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If you have ever worked on a health care facility project, you probably ran into some inter-esting
challenges. And if lack of coordination was at the top of the list and the bottom of the
problem, then you are not alone.

“Coordination, coordination, coordination is a must,” insists Bob Burgess, president of Cas-cade Acoustics in Tualatin, Ore. “We have coordination meetings with the GC and the other subs—or resort to writing nasty letters, but these don’t work as well as a proactive approach
to scheduling issues.”

“Our biggest challenge with hospital jobs is meeting the rules and regulations,” adds Barry Gibson, president of Commercial Drywall and Plastering in Ocala, Fla., “especially for one-and two-hour walls, and two-to-four-hour rated walls for stairwells and elevators. Everything
has to be built with a UL design and label so we can pass all the inspections, fire ratings and smoke walls, etc. The biggest hurdle to this occurring is being able to coordinate the wall systems with the med gas, mechanical and electrical contractors, so that all the wall penetra-tions
are sealed perfectly. We take care of our own penetrations the mechanical and elec-trical contractors have a sleeve in the wall that we seal using a fire rated caulking material.
Anything inside the sleeve is the mechanical or electrical contractor’s responsibility. It’s a lot of very slow, tedious work with an unbelievable amount of coordination required.”

The way Keith Hoffman, estimator at E&K in Phoenix, Ariz., says they handle coordination with the other trades over the large amount of penetrations, is they “frame the walls
Little Rock, Ark. “Subs don’t like doing this
generally, but the GCs push the coordination
on them as it makes jobs progress so
much more smoothly.”
and hang the drywall from the top down,
to between 4 and 8 feet from the deck, and
then let the guys install their electrical. The
duct guys can either go under our rack or
show us where they want us to cut out
openings in the wall.”

For George Kealoha, supervisor at Kealoha
Construction in Wailuku, Hawaii, the trick
is “a good GC who is aware of the problem
and coordinates trades sequence. “AC
ducts should go first, as they are tight to the
ceiling, then the drain lines, and then the
bigger pipes, fire sprinkler etc.; then electrical,
because it is much more flexible.
Smart contractors share the same carriage
down the hallway. Coming to a hallway is
a problem area, as pipes have to turn, and
that means some pipes have to go above or Hitting the Brakes
below others.”

“One of the most critical actions to take is
pre-production planning with all parties
concerned,” according to Ron Jefford, pro-ject
manager at Horton Drