Growing and expanding Mayo Clinic’s Eastern District expansion project is part of a plan that will double the facilities on the Phoenix campus to serve an increasing number of patients with complex diseases.

Image courtesy of McCarthy Construction.

Hospital expansion is rarely an easy proposal. In addition to the technical challenges inherent in medical facilities, almost every aspect of surgery, from delicate surgical procedures to bed sheets and other supply services, must be protected from the destructive effects of construction. This will cause a lot of trouble to the project team.

The Mayo Clinic’s $145 million East Side expansion project is currently underway in Phoenix, but this is not the case. Different from traditional delivery methods, the project combines elements such as integrated project delivery, "large space" planning, and an attitude to treat difficult issues as opportunities for innovation. After more than a year of construction, the prediction of successful results seems very positive.

The 330,000-square-foot project includes the expansion of the clinic, hospital, and East Restaurant building, and is part of a comprehensive campus development plan that aims to increase the patient capacity of the Mayo Clinic in the next two years.

Structural synchronization: The custom-made floor integrates the new floor layout of the clinic with the existing structural grid. Image courtesy of McCarthy Construction.

“Every time you add a bed, you have to add support space to serve the patient population,” explains Tim Carpenter, project manager at the Mayo Clinic. He added that in order to be consistent with the Mayo Clinic's patient-first philosophy, everyone involved in the project must accept that their reason for being there is "for the patient."

Before construction starts in January 2020, coexisting team members in a large room environment for one year helps to reinforce the concept, while also facilitating the use of lean project concepts and modeling techniques to develop complex designs and constructability details. cooperation. Justin Adams, McCarthy's senior project manager, led the expansion project as a construction manager at risk. He said that 70% of the team's trading partners played design assistance roles.

Adams said that the involvement of major subcontractors during the expansion planning phase produced many efficiencies and other benefits. For example, McCarthy worked with the project’s steel subcontractors, structural engineers, manufacturers and installers to optimize the amount of steel required for the 236,000 square foot vertical expansion of the clinic building.

 By adjusting connections and reducing or discarding components, the team reduced more than 500 tons from the design—"This is a huge budget opportunity," Adams said. He added that the design assistance also helped the team prepare ahead of pandemic-related procurement disruptions, ensuring labor and material safety before the COVID-19 outbreak shuts down manufacturers and closes international borders.

Accelerating elements: Prefabrication helped to accelerate many elements of the project, including the custom-made aluminum facade panels of the clinic. Image courtesy of McCarthy Construction.

Scaling up the four-year-old clinic will provide a large number of other tests for the project team's opportunity-based approach. Logistically complex work adds three new floors to the full-floor extension of the mechanical penthouse. 

Although the building was designed to accommodate additional floors, the tolerance differences of the existing columns would complicate the design of the new slab with intensive expansion. 

Use custom caps and base plates to increase the original roof horizontal pillars, ranging in size from 1.5 ft x 2.5 ft to 2 ft x 3.5 ft, with correction offsets up to 3 inches, allowing new floors to rise as designed. 

In order to maintain more vertical expansion potential in the future, “we must treat it as an overall design that integrates structural and system perspectives,” said Michelle Mantegna, project manager of lead design company Shepley Bulfinch. She added that the team is very proud to ensure that design and construction decisions are fully documented to help those who truly and vividly build their efforts. 

"While we strive to make this project a success, we also hope to build a successful team in the future," Mantenia said. 

Future growth: The four-story extension of the clinic can accommodate further vertical growth as needed. Image courtesy of Sheply Bulfinch

One aspect of the expanded summary is sure to cause interesting reading, and that is the part dealing with the "opportunity corner"-part of the existing clinic's penthouse, so named to ensure that the team is focused on finding solutions rather than frustrations.

Although it is relatively simple to extend the penthouse horizontally to the perimeter of the building to accommodate future mechanical systems, extending the vertical concrete core for the elevator shaft requires the team to expose and protect the critical MEP and elevator control equipment, all of which must remain fully functional throughout the process Built to support ongoing clinic activities and procedures on existing floors.

Opportunity Corner lives up to its name with a specific design package that protects the building system and promotes the strategy of "jumping" elevator control to higher floors. Carpenter attributed this optimistic approach to helping alleviate the inconvenience of the clinic building staff and patients caused by occasional elevator blackouts.

"Everyone knows that in the end, this will be a big and beautiful building," he said. "This helped us through the storm."

Don't hurt: Project planning includes reducing interference with Mayo Clinic's logistics operations and ongoing surgical and clinical services. Image courtesy of McCarthy Construction.

Collaborative planning also played a key role for the 60,000 square foot hospital, which will include an expanded environmental services department and new operating rooms, perioperative and post-anaesthesia care rooms, and supply space. 

Because the site is constrained by the existing structure on three sides, Adams said vibration control is an ongoing concern because delicate medical procedures are being performed only a few feet away from the busy building activity. Unlike working on the top of the clinic building, “this is not a type of space that is only used during the day,” he said.

Complicating the logistics problem of the tight site is the restriction of the construction phase of the hospital's main supply chain channel, and the number of loading docks has been reduced from five to two. This means that even harmless project tasks such as site fences require a certain degree of flexibility to accommodate multiple trucks.

For the newly added 20-foot-deep excavation, the team designed a support system to help support the existing bridge piers, while the sensor network helped to ensure that any building-related internal vibrations were kept within strict limits. Instead of taking the risk of using potentially destructive hard connections to connect new and existing structures, the team designed a 1,473 linear foot expansion joint system to minimize the risk of vibration and damage to the sterile environment.

In addition to turning countless challenges into opportunities, the large room approach also found ways to utilize prefabricated MEP system components in clinic and hospital projects. The team used innovative technologies, such as connecting pre-installed variable air volume fans through ducts and using surface-mounted end walls in the perioperative area to speed up installation. 

"We also came up with a way to install the blank components before the wall frame, which also helps to save time and space," Adams said.

Countdown: The expanded hospital and cafeteria will end this year, and the clinic is expected to be basically completed next summer. Image courtesy of McCarthy Construction.

However, the largest prefabrication is likely to be the unified aluminum skin system outside the clinic. The addition of a concrete slab edge edge on each floor allows most 20-foot-high, 10-inch-thick panels to be bolted together and eliminates all connection points except for a few welded connection points.

"This allows us to use tower cranes for installation instead of erecting scaffolding around the building," Adams said. "The whole process takes about four months."

These and other efforts have helped to speed up the expansion of the Eastern District, and the expansion of the hospital is now expected to be basically completed in July, a few months earlier than originally planned. 

The three-building, 6,000-square-foot extension of the Mayo Clinic East Restaurant will be delivered six months ahead of schedule in December 2021. The vertical expansion project of the clinic is scheduled to end in June 2022, marking the substantial completion of the entire project.

The MEP in the middle: Logistically complex efforts have added three new floors to the full-floor extension of the mechanical penthouse. Image courtesy of McCarthy Construction.

With the Mayo Clinic’s first large room project coming to an end, Carpenter found that this method was very popular, even if it did take some time to adapt. "This is a very busy room, never a dull moment," he explained. "But from our point of view, it is difficult to return to the previous way to do projects."

Adams has no doubt about the benefits of collaborative project delivery. 

"As for how we unite on each issue, it's really important for the whole team," he said. "This is not a designer's problem, nor is it a contractor's problem. This is an opportunity for the team to solve the problem." 

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