In early 2021, Bon Secours Mercy Health Mercy Health in Mason, Ohio announced plans to build Kings Mills, a 60-bed hospital and medical office building – the system’s first new hospital in the Greater Cincinnati area since 2014.
Molly Ironmonger, director of systems planning and preconstruction at Bon Secours Mercy Health (Cincinnati), says that during the proposal submission process, she challenged contractors to demonstrate “creative problem solving” to meet the department’s goals of delivering the project faster, more safely and more cost-effectively, as the organization had done in the past.
“It’s not my job to tell you how something should be done,” she says. “We said, ‘These are our problems. Let’s solve them.’
This effort for new strategies was in response to many other challenges related to organization and construction labor shortages, supply chain disruptions, and increased material prices.
She says, “As the person who sits in my chair in a healthcare organization, if you are not working on conversations about improving and changing the way you project, you are really missing out on opportunities because it will not be possible to do it the way you have always done it.”
prefabrication in health care
separate construction There is a strategy used to overcome these challenges. In fact, several companies applied for the role of general contractor on the 206,000 sq. Kings Mills The project proposed prefabrication, following a traditional approach where building components are built off-site, stored, and then transported to the final location for timely delivery.
however, so is Had another thought. The Dayton, Ohio-based construction company proposed building an Industrial Fabrication Center (ICC) at the construction site next to the ongoing hospital, where prefabricated components would be assembled and immediately placed into the building.
Mickey Leroy, Director gbbn (Cincinnati), the project’s architectural firm, participated in interviews with the contractor and said Dennis’ idea stood out as the “real differentiator”.
This was partly because it eliminated some of the issues associated with off-site prefabrication, such as warehouse requirements and the cost and logistics of shipping components to site, ultimately limiting the size that could be prefabricated to fit on a truck.
“It removed some of the limitations and opened up the possibilities for design at a larger scale,” he says.
Furthermore, Dennis ensured that the use of the ICC would allow for an accelerated construction schedule of 24 months from November 2021 to November 2023 – five months shorter than the traditional construction time without ICC.
While the proposal meets efficiency and cost-cutting goals, Ironmonger said it was hesitant to build the temporary tent structure on-site, citing safety implications and concerns about the risk of damage to materials left in the tent.
“It was fear of the unknown,” she says, noting that she was not aware of a similar solution previously used in the health care manufacturing.
But after working with the organization’s risk assessment, local jurisdictions and project team members to address those concerns and map out backup strategies, the team gave the go-ahead to the ICC.
“Now is the time for me to put my money where my mouth is,” she says. “I said all those things, and now is the time to actually do it.”
Construction of an industrialized manufacturing center on site
Jim Lupidi, vice president of Dennis (Cincinnati), says a master plan for the ICC was created on the site before design work began on the project. This enabled the integrated project team including owner GBBN overweight (Mechanical, Electrical and Plumbing Engineers), and Schaefer (structural engineer), to consider which multithreaded assemblies can be prefabricated.
According to Lupidi, the prefabricated components were to create value for the client in order to optimize the construction time of the project. So instead of building a bathroom pod, which is a common prefabricated item on healthcare projects, he wanted to see how a finished building shell could be delivered more quickly by assembling exterior walls and superstructure, allowing the entire interior to be fitted quickly.
In addition, he wanted prefabricated components to help solve or improve the problem of labor and congestion.
For example, key elements in building healthcare interiors include the central backbone of utilities, the space above the roof that contains HVAC, medical gas, electricity, and other major system components. All craftsmen need time and space in the hallway to set up their parts during a project, which can be a hindrance if an employee is late or a delivery is delayed.
Lupidi saw a way to solve this problem, by prefabricating all utilities and building a shelf above the ceiling.
Ultimately, the project team decided to use ICC to pre-fabricate 90 percent of the exterior walls as well as mechanical, electrical, plumbing, fire suppression, technology (MEPFT) full aisle racks and mini racks. These racks are installed along the end wall of the patient room and bathroom along with electrical lines, domestic plumbing and medical gas.
Maximizing production flows within the ICC
Industrial construction at the ICC site began in April 2022, with a free-span structure 25 meters wide and 60 meters long.
Inside, three in-house assembly lines were installed, designed and built by Dennis, including one assembly line built for exterior wall panels, which would later be converted to supply interior walls, and two more lines built for MEP shelving.
All materials were pre-cut or partially assembled before arriving on site and then moved to one end of the ICC to begin prefabrication with other business assemblies. Because there was no overhead crane at the ICC, everything in the facility had to be mobile and could be moved by one person, including the large format walls.
The solution was to put everything on manufactured carts or rolling assembly lines, which would move the units along the lines as the various trades worked on the units.
At the end of the ICC, assembly lines extended 40 feet outside the tent, where finished components were lifted by the project’s tower cranes and placed immediately into the building—an important detail because the ICC lacked warehouse space.
To aid in production flow, Dennis used tact scheduling, a scheduling method designed to create an expected flow that maps the delivery of components by different trades in the assembly line at specific times.
Benefits of pre-fabrication on the Kings Mills Hospital project
During ICC’s six months of operation, 25 percent of the King’s Mills project’s critical components were prefabricated, including 90 percent of the building’s exterior walls and 1,770 full aisle racks and 1,440 mini racks.
In fact, construction of the exterior walls proceeded so rapidly that four weeks after the superstructure was completed, the building’s shell was virtually waterproof, so that interior finishing could begin; Lupidi says a more traditional timeline would be about four months.
Without the constraints of ensuring that prefabricated shelving or wall panels would fit on the barge, the project team was also able to think outside the box when sizing, providing 30-foot-long shelving and 15-foot x 32-foot large-format wall mounts that weighed 3,000 pounds.
To illustrate the benefits of on-site prefabrication, Lupidi noted that Dennis had another health care project under construction as well, the $200 million Kings Mills Hospital. Prefabrication was also used in the smaller project, at 15,000 m², but in an external prefabrication centre, which meant it had to use more traditional building components.
“That building required 970 prefabricated exterior wall panels,” he said. “King’s Mills, which is 30 percent larger, took 177 panels.”
This process not only helped save money and reduce construction time, but also had a positive impact on labor consumption. When the ICC was in production mode, manpower utilization improved by 81 percent. More specifically, the traditional average manpower required on site for a $7 million per month project is 203 skilled trades; The average manpower on site at the King’s Mills project was 112 skilled tradesmen.
“We were still able to generate the same amount of revenue with significantly fewer people than we had on our site,” Lupidi says.
Ironmonger says the Kings Mills project is expected to be completed in November. “I keep telling our operations team that we will give them the keys on November 16,” she says. The hospital hopes to receive its first patient in early 2024.
Anne DiNardo is editor-in-chief healthcare design, can be reached email@example.com,
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