Healthcare Design - August 2015 - 34

Scale and scope
When the New Parkland Hospital project first got off the ground, its trajectory
forward was soon tempered by immediate budget concerns: On day one, it was
sitting more than $100 million over budget, largely due to scope creep. The original
program was based on a projection of 1.68 million square feet, but the resulting
Parkland is 2.1 million square feet. And thanks to a $747 million bond referendum
that was passed by Dallas County voters to partially fund the project, all eyes-particularly those of the local media-were on the hospital.
"We made a commitment to come in within their funding, to size these buildings efficiently and still try to get LEED Silver so that they're not operating drains on
the county going forward," says Lou Saksen, senior vice president, New Parkland
construction at Parkland Health & Hospital System (Parkland earned LEED Gold in
June).
A building controls company, CH2M, was hired to capture every transaction associated with the project (and make them all available to the public) and keep track
of estimates to report to leadership, specifically noting projects that took the budget
into the red. Over time, that red was eliminated through a lot of rightsizing and
dissecting of project scope.
Thanks to a flat Dallas economy, though, some of the overrun was eliminated
very quickly, as bid packages came in in 2010 with a guaranteed maximum price
well under original estimates. "It's an entire replacement of the inpatient functions for
around $300 per square foot, which is unheard of in Dallas," Saksen says.
Next, Saksen and his team turned to scope. "We had projects that absolutely
had to get done and projects that we could scale back," he says. For example,
original plans to move administrative offices and some outpatient clinics to the
new site went by the wayside. Those would go into space at the existing campus
instead, in order to ensure that what was promised to voters-a new hospital-
could be achieved.
The team then turned to the program to see where it might be nipped and
tucked. "The program is all the things you need to get done, but it doesn't say
anything about how big they need to be necessarily," Saksen says. So, for example,
original 32-foot column spacing created a building that was too large to afford, so
Parkland was brought in to 30-foot columns. The Women's and Infants Specialty
Health (WISH) clinic was also downsized based on lower volume projections from
earlier estimates, a response that allowed the freed-up square footage to be reassigned to an urgent care center and observation unit to take pressure off the ED that
was anticipated to be full upon opening.
Stakeholders were involved to ensure that the right decisions were made in the
value engineering process, and that input didn't end at early design stages. "The
best construction decision may not be the best clinical decision, and likewise sometimes the best clinical decision you really can't do on the construction side," Saksen
says. "One of the phrases we use around here is 'the third best answer.' It can't be
all clinical and it can't be all construction. It's got to be something that's a reasonable
compromise."
To aid the process were mockups of eight individual spaces, says Hank Adams,
project design manager and director of healthcare at HDR. "The neat thing is we
were able to take something like an OR and mock it up and have the clinical staff
come in and evaluate it to help us make decisions to see if we could downsize and
make that department smaller," he says. From there, they took the mockup process
to inpatient rooms and ED exam space, looking carefully at each department to
ensure the square footage, among other details, was right.
In the end, Parkland came in under budget, with the balance able to be used
for the added observation unit and urgent care, and the team delivered the hospital that Dallas County residents agreed to support.
34 HCDmagazine.com 08.15

was extended to accommodate the additional rooms
by spanning the 60 feet that create the cantilever,
a move that also allowed light into the NICU below
and permitted a necessary alignment of an elevator
bank.
Another key to the massing was to create a separation between the Women's and Infants Specialty
Health (WISH) tower and the acute care tower so
they would be of the same hospital but with distinct
identities-and fit on the site. "That's when the whole
idea of taking the bars and rotating them 90 degrees
came along, and then the idea of having the WISH
tower span across the entry and connect to the
WISH clinic below," Adams says of the bridge effect
created.
In sum, these strategic decisions ultimately created Parkland's dynamic massing. "Once we did
all those moves, it was clear that the building itself
became an icon, but it really is a simple expression
of the function," says Jim Henry, healthcare designer
on the project and design principal at HDR (Dallas).
(For details on how the building was constructed
by general contractor and construction manager
BARA, a joint venture of Balfour Beatty Construction,
Austin Commercial, H.J. Russell & Co., and Azteca
Enterprises Inc., see sidebar "From the Ground Up"
on page 31.)
Pieces and parts
Despite the creative solutions found to fit the program
on the site as efficiently and functionally as possible,
the result will still likely be one of the largest buildings
patients or staff will ever enter. "The idea of making
2 million square feet feel accessible was something
we started out with from the very beginning: How do
you make it easy to navigate and how do you make
it feel accessible so it's not overwhelming? It comes
down to this idea of decentralization and breaking it
down into smaller, usable components," Henry says.
For starters, Henry describes, the new Parkland
has distinct onstage and offstage zones in both its
horizontal and vertical circulation paths. The 72-bed
inpatient floors are divided into two 36-bed units
and the ICU uses a single 36-bed unit. The beds are
then broken down into two 18-bed groups and three
six-bed pods per group, each with its own work and
resource areas, and staff are assigned to just 18
rooms. "Because the building is so large, it creates
a neighborhood or zone that you go to every day so
you're not distracted by the fact that this floor is 72
beds long. You're really focused on this 18-bed zone,
and it's not that big. It's not intimidating," Larsen adds.
The building has 45 elevators with separate
systems for public, supplies, and patient transport, with the latter two out of site from visitors so

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Healthcare Design - August 2015

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