By the time readers see this story, Turner Construction Company's Memphis office will be engaged in one of the most challenging aspects of a $275 million project to build a 455,000-square-foot, nine-story patient tower at Methodist University Hospital built on top of the existing emergency department and straddling a main thoroughfare. This phase of work includes the vital task of re-feeding the entire MUH campus medium voltage power through a new electric room without interrupting power to the hospital.

"We spent about six months planning the switchover, which we'll begin in February, with plans to have permanent power on March 1," said Frank E. Parker, Turner's Senior Superintendent for the project. The local utility conventionally installed 14,000-volt feeder conduits from service point to service point. Turner is responsible for taking over the conduits from new service meters into a newly constructed electric room that the contractor built beneath MUH's existing emergency department, then re-feeding the existing medium voltage switchgear.

"Our plan is comprehensive and includes fail-safes, back-ups, and contingencies so that the hospital maintains power the entire time," Parker said. "Our construction plan is designed to keep people safe by making sure there is no interruption to patient care."

There's no reason to think Turner won't deliver, as the general contractor delivered on a previous milestone to re-route two new 22-inch HDPE chill water lines and 14, 4-inch electrical conduits for power and controls for emergency generators by boring 27 feet below Bellevue Avenue, which bisects the hospital campus, and pulling the utilities through.

"The existing central energy plant didn't have enough chilled water supply or emergency power for our new tower, so we had to construct new utilities from the new tower about 700 feet to the central energy plant, which is located west of the hospital across Bellevue," Parker said. "While it took about four to five months of planning, it took only one week to run the 14 conduits and two weeks to run the 22-inch water lines. It went amazingly smooth."

Had Turner used conventional excavation, re-routing the utilities would have been "incredibly intrusive" to the general public and hospital patrons, Parker said, and would have taken an additional six or more weeks.

Transformative Project

Methodist LeBonheur Healthcare selected Turner and HKS, Inc. of Dallas to lead the Integrated Project Delivery (IPD) team, which also includes Memphis-based Allen & Hoshall, Self+Tucker Architects and archimania. Work on the project began in the fall of 2016, and is slated for completion in the spring of 2019.

Creative problem solving through the IPD method of construction management has been a hallmark of the campus modernization and expansion project. IPD fosters a more thorough collaboration between the owner, contractors, designers and other members of the project team throughout the project, by ensuring the talents and insights of the entire team are brought to the table to give the owner the best project possible within the allotted budget.

"We've had our trials and tribulations, like every project, but we are still on time and still under budget, which is good," said Richard Kelley, Vice President, Corporate Facilities Management for Methodist Le Bonheur Healthcare.

Located in the heart of the Memphis Medical Center, the 617-bed MUH is the largest, most comprehensive hospital in the Methodist Healthcare system. It is the major academic campus and principal teaching hospital of the University of Tennessee Health Science Center, bringing together research, medicine, innovation and multidisciplinary collaboration among doctors and clinical team members, which leads to more advanced medical care for patients.

The $275 million project will give the 1950s-constructed campus a much-needed aesthetic update, as the sleek, modern, metal- and glass-clad tower will create a visual focal point amid the conservative, red brick campus. The project will also update the hospital's operating rooms, ICUs and patient rooms, while streamlining points of entry from 15 to three. Construction of the tower will: consolidate the hospital's transplant services into a comprehensive, two-floor inpatient/outpatient transplant institute; connect oncology and outpatient care to create a new, state-of-the-art cancer center; increase the hospital's ICU capacity by 36 percent; and increase the hospital's operating room capacity by 20 percent. The new facility will be one of the most advanced patient- and family-centered tertiary care facilities in the Mid-South region.

In addition to the new tower, the project includes construction of a 700-space parking garage that was completed in early 2017, as well as 94,000 square feet of renovations of existing patient and operating rooms, the addition of a 66,000-square-foot cancer center and an 80,000-square-foot transplant center.

"The project, which is currently the largest ongoing construction project in Memphis, is certain to elevate the city's international profile," said Andy Davis, Turner's Mid-South Business Manager. "This project isn't so much about growth, per se, but it is modernizing the campus, creating efficiencies around workflow, and improving the overall patient experience."

"MUH is the largest indigent care hospital in Memphis and probably the entire state, so this investment is a testament to our mission of providing healthcare regardless of anyone's ability to pay," Kelley said. "It's part of our faith-based mission, and it will also be a great recruitment tool for bringing top medical talent to this community."

IPD Delivers

The IPD method, paired with the use of 3-D modeling and target-value design, helped to save time and resources, and ensured that creative design and construction methods were considered, Davis said. "Methodist LeBonheur Healthcare is a non-profit, and so they've got to make sure they maximize every dollar to the fullest extent possible to get it right for the people and community they serve," he explained. "Using IPD means we're constantly adjusting during the process, coming up with solutions to figure out how to offset every cost. If the owner says something needs to be added, something else needs to go away. The designers, contractors, owners and engineers are all partners. We're all raising our voices on what we feel is going to work, so it's a complete collaboration."

