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Tue November 22, 2016 - Southeast Edition #24
Designed to serve the community for decades to come, the $250 million M.T. Mustian Center is under construction in Tallahassee, Fla. The five-story, 340,000 sq. ft. (31,587 sq m) addition will be located at the southeast corner of the Tallahassee Memorial HealthCare (TMH) campus, near the corner of Miccosukee Road and Medical Drive.
From start of construction, the project is estimated to take 30 months to complete. Crews are still early in the process. Over the next six months, workers will complete excavation, deep foundations, structural steel and the placement of floor slabs.
“The M. T. Mustian Center is a transformative building for us and our community,” said Mark O'Bryant, TMH president and CEO. “It allows Tallahassee Memorial to build a platform for our clinicians so they may provide state-of-the-art quality care with an emphasis on meeting the needs of patients and their families.
“Discussions about this project began approximately ten years ago. The first several years were focused on building a financial platform that would allow us the ability to take on a project of this magnitude.”
O'Bryant said planning was crucial for a successful outcome.
According to Barbara Alford, R.N., vice president, chief nursing operations officer, “When we looked into the development of the ICU Rooms, we researched the evidence on what kind of design would provide the best patient care. The elements we focused on were the minimization of movement for patients and family, bringing in as much light as possible, providing comfortable family sleeping, and colleague working and respite areas.”
Officials developed plans to modernize the operating rooms and adult intensive care units to meet the growing demand in the area. The planning process included input from doctors, nurses, clinical staff, outside consultants, patients and family members. The result of this planning effort is the proposed construction of a structure containing 28 operating rooms that replace all existing operating rooms, four interventional suites for neurosurgical and vascular procedures and 72 adult medical/surgical intensive care beds.
The center will be designed to accommodate future additions of operating rooms and intensive care beds, as well. This facility also will house all the necessary support services for the operating rooms and the intensive care beds, such as preadmission testing, perioperative services, post anesthesia care unit, sterile processing services, blood banking, respiratory therapy, CT imaging, pharmacy and materials management.
Brian Smith, Brasfield & Gorrie senior project manager, said crews have been performing various tasks to prepare the site for construction.
“Currently, we are excavating and installing shoring and deep foundations,” said Smith. “Preparing the site for construction has been challenging. We've had to relocate critical infrastructure, such as loading docks, ambulance access, three hospital buildings, a school and major utilities. This process required almost one year to plan and about the same amount of time to execute. We are looking forward to building the new facility.
Smith's chief concerns regarding the project comes from a patient's perspective. The facility must be quiet and comfortable.
“The hospital staff likely will appreciate having the latest and greatest medical technology and equipment that will enable them to offer the best possible care. This can be a challenge for our logistics team, since we are sometimes building hospitals that will feature equipment that has not yet come to market. Additionally, the facility should have reliable systems that are easy to maintain. In my opinion, the most important consideration in construction are the things that are not immediately visible to the patients and staff. You can change colors on the walls down the road, but the concealed structure and systems should be well planned and executed from the beginning.”
Demolition was completed last month. This phase included three office buildings, a school, hospital laundry, bulk oxygen storage and a large bridge that ambulances have been utilizing to access an elevated emergency department.
“Prior to demolition, our team constructed or renovated new offices, classrooms and laundry services areas. Additionally, all of the receiving docks had to be relocated, and all major utilities were rerouted. This work was performed on an active, busy campus. Additionally, it was difficult finding locations that functioned properly for staff. However, the greatest challenge has been logistics and the elaborate matrix required to accomplish these feats. However, the collaboration among the designers, hospital staff and other Tallahassee general contractors has been instrumental to our success up to this point.”
Smith said haul-off will include general construction debris. Old concrete will be recycled for use as gravel base.
“We will remove approximately 30,000 cubic yards of debris from the site. We expect to excavate to almost 20 feet in some areas. Prior to excavation, we are installing sheeting/shoring,” said Smith.
Smith said operating rooms will be the most challenging to construct.
“For this reason, there is meticulous pre-planning to ensure success. We began by considering all of the functions and services in the rooms. Most of these are either installed in the ceiling or in the walls. Our computer modeling capability allows us to plan where everything will go and to make sure the equipment will fit the space. Additionally, there is a great deal of coordination with the medical equipment supplier.
“We are building and planning today for something that won't open for a few years, so we must work closely with the owner and equipment planner. Equipment selections are made as late as possible to ensure that the hospital is able to secure the latest equipment available for the new facility.”
According to Smith, a patient/family advisory group is providing invaluable feedback about the design for the intensive care unit (ICU) rooms. This group includes former patients and family members who have spent time in the ICU.
“We've also used mock-ups during the design phase of the project. To accomplish this, we leased a warehouse near the facility to house completely built-out patient and operating rooms with finish details. Staff, designers, patient/family advisors, and contractors were invited to comment on the details of the rooms. This was an important step because it is sometimes difficult to visualize what a room will actually look like from a set of drawings. This effort will help manage expectations for the project and improve outcomes.”
For crews on the job, working on a healthcare project requires an even higher level of responsibility.
“A superintendent once said, 'Building a hospital is like building anything else, but with just a few extra pipes.' While there are many more pipes, there is an extraordinary amount of meticulous coordination required to make sure everything is in the right place and working properly,” said Smith. “In my 20-year career working on healthcare projects, I know that it is important to maintain keen awareness when it comes to building facilities that will house complex medical equipment and provide critical healthcare services. Additionally, we are very mindful to keep things clean as we are installing equipment because these instruments will serve patients.”
For site work, excavators are being used, along with dump trucks, loaders and compactors. Crews are hauling around 120 truckloads of earth off the site each day. Deep foundations and steel crews will utilize large mobile cranes. Given the large footprint of the building, two cranes will be on site to help expedite the work.
“The exterior of the building will be a combination of synthetic stucco, glass, and metal panels with a modified bituminous roof,” said Smith. “The structure for the building will be structural steel sitting on pile caps with roughly 700 18-inch auger cast piles. Our interior finishes will be various combinations of sheet vinyl flooring, tile and terrazzo.”
Smith said weather is always a concern when starting but the rain has not had an impact on construction.
Assisting the owner with equipment procurement and installation and commissioning the building prior to opening is another aspect of the project.
“In this area, Brasfield & Gorrie's extensive healthcare experience adds value to a project. Because we work on so many healthcare facilities, we have acquired great experience in equipment installation methods and practices. Therefore, we are able to advise our clients about issues such as coordination and scheduling early on. This is important because these considerations may be overlooked and could become costly considerations later.
To make way for the new surgical center, property belonging to Holy Comforter Episcopal Church was acquired by TMC. During Easter weekend, crews took the time to remove a 14,000-lb. (6,350 kg) concrete dove encased by bricks from the church's walls.
With the help of two cranes and a cutting torch, the dove was removed and positioned upright on a trailer latched to a demolition pickup truck and was transported to the church's new location. TMH, Childers Construction, Southern Demolition and Southway Cranes donated their time and resources to move the dove.
Robert “Skip” Yauger, AIA, senior vice president, project principal, Gresham, Smith and Partners, said the vision for the project was developed in collaboration with the leadership team at TMH.
“The vision for the MT Mustian Center is to create technologically advanced surgical and critical care tower that will meet the needs of the Tallahassee region for next 50 years, in a safe environment that enhances the patient and family experience, improves staff efficiency and effectiveness, and achieves improved patient care outcomes.
“The biggest challenge is integrating the new tower with the existing hospital that was built in 1948 with many subsequent renovation and expansion projects. Improving wayfinding and the existing older engineering infrastructure are significant challenges.”
Sustainability, both economic and environmental, is important to the entire creative team. According to Yauger, the new tower will include sustainable features such as 100 percent LED lighting, highly insulated exterior walls, windows and roof and energy-saving mechanical equipment. Economic sustainability is achieved by planning clinical areas that reduce travel distanced for staff, and provides separate dedicated elevators for the public, patients, staff, and materials.
“Many features of the design are a source of pride for the design team,” said Yauger. “It is a very large project, with a simple circulation system. Public 'on-stage circulation is separated from 'off-stage' staff and materials circulation benefits both groups. Standardized operating rooms, perioperative rooms, and critical care patient rooms will maximize flexibility both now and in the future. Interior design, artwork, and new signage throughout the existing hospital and new tower is anticipated to significantly improve wayfinding.
“As healthcare architects, we understand that doing no harm is first and foremost, meaning creating a design that does not contribute to an increase in medical errors, and ideally, helps to reduce them. Helping to reduce the cost of healthcare is also very important. And, our passion is to design healthcare facilities that contribute to improving health outcomes, while delivering an exceptional patient experience.”
The completed project will be a tribute to M.T. Mustian, who led TMH as chief executive officer of TMH from 1964 to 1989.
“Tallahassee Memorial was created in 1949 by a group of Tallahassee's civic leaders. But the hospital really did not thrive until M. T. Mustian became its leader. It was during Mr. Mustian's tenure that TMH became the hospital this community deserved, a progressive, caring institution that moved aggressively to bring the best physicians, technology and hospital staff to Tallahassee,” said O'Bryant.
“Under his 25-year watch, Tallahassee Memorial grew by adding excellent physicians. The hospital bought the latest equipment, including the fourth MRI installed in the United States. The medical staff developed excellent programs including such specialties as cardiac, pediatric, neurology, surgical, and cancer care.
“When this area did not have enough family physicians he created a family medicine residency program. Today, of the 353 physicians graduating from that program, 250 care for patients throughout Florida. Mr. Mustian laid the foundation for what the hospital has become today and this building will be a testament to his life's work.”
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