Turner Construction Brings Facilities to Life

As the leading builder of healthcare and medical research facilities in the nation, chances are you are familiar with a Turner Construction Company project.

From the Ronald Reagan UCLA Medical Center in Los Angeles to the Yale University Health Services Center in Connecticut, Turner projects literally crisscross the country. Closer to home, Turner was the builder in charge of the Middle Tennessee Medical Center replacement facility (now Saint Thomas Rutherford Hospital) and is working on HCA’s new downtown building project. After building the original hospital back in the 1970s, Turner has been named construction manager of the $110 million Saint Thomas West expansion and modernization plan, and the company also has worked on various building projects at Vanderbilt University Medical Center for more than three decades.

Founded in New York in 1902, Turner has a number of international offices, as well as more than 40 North American offices across 24 states and two Canadian provinces. The company, which has a global staff of 5,200 employees, has an annual construction volume of $9 billion. Of that total, a little more than 20 percent … close to $2.1 billion last year … is in healthcare construction. The company’s Nashville office oversees much of the builder’s medical construction work nationwide.

The Trends

“Over the last 10 years, certainly I would say technology is the driving trend-changer in healthcare,” said Howard Allums, a vice president in the healthcare practice who is based out of Nashville. The demand for electronic health records and hybrid ORs, plus a focus on specialty procedures, has helped fuel the need for increasingly complex building and engineering configurations.

Flexibility is another request by many clients. “A lot of people say, ‘I want a 50-year building,’” Allums noted. Of course, he continued, it’s hard to predict exactly what will happen over the next five decades, but universal rooms that can be reconfigured to meet multiple needs are one solution. “They can spend more money on the up front side but save money in the long run,” he added of clients who invest in flexible spaces.

Chip Cogswell, vice president and national healthcare director who is based in Atlanta, concurred, noting another phrase being used is ‘acuity adaptable rooms.’ Traditionally, an ICU and standard inpatient room would be built differently to meet very specific equipment needs. “Now, hospitals aren’t sure what the census will look like so they want rooms that will do both,” Cogswell said.

“There’s no question with healthcare reform and other activities, we are seeing a lot more outpatient facilities,” he continued of the incentive to keep people out of the hospital.

The various building trends noted by Turner’s healthcare team dovetail neatly. As more care is delivered in the outpatient setting, the acuity level of patients in hospitals is rising thus fueling the demand for increased technology capabilities and more flexibility of inpatient spaces.

The Process

Timing is everything … particularly in a healthcare world focused on cost and efficiency. When it comes to bringing in the construction team, Cogswell said sooner is much better than later.

“In a perfect world, we would tell a client we’d like to be at the table the day after they pick an architect,” Cogswell said.

Allums added the benefit often shows up in the form of significant cost savings. The T-Cost Modeling System, which Turner has developed over the last decade, allows clients to immediately see the impact of materials and design decisions before designs are finalized.

“It allows us at a very, very early stage to help a client understand the impact of their decisions,” Allums said. “We can construct a model of that hospital from a budget standpoint.”

The analytical system shows not only the cost of materials — for example an exterior finish of brick, concrete panels, stone or glass tiles — but also how that decision impacts energy costs and long-term operations and maintenance.

Something as simple as a flooring decision can have a major impact. Cogswell pointed out choosing between PVC or terrazzo tiles might seem like an easy choice from an immediate perspective, but that view could change when considering costs over time. The inclination, he noted, is to say, “’Let’s go with the cheapest one from a first cost standpoint,’ but then they have to wax it every week.” When a client realizes a different material might offer a three-year payback, the decision could change … particularly considering the lifespan of many healthcare facilities.

A little later in the process … but typically still before the first brick is laid … architects provide a model of the building design so that Turner’s experts can add in materials and mechanical and electrical specifications to create a three-dimensional model of the project. Building Information Modeling (BIM) means building twice, once on the computer and then in the field, but like the T-Cost Modeling System, it can save clients money in the long run.

Allums said equipment costs and communications systems are areas that are often under-budgeted and too often cause sticker shock well into the building process. “If clients miss those costs, the only place they have to make up those numbers is out of the construction budget.”

It’s a key reason why Turner’s Medical Equipment Planning and Management service, also headquartered out of Nashville, is a win/win for the builder and client. “There are not very many companies that I know of in the construction business that offer this kind of service,” Cogswell said.

Having spent more than two decades in healthcare program management before joining Turner two years ago, Cogswell added he is all too familiar with the problems caused by having to go back to a board and ask for more money to offset cost overruns.

“Our real value proposition,” he said of Turner’s breadth of experience, “is we offer predictability of outcome. The owner can march forward with confidence.”

While the majority of the healthcare group is located in Nashville, Allums and Cogswell said most every office has a local healthcare champion to help oversee this important sector of Turner’s work.