COVID Insights, Perspectives 07.08.2020

How a Shuttered Medical Facility Became Functional In 26 Days: A Collaboration Story

Managing Principal Elizabeth Rack, Project Manager Jenny Riddle Curley, and our Global Director of Technical Design Mark Walsh share insight into what it was like working around the clock to transform an old medical facility into one that could serve COVID-19 patients in the Chicago suburbs.
The project team gathered 6 feet apart on the day of substantial completion. Representatives included personnel from the US Army Corps of Engineers, Turner Construction, Perkins&Will, Salas O'Brien and other key partners.

Over the course of weekend in March 2020, our healthcare team joined Design-Build partner Turner Construction to respond to a U.S. Army Corps of Engineers (USACE) solicitation to transform shuttered medical facility into an Alternate Care Facility (ACF) for COVID patientsThe Request for Proposal was released Friday night and was due Saturday at noon.  The contract was awarded Sunday night, making this the second ACF our healthcare practice would be working on over the same timeframe: the other was the MetroSouth Alternate Care Facility in Blue Island, Illinois. We mobilized and were on site Monday to make the former Sherman Center Street Campus in Elgin, Illinoisfunctional in less than one month.  

How did all parties work together to quickly create these additional spaces for patient care? Client teams, contractors, architects, and trade partners used an efficient process built on a singular goal, motivation, trust and collaboration, knowing that a successful and timely project would ease the burden on local hospitals and potentially save lives.  

Our Chicago healthcare team provides insight below on what this process was like, how the collaboration met speed-to-market demand, and lessons learned that can be applied to more conventional projects in the future. 

The decision-making process needed to keep things moving efficiently:

From project kickoff to delivering a GMP pricing setonly six days passed. There was little time to cycle through decisions. The entire team understood that when a decision was needed along the critical path, we had to make it quickly. The team remained open to changing course because we were simultaneously investigating existing conditions, planningand building.  Reacting to new information decisively in  these moments was key to reaching successful project completion.  

How we made the right decisions with the right people, sometimes in a matter of minutes, to keep the project moving:

In this nonstop environment, the key was constant communication. The Perkins&Will team along with the Salas O’Brien MEP team engaged with the contractors every morning, before the Design-Build team provided a daily afternoon report to USACE. After morning discussions, the onsite team relayed information back to the medical planning team, who generated new content within hours. This new content, stemming from the morning’s collaborative discussions, informed that day’s afternoon report to USACE. It was common for the design team to issue drawing revisions multiple times a day. 

It was also critical for the design/construction team to identify decisions that needed to be made by USACE and the Illinois Department of Public  Health (IDPH) and develop the necessary collateral. The presentation of thorough and organized material allowed decisions to be made on the spot during the USACE/IDPH update meeting.  

For decisions requiring field investigation, the project team walked the site and inspected the area in question collectively to determine direction before day’s endFor the most time-sensitive issues, we were able to instruct subcontractors in the field. The level of complexity and speed required agile decision-making based on constantly evolving information. USACE’s willingness to make critical decisions and keep the project moving showed how everyone worked toward achieving the goal. The right people were on the project from all parties and everyone was dedicated to doing whatever it took to make this conversion happen in a matter of days. Strong leadership across the board also helped keep the large team focused on making sound decisions and continuous progress.  

Formerly a compact medical office space, interior demolition enabled the team to maximize patient bays within the building footprint.
After interior demolition, the Design-Build team worked together to efficiently construct new patient units with readily available materials.

How the Centers for Disease Control and Prevention’s Alternate Care Site and Isolation Guidelines and IDPH’s Level of Care Requirements informed planning:

The guidelines provided direction for critical infection prevention within non-traditional environments, including essential considerations that supplemented IDPH’s pandemic planning guidelines. They were our roadmap for defining patient bay size, major building circulation segregation, and clinical and staff support requirements within the existing building. 

ACFs are intended for patients who require some degree of medical care but do not need the level of care available at an acute care hospital. The CDC outlines a three-tier range of patient acuity levels, in which Tier 1 patients do not need medical attention but require isolation, and Tier 3 patients are high acuity. IDPH’s Levels of Care Requirements are outlined specifically for the patient environment within the ACF, with factors such as requirements for handwashing, toilet and showers, electric outletslighting, medical gas needs, and air flow 

A quick assessment of existing conditions and an alignment of IDPH’s Levels of Care Requirements within the building activation timeframe determined that a mid-tier level of care was achievable. 

