In Greenbrae, California, work is progressing at a steady pace on the $500 million-plus reconstruction and expansion of Marin General Hospital (a project often referred to as “MGH 2.0”). The first phase of the project – a new modernized four-story, 260,000-square-foot replacement building that connects to the hospital’s existing west wing – has reached the halfway point, on target for opening in the summer of 2020.

This new building will house 114 private rooms, an expanded emergency department and six new operating/procedural suites – designed to accommodate state-of-the-art imaging equipment and other technical innovations, such as robotics. Special amenities and landscape features, such as rooftop gardens, balconies, and natural light in every patent room, will be incorporated to create a healing environment for patients and families.

Already complete is a five-and-half-level, net-zero parking structure with rooftop solar panels, built to support the current and future hospital. After the new hospital building opens in 2020, work will begin on a second parking structure.

Even with challenges related to connecting the new construction with the existing west wing, and of building on a site with a functioning hospital, Marin General’s original facilities are continuing to operate throughout the construction process.

Major Upgrades Necessary to Meet Changing Needs

Marin General Hospital has been an integral, vital hub for Marin County healthcare needs since 1952. As Kevin Coss, Project Director at Vertran Associates, the project’s developer, relates, “In the 1950s when the hospital was built, the population of Marin County was approximately 85,000 people. Now, Marin County has more than 261,000. The hospital has undergone several renovations and expansions over the years to accommodate advances in technology and significant growth in our population base.

“Marin General is a vital resource as the area’s only full-service hospital with capabilities for diagnosis, treatment and rehabilitation of most injuries and illness. We are a healthcare safety net for the community, providing wide-ranging services in all major service lines (heart, cancer, orthopedics, etc.), as well as the area’s only Comprehensive Emergency Services, In- and Out-patient Behavioral Health Program, Hospital Labor and Delivery Unit, and Level II Neonatal Intensive Care Unit (NICU).”    

Coss points out that while Marin General continues to deliver high quality care, the inescapable fact is the hospital dates to 1952. “Medical procedures and patient care have changed dramatically in the past 60 years. Our Emergency Department and Trauma Center must be upgraded. Surgery has greatly evolved since the sixties, and modern operating rooms have doubled in size. Patient rooms need to be larger to accommodate personnel and equipment and ensure patient safety and privacy.”

As to necessary technology upgrades, Coss says an evaluation of the existing facility deemed nearly all the spaces within the hospital, including patient rooms, operating rooms and emergency rooms, to be too small to accommodate new equipment that would utilize the latest technological advancements, based on current codes.

Another major consideration driving the replacement project is the rigorous new state and federal regulations in healthcare and seismic safety to which all California hospitals must comply by the year 2030.

Design-Build Model Gaining Popularity for Healthcare Projects

Perkins Eastman Architects designed the new facilities. General contractor on the MGH 2.0 project is McCarthy Building Companies, Inc., and the landscape architect is SWA Group.

Excavation for the first parking garage began in April 2015, and preparation work for the connection between the existing west wing and the new building started that June. The parking garage was completed a year later, with the ground-breaking ceremony for the new hospital following later that summer. Construction of the hospital is scheduled to be completed in late 2019, followed by the opening of MGH 2.0 in mid-2020.

The project is being built utilizing a design-build model. Simon Gregson, Vice President of Healthcare for McCarthy Building Companies, says this model is becoming more popular for major healthcare projects. “A design-build environment fosters a more collaborative relationship between the owner, architect and contractor whereby project risks are thoroughly identified and managed,” he comments.

“The MGH 2.0 project is a perfect example of the evolution of the design-build process, whereby we recognized that there were unique and specific challenges to working on a large healthcare project with specific scheduling and budgetary demands, and worked together to employ value-added solutions, resulting in a customized delivery method.”

Sandwiched between the Hayward and San Andreas earthquake faults, the 260,000-square-foot steel framed building is designed to withstand a 9.0 magnitude earthquake.  The earthquake system utilizes laboratory and field-tested steel moment frame “SidePlate” joints that were specifically developed for high seismic regions and critical facilities. Even with a significant earthquake, the building is designed to remain operational and open to the public.

“The project’s shoring system and build-out of the sunken garden presented a challenge for the team,” says Gregson. “Its proximity to the existing facility, excavation on hard rock and complex concrete work, coupled with the topography in the area, presented a layer of complexity for completion. In order for our team to better combat the challenge of elevation changes of the sunken garden, we 4-D-modeled the existing facility and terrain as well as the shoring.”

The project is pursuing LEED Silver certification. Sustainable features consist of capturing storm water runoff; photovoltaic panels on one side of the new parking structures; and environmentally-friendly substances, such as low-emitting materials, adhesives, sealants, paints and flooring; plus water-efficient landscaping, with ample green spaces on the grounds and rooftops, and the elimination of the use of potable water for landscape irrigation.

Drones and VR Enhancing Construction Efficiency

To meet the construction challenges and enhance the efficiency of the construction process, the MGH 2.0 team has made extensive use of drone and virtual reality (VR) technologies.

“We have been utilizing drones on a weekly basis to take aerial images of the site,” Gregson reports. “The images are then used to create VR environments that can communicate any project rework that needs to be done, or to share with project owners at meetings to better track progress and know exactly where things are located. Image captures also aid in ensuring safer work conditions as dangerous situations can be identified before a treacherous incident occurs.” He adds that the implementation of VR also serves to prevent the waste of time and money on projects by allowing end-users to view design flaws or make aesthetic decisions prior to construction.

“Drone technology offers a range of benefits depending on the markets we’re working in and the projects we’re delivering our clients,” states Dave Burns, Director of Innovation and Field Applications for McCarthy Building Companies. “The most common-use cases for drones across the majority of our sites is communication.Our field teams leverage current aerial imagery shots to facilitate discussions with project stakeholders, including progress updates with our clients and logistical planning across our trade contractors.

“VR technology enables McCarthy, in partnership with our designers, to provide highly immersive and highly interactive virtual experiences early in a facility’s design.As a project progresses from early conceptual design through final permits and into construction, the cost of making changes increases significantly. VR technology helps our clients make better, more informed design decisions earlier in the design process.”

Use of the new technologies continues to expand across all five of McCarthy’s national regions, Burns reports. “For McCarthy, VR offers opportunities to rapidly produce virtual construction mockups to help confirm our approach to construction of complex scopes. VR and drones enable greater levels of communication around critical project information for the design and construction.  More informed decisions can be made with greater alignment around this information, which drives down cost, improves quality and safety, and enhances the construction schedule.”

Collaborative Efforts

Coss says the MGH 2.0 project has been a “labor of love” for all parties involved in its development. In addition to the lean construction practices employed by the project team, there has been a massive collaborative effort among patients, practitioners, employees and visitors to create an environment that is more hospitable, pleasurable, residential and healing than the traditional hospital environment. “Throughout the course of the process, the underlying goal has been to put patients first,” Coss comments. “The civic engagement witnessed on MGH 2.0 has truly made this a community project that will benefit the region for years to come.

“Marin General Hospital has always been driven to serve our community with technologically advanced, patient-centered, high-quality care. This has not and will not change. The difference will be in what it takes to deliver on these things. Our new building will enable us to meet the needs now, and in the future, with facilities that are flexible and allow for change and growth.”

*Photos courtesy of McCarthy Building Companies Inc.