Tucson Medical Center (TMC HealthCare): Richard Prevallet, Vice President of Facilities and Construction

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Several years ago, Tucson Medical Center in Tucson, Ariz., determined that it simply wasn’t feasible to build a complete replacement hospital.

“We certainly have the space for it on our campus because we have a lot of acreage, but the cost of construction to build a replacement hospital was too high,” Richard Prevallet, vice president of facilities and construction, said. “What we did recognize was that the existing hospital really had good bones in the sense that we could do major core renovations within the hospital and make some additions and improvements and really modernize the hospital for the next 25 years.”

This decision by the TMC Board of Trustees and it chief executive officer, Judy Rich, set in motion a campus redevelopment plan that has transformed the 115-acre campus and its 629-bed, 750,000-sq.-ft. hospital, the largest single-story hospital in the country.

TMC has already completed expansion on its pediatric and maternity units and will soon complete construction on its new operating rooms, entrances, parking garage, four-story surgical and bed tower, and physician medical offices.

Much of the planning for this $125-million expansion and renovation project took place throughout 2010. By June 2011, TMC had successfully expanded its pediatric and mother-baby units along with much of the roadway and infrastructure work on the east side of the campus.

That was the first of two phases and cost the organization roughly $20 million in construction and improvements. TMC is currently in the middle of the project’s second phase.

Delivering quickly and staying on budget

Prevallet said his primary challenge on this project has been time. Once he had approval from the Board for the project, he needed to start delivering.

“It’s really how fast can you get going and how fast can you get the place opened up so you start generating income,” he observed.

Initially, Prevallet was concerned that various commodity prices, such as steel, were going to skyrocket. He immediately went out and struck long-term deals with manufacturers that locked the prices at their then-current levels.

Another decision Prevallet had to make early on regarded LEED certification. He ultimately decided that TMC didn’t have the money to spend on the certification process. However, this didn’t deter him from modeling the project after LEED standards, and he figured that he could achieve 80 to 85 percent of LEED benefits just through good design.

“For me, that’s a nonnegotiable that we are designing to a LEED standard even though we would not go through the formal certification process,” Prevallet explained. “Certainly as a design requirement, when it comes to energy, the facility will be designed and built so it earns an EPA Energy Star rating.”

A solid energy-efficient design also makes for a better environment within the building, he added. Not only does the facility have better thermal control and comfort for the people that are in the building, but the building also has better indoor air quality and a safer environment for patients.

“What it ultimately comes down to in my mind is the commitment of the organization and the commitment of the facilities team year in and year out to maintain the building and environmental systems for the hospital in a way that drives the best operational costs and the lowest energy costs,” Prevallet stated. “If you don’t have that commitment, it doesn’t matter whether you’re LEED certified or not.”

Confronting infrastructure challenges

One of the most challenging areas in the project so far has been the low-voltage systems. With a complex IT infrastructure supporting 24 operating rooms on two floors, the cabling infrastructure is extensive.  It was vital that the design team had a clear understanding of low-voltage systems, because managing the installment of those systems was vital to the project’s success.

Also, it was important to first understand the front-end costs and benefits of distributed chilled-water systems versus a stand-alone system before making a decision as to what was best for TMC. Initial costs for stand-alone systems tend to be lower, but the life-cycle costs are higher.

“Understanding the costs-benefits analysis for infrastructures is critical and then being able to show the benefit over the life of the building is important as you move forward with planning and budgeting for a project,” Prevallet said.

Transitioning personnel from one stage of a project to the next was something else that needed to be taken into account. Currently, Prevallet is figuring out how to move an entire surgery department into the new wing and still keep operations flowing for both the surgical services and the sterile-processing department.

“It will be really tricky to figure out how we piece-by-piece room-by-room leave the existing location and then move  into the new building while maintaining our high standards for patient safety and minimally impacting surgical volumes,” he said, adding that multi-disciplinary teams have spent many months developing the transition plan.

Making a project successful

Prevallet has three barometers by which he will measure the success of his redevelopment plan.

First, have they built the safest environment possible for their patients, visitors, and staff?  Second, have they built an efficient and effective environment for their staff and physicians?

Receiving input from the physicians and staff has been critical in the planning and design process, he said.  Six months after it is in the space, TMC hopes to see improvements in efficiency and increased surgical volumes while maintaining the highest standards for patient safety.

Third, he asks, what are the patients saying about their experience in the hospital? Patient input was also an important element of the project planning. What did former patients think TMC needed to do differently in pediatrics? Much of the design for patient rooms came from their feedback.

“It comes down to really high-quality care, which will drive to great outcomes and the best possible patient experience,” Prevallet said. “If we can hit those three things on the project, then we’ve done well.”

-by Pete Fernbaugh

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