This project posed several unique challenges:

The Sherman Center Street Campus had been closed for half a decade. After the demolition of the inpatient hospital years prior, the campus operated as an outpatient facility that included operating and imaging rooms and as a medical office building.  Very few rooms were suitable for ACF patient use. Walking into a building that has been unoccupied for years is always a window into a previous point in the building’s life: you can see the passage of time. For this building, that meant finding abandoned supplies, equipment and furniture in most rooms and significant water damage and mold. Knowing there were four weeks for cleanup and conversion felt like the challenge of a lifetime.  

The quick turnaround – 26 days  and availability of materials were central challenges. The trade partners identified available materials and equipment, and the architect/engineer team reviewed options with the trade partners to find the right solution using what could be delivered and installed within the timeframe available. This high level of coordination ensured a smooth process.  

In the first days on site, we determined that some demolition would be required to optimize the bed count. Our initial goal was to limit demolition and use existing spaces as much as possiblelimiting reconstruction would be most time efficient. However, with the help of superintendents from Turner and the subcontractors, we quickly realized that wholesale interior demolition would be the most efficient solution in the southern zone of the building. This approach allowed for more beds by creating an open ward concept with 3-sided walled patient positionsOpening the floor plan also increased nursing visibility into patient bays, which would not have been possible with the existing cellular nature of the prior medical office space. This same area was converted to a negative pressure zone to increase patient comfort. With natural light at the perimeter now penetrating the entire unit, this zone of the building received a facelift that would not have been possible without extensive demolition.  

Early in the projectwe used a bay module with CDCrecommended bed clearances to evaluate whether an existing space could adequately house a bed. By mapping out all available existing locations, we determined a target bed count. During the first week, the Design-Build team and the USACE team continuously evaluated space conditions and tested infrastructure approaches to refine the bed count. Clinical guidance from regular visits by IDPH further informed decisions. As Turner Construction and our trade partners generated cost information, planning decisions were re-evaluated and the plan was adjusted. 

Once a surgical waiting area, this zone of Level 2 was converted to patient bays for COVID-19 positive patients.
Members of the Perkins&Will team were present on site throughout the construction of the Alternate Care Facility.

What we needed to determine on Day One for a project like this to work:

Overnight mobilization: the core team was identified and ready before the project was even awarded. Without much building information to kick off the effort, we brought key individuals to the site on Day 1 so planning, technicaland management components could simultaneously assess the challenge ahead. This enabled the whole team to start on all efforts on day one. In the initial hours on the project, defining building conditions, project objectives, and quality expectations was a collective effort. 

Because the schedule is paramount on a project like this, on Day 1 the team committed to adaptability. Every team member committed to taking on whatever role was necessary from moment to moment. The teams also had to be willing to set aside normal processes to deliver at extreme speed. For Perkins&Will, this meant we had to accept that construction would proceed with few or no drawings, based on field direction and efficient decisionmaking. 

Assembling the right team members, both on the architectural side and with the consultant and client teams, was also fundamental to the success of the Alternate Care FacilityEven in a Design-Build relationship, it is important to note that we were not in a traditional role with our typical balance of priorities under a typical schedule, so adaptability was critical. There was a strong emphasis on trust, which increased efficiencyDespite the challenges, working with USACE and their mission-driven mindset was extremely meaningful and inspirational to every member of the team 

In a show of support, neighbors in the Elgin area delivered homemade treats to encourage the project team in their efforts to build the Alternate Care Facility.
No longer used as a Prep/Recovery unit for the inactive surgical suite, the patient bays received minimal demolition and then were refreshed with new finishes and rehabbed HVAC systems.

We learned some key lessons that can be applied to project delivery in the future:

Looking back on this project, a few items stand out 

  • A clear mission is a powerful motivator. Every person involved worked extraordinarily hard and exceeded expectations in service of completing the goal. 
  • Trust is key to success. Delivering under the circumstances of a pandemic required that we each trust that the other was acting in the interest of the project. Mutual trust allowed us to let go of our traditional siloed positions and function as a unit. 
  • Appreciation is priceless. From the neighbors’ delivery of treats to the messages of thanks heard daily at all levels of the project, collaborators supported each other in working toward a common goal.