of work and the trades can work together to resolve issues.

Keeping phasing costs in check

The bottom line is knowing when and how to phase a project to achieve optimum results while striving to keep costs down by minimizing the number of phases. If trade work is constantly demobilized to allow the building owner to occupy an area, delays are bound to occur in bringing trades back to the site. The best case is if a swing space can be established for the duration of the project, which eliminates multiple setups and takedowns. Knowing that they can schedule their work in advance also helps trade workers phase their activities.

Another way to avoid added costs is to look at access and removal during construction. If possible, if the project is on an upper floor, designate an elevator for dedicated contractor access, which allows work to take place during normal hours. Otherwise, outside hoists and complicated debris removal requirements can add significantly to the project budget.

Materials and methods for construction are an important factor in overall constructability and should be included in the upfront planning. On one recent project, the building structure required significant upgrading to bring it to conformance with fire codes. Spray fireproofing is wet and messy and poses risks to lower floors with associated cleanup costs. This additional work delayed the project until alternative solutions could be found that would mitigate this risk and reduce overall construction costs. Fortunately, recognizing this upfront meant that alternatives could be looked at early without affecting the budget or schedule.

A modular approach speeds installation and reduces time on site. This approach is two-fold. First, using a modular layout for laboratory design establishes economy and speeds fabrication time. Second, by prefabricating much of the work off site to a set modular dimension, the general contractor's time on site can be reduced.

Laboratory renovations frequently require coordination with ongoing operations. The critical nature of many research or clinical functions means that downtime is not an option. Spending the time upfront to determine the best phasing and implementation plan early and to include those costs in the very first cost estimate provides a realistic estimate of the cost of the project and its potential impact on operations. While there is a tendency to think that these issues will get worked out during construction, detailed drawings and specifications make all the difference in terms of competitive pricing and minimal disruptions to on going operations. Including staff and users in the initial decision-making will earn buy-in critical to the project's overall success.

Jonathan F. Douglas, AIA, is managing principal overseeing the South Atlantic and Latin American operations of VOA Associates, a professional design services organization with practice groups focused on health care, education, commercial, institutional, corporate, hospitality and government sectors.

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  posted on 9/1/2005   Article Use Policy

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