concepts
02 | 2020
5/12
© Studio ThirtyThree Pty LTD

Hospitals–complex and emotional

"When you’re building hospitals, three things are different,” says Randy Keiser. Keiser, a native of Nashville, Tennessee, knows what he’s talking about. He has been building hospitals for the HOCHTIEF subsidiary Turner Construction Company for the past 39 years. He is the Vice President responsible for the Healthcare division—a field in which Turner has been the market leader in the USA for the past 20 years. “Between 70 and 75 percent of our projects are carried out while the hospitals are in operation, and we are absolutely not allowed to disturb that. We have to do our work very quietly and discreetly. Besides, these buildings are extremely complex. Most importantly, it’s a very special thing to build places that are dedicated to saving lives,” he says. Discretion, complexity, and humility are concepts that often come up in conversations with hospital construction specialists. Turner has just completed three clinics in New York City, each costing more than 1 billion U.S. dollars. At more than 10,000 dollars per square meter, clinics are among the most expensive buildings in the world, Keiser says.

EVERYTHING IS MORE COMPLEX

Anthony Armstrong is another expert who can explain what makes hospital construction so complex and expensive. For the past 22 years, he has been building clinics for the HOCHTIEF subsidiary CIMIC  in Sydney and the New South Wales region in Australia. “Isolation wards kept at just below atmospheric pressure, medical gases, complex air filtering systems, lines for medical oxygen, cancer wards where radioactive therapy is carried out”—Armstrong offers a long list of the special features of hospitals. Hospitals harbor more “life” behind their walls, ceilings, and floors than ordinary buildings do. Air conditioning control, pneumatic tube systems, radiation protection, emergency backup systems in case of a blackout—behind the scenes in a hospital, everything is more complex than it is elsewhere. In addition, there are the challenging procedures of the hospital operations themselves, in which every gear has to mesh with the next one in order to help people in highly critical life-and-death situations. A network of experts working in hospital construction ensures that today’s high-tech medicine gets the space it needs. These experts include specialized hospital planners as well as architects and construction workers. “They understand the work of the medical personnel on site, and they can discuss the hospital’s needs in detail with the physicians and the nursing staff,” says Dr. Gaby Ehrhardt, who is currently in charge of scheduling and construction logistics planning for the renovation work and new construction at the Inselspital hospital in Bern for HOCHTIEF IKS Schweiz AG . This is the biggest clinic project to be implemented in Switzerland for many years. This hospital complex in the city of Bern covers more than 180,000 square meters. Its new central building is due to be completed in 2025.

Building Information Modeling (BIM), a method the architect and BIM manager Frank Albrecht is using in his work for the client, the Archipel Planning Association, supports the specialists during the challenging planning process. Thanks to BIM, there are no cardboard file folders or scattered notes at the construction site. Digital twins of the buildings are created on the basis of 3D models on the computer, and they can already be accessed virtually and modified if necessary by the clients, construction professionals, and future users during the planning and construction phases. The project controlling via BIM by the specialists from HOCHTIEF is a flagship project for Switzerland. This is the first time this method has been used to plan and manage a construction project of these dimensions in this country. Plans call for the use of BIM to be mandatory for every hospital project in Switzerland within a few years.

THE EFFECTS OF THE PANDEMIC

What other developments in hospital construction seem likely in the future? “The baby boomer generation is aging,” says Keiser. “Nonetheless, there’s not much demand for more hospital beds. Instead, there is a need for highly specialized clinics that provide modern treatment methods. In addition, more and more complex health services are being prescribed for outpatients. That also affects hospital architecture.” Covid-19 will also change the clinic buildings of the future. Waiting areas, canteens, and elevators will have to be larger to permit social distancing. Keiser also believes that telemedicine will become much more important. Incidentally, Keiser was able to keep his team intact during the pandemic that overwhelmed the United States with a devastating wave of unemployment. “We completed about 30 projects worth around 300 million U.S. dollars within 60 days,” he says. “Most of them were restructuring jobs or new buildings for Covid-19 projects. That included space for many emergency beds and testing facilities. This was an important lifeline for us, because many other projects had to be put on hold. As a result, we could continue to employ most of our personnel.” However, the most impressive thing he has seen in his long career was a job that his team carried out on the campus of Stony Brook University in New York City. There they built a Covid-19 hospital with 1,039 beds in a record time of 24 days including planning. Every day, one thousand employees worked on this project, which cost 155 million U.S. dollars. Building emergency hospitals is not a standard assignment. And that becomes especially clear in times of crisis. But thanks to their experience, the Turner teams in New York and many other locations in the USA were able to make a total of 4,000 additional beds available for coronavirus patients in record time.