Methodist LeBonheur Healthcare has worked with Turner on five previous IPD projects, including Methodist Olive Branch Hospital in Olive Branch, Mississippi, which was completed in 2013.

"IPD is our preferred method for projects over $10 million," Kelley said. "It makes for a more streamlined, integrated process, where everyone shares in the common goal and there is no finger pointing at the end of the project."

Using IPD for this particular project increased speed to market, Davis added. "From the time we started working with the designer in October 2016, we were able to do make-ready work to allow the project to continue to move forward while design was still being done. Normally, it takes 18 months to two years to plan and design a project of this size."

Through the IPD process, Turner estimates a gain of 20,000 to 25,000 square feet of patient room shell space as a result of reconfiguring the number of beds per floor from 36 to 48 early in the design phase.

"We suggested putting the mechanical on the roof and using that freed up space to create more rooms for future expansion," Davis said.

The IPD process also helped to maintain the owner's budget while incorporating a "wow" factor item the owner felt was a must-have for the project - dynamic glass cladding for the tower patient rooms and third-floor pedestrian concourse - that is an integral part of the hospital's new, modern look and will tie the new components into the existing structures.

"We used dynamic glass on the Olive Branch project and knew we wanted it here," Kelley said. "It reduces glare, is energy efficient and creates that modern look we want. Even though it's a premium, we see value in it. The IPD process allows constant, "˜live' budget analysis that helps ensure we get our primary conditions of satisfaction in the final project."

To reduce cost and ensure quality, Turner recommended that the specialty manufacturer, View Glass, produce the glass at its Olive Branch facility and then ship it to Memphis for installation. "That allowed them to save having to use all of those labor hours with a local contractor who may not have been as familiar with the product, and also enhanced safety," Davis said.

Every element of the project was scrutinized accordingly, beginning with twice-weekly IPD team meetings. The IPD process gave birth to creative solutions such as the afore-mentioned boring and pulling of utilities beneath Bellevue Avenue. The process also kept the entire team on the same page with regard to logistics and safety issues. For example, the team determined not to put any construction traffic on Linden Avenue, which runs adjacent to nearby Central High School.

"It's a large high school with almost 2,000 students, so there is a lot of traffic in the mornings and afternoons," Parker said. "We have gone to great lengths to eliminate construction traffic on that street, even setting up our delivery routes to come from Bellevue Avenue, complete with all right turns in order to avoid traffic congestion."

Pulling Together

HKS Inc. uses the IPD method quite often, and may be considered an architectural firm industry leader in its use of the delivery method, said Norman Morgan, Principal and Senior Vice President, Regional Director HKS Health. "The key to IPD is you've got to have trust. We brought our IPD experts together with Turner's, and I think that made it more workable for all of us."

The IPD team came together in November 2016 and "hit the ground running," Morgan said. "We put together a preliminary program and budget to bring to the board before we did any drawings and designs and worked from that. If we weren't an IPD team, that would have been a huge struggle. We were constantly checking in with the contractor and owner, making sure we were all on the same page."

When the emergency department was originally constructed in 2014, there was a master plan for vertical growth for a patient tower, but it didn't anticipate the large, third-floor surgical department and pedestrian concourse that would tie the whole campus together.

"We have 20 brand new operating rooms on that floor, which is a very large surgical department," Morgan said. "To maximize that floor plate to accommodate those open surgery rooms and to create additional area for the concourse to circulate people from the parking garage to the main entrance, we cantilevered across Eastmoreland Avenue with some very large trusses and added to the existing columns."

The 10-foot-deep plate girders span 75 feet across Eastmoreland, and the heaviest weighs 92,800 pounds, Parker said. The heavily traveled Eastmoreland Avenue was closed in December of 2016 as the tower was constructed. When Eastmoreland is re-opened to traffic in October, it will be 32 feet wide and accommodate all normal traffic allowed within city limits.

The IPD team chose a shear-wall configuration to bolster the existing columns and brace the steel structure for seismic loads. The seven main shear-wall shafts contain elevators, stairways or a combination of them, Parker said. "The largest shear wall is approximately 21 feet by 30 feet. All shear walls were constructed four floors ahead of the structural steel.

The project met its halfway point in October 2017 when Turner officially topped out the tower, recently named the Gary Shorb Tower in honor of Methodist's long-time CEO.

Morgan lauded Turner for the contractor's previous experience with dynamic glass and for bringing that owner-desired, key element to the project.

"If you look at the campus, it's predominantly older, red brick, so the owner really wanted this tower to stand out, to show what a forward thinking, state-of-the-art medical center it is," he said. "Between the dynamic glass, the curved walls, and colorful metal panels, we've achieved a fresher, newer, high-tech look that really changes the whole image and approachability of the facility. It was hard to find the original main entrance, but this creates a front entrance that will be a beacon to the neighborhood. When the elevator towers and concourse are all lit up at night, it will draw everybody to the main entrance."