Published on October 1st, 2014 | by UC&D Magazine


Healthcare Market Robust

The design and construction of modern-day healthcare facilities continues to evolve in remarkable ways, with the industry ever- changing in a shift towards better outpatient care, utilizing rapidly-advancing technology, more specialty care, and streamlined emergency rooms.

These trends are driving a flurry of significant healthcare projects along the Wasatch Front, which has proved fortuitous to Utah-based A/E/C firms working in that market.
Since the beginning of the 21st Century, U.S. Census data shows the Salt Lake metropolitan area grew by 17% to its current 1.14 million population. Healthcare providers are responding with new state- of-the-art clinics, large outpatient facilities and major renovations or expansions of existing facilities to meet growing demand.
Many of Utah’s largest design and construction companies (ranked by annual revenues) show significant earnings from healthcare-related projects within Utah, regionally, and even nationally in some cases, and most have divisions or areas
of specialization dedicated to what can be very complex and highly challenging buildings and processes.
According to 2014 surveys by UC&D of Utah’s top revenue-earning architectural firms and general contractors, seven architects and five GC’s reported healthcare as one of their top three markets from 2013.
Sandy-based Layton Construction made it a point to target the healthcare market more than a dozen years ago, according to Mike McDonough, Executive VP for Layton’s Healthcare Division. The firm is flexing its muscle nationwide,with six offices outside Utah and each aggressively pursuing work in that arena. Layton had nearly 40% of its 2013 revenues ($601 million) come from the healthcare market nationally and is currently ranked the No. 10 general contractor by Modern Healthcare magazine.
McDonough said Layton currently has healthcare work spanning from Austin to Boston and Florida to Alaska. He said three factors are contributing to the market’s growth, including the continued aging of the Baby Boomer generation, projected immigration numbers (20 million more people in U.S. by 2020), and the need to renovate or replace old, out-of-date facilities that were built 40-50 years ago.
“The next two years look really good,”said McDonough, who joined Layton 13 years ago. “We have a tremendous backlog already for ’15 and ’16. One client is forecasting spending $2 billion in healthcare construction in the next two years. We developed a strategic business plan to focus on the healthcare sector; we knew it was somewhat recession-proof. We’ve positioned ourselves well (nationally).”
“We have developed strategic partnerships, built the right team, and have a nationwide focus,” added Alan Rindlisbacher, Director of Marketing, regarding Layton’s national success in this market. “We expect it to grow steadily as Mike taps into other markets.”
One of the firm’s largest recent healthcare projects is the $615 million, 1.2 million SF expansion of the University Hospital Medical Center at the University of Texas Health Science Center in San Antonio. Layton was one of three firms on the joint-venture, which included San Antonio-based GC’s Vaughn Construction and Zachry Construction.
Locally, Layton completed the $54million, 118,000 SF Lone Peak Hospital in Draper in 2013 and is building Mountain Point Medical Center in Lehi.
Salt Lake-based Jacobsen Construction reported that 24% of its 2013 revenues ($364 million) came from the healthcare sector, and the firm has been working on a bevy of high-profile projects locally, including the recently completed $128 million George S. and Dolores Doré Eccles Primary Children’s Outpatient Services Building in Salt Lake, a significant multi-phase, multi-year expansion/ renovation at Utah Valley Regional
Medical Center (UVRMC) in Provo, and the $100 million, 220,00 SF Primary Children’s & Families’ Cancer Research Center at Huntsman Cancer Institute.
The latter, said Jon Erdmann of Salt Lake-based Architectural Nexus, said this fourth phase is designed to promote collaboration among University of Utah-based research teams.
“This phase will bring all researchers together, many of whom had previously been spread out in buildings both on campus and in Research Park,” said Erdmann. “The open design of laboratory modules in public and private areas allows teams involved in different areas of research to share ideas and spark new thinking in their work. The design supports the researchers in working together for a common goal.”
Highlights will include multiple connections to existing buildings, a public lobby and an auditorium. The project is aiming for LEED Silver or better and will be completed in December 2016.
Another key project at the University’s Research Park is the Ray and Tye Noorda Oral Health Sciences Building, slated for completion in December. In addition to being a major improvement for the U’s School of Dentistry, the new $36 million, 86,000 SF building will include a dental clinic and oral surgery suites, simulation and technique laboratories, and lecture and research space. The project was designed by Salt Lake-based MHTN Architects and built by Salt Lake-based Okland Construction.
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Gauging Community Needs

Owners look at factors like demographic growth, unmet community needs, and aging facilities in need of restoration when making five-year plans for new construction, said Clay Ashdown, Assistant VP of Capital Planning/Finance for Intermountain Healthcare.
He said the non-profit, which is Utah’s largest healthcare provider, looks at “the long-term best interest of the community” when deciding to renovate an existing building or building an entirely new facility.
In addition to the recent Primary Children’s projects and the UVRMC expansion, Ashdown said IHC is planning on major expansions at facilities in Riverton and Park City.
“We opened Riverton in 2009 and there was some uncertainty in the market at that time so we didn’t want to overbuild,” said Ashdown. “But that area has grown significantly. The same thing happened around our hospital in Park City.”
Ashdown added IHC will soon be adding new primary care health centers with urgent care services in both Draper and Kaysville to go with a new Home Care Operations Hub in South Jordan.
The University of Utah Health Care System will continue its growth, said Christopher Nelson, Assistant VP of Public Affairs. As a health care system connected to a research and teaching institution, Nelson said new projects will expand both missions at the U. Off-campus U projects,he added, include a new specialty clinic in Murray and a new 130,000 SF, $40 million health care center that will soon take shape in Kaysville, near Station Park.
Neslon said he sees the U’s Health Care system as one that delivers speciality care to the region, while being supported by the research and training of U’s School of Medicine and Health Sciences.
Neslson said the U has plans to demolish the original School of Medicine building, built in the mid-60’s and which now houses most physician and staff offices, and replace it with a new facility for ambulatory care west of the current hospital, next to the new Primary Children’s building.
The continuing move to build facilities for outpatient treatment, or management of chronic conditions, is one of the largest drivers of new health care construction,“We don’t want to put people in the hospital,” said Ashdown. “There is more and more demand for outpatient services and when it is prudent from a clinical standpoint, it can be better for the patient and the family for someone to recover at home.”
Ambulatory care facilities can be built to a different standard than hospitals and can afford designers and owners with more leeway, according to Brent Agnew of Salt Lake-based MHTN Architects, the design team leader for the new Primary Children’s facility.
“Unlike a hospital, the things we’re seeing with the design of ambulatory care facilities is to design flexible spaces that can be used for a number of different things,” said Agnew. “We’ll design a space where one day of the week they can dosomething like hearing tests and then later in the week, a whole different clinic staff and patients will use the same space. This way you don’t have space sitting idle.”
Agnew said there are some specialty clinic spaces in the Primary Children’s outpatient facility with the rest designed as shared, flexible space.

Coordination and Caring

Healthcare facilities can be challenging construction projects because often they are additions, renovations or major expansions of existing, operating facilities.
“These are places that are open 24 hours a day, every day. As contractors we really have to get to know what is going on inside the hospital and coordinate with them very closely,” said Blake Court, a Vice President at Jacobsen Construction.
Court said most of the healthcare projects Jacobsen has taken on in recent years have been done with a CM/GC contract, allowing for the building team to become more integrated with the owner and design team.
“That has been the standard for us recently and it is a result of the complexity of construction,” said Court. “It allows us to better understand the project and work around the needs of the providers.”
Court said Jacobsen had developed systems for mitigating dust and creating negative pressure zones when connecting new sections of the building to existing structures. The new Primary Children’s facility is attached to the existing hospital by a sky bridge over a street. Court said in order to minimize disruption the bridge frame was fabricated in one piece and placed using a crane.
“Traffic could continue and the quality was really good because they could fabricate everything in shop,” said Court. “We have to be innovative, and there can be some challenging coordination in order to meet the infection control requirements, cleanliness requirements and keeping down noise and vibration during construction. Those requirements get more stringent each year and we have to stay on top of them and keep innovating.”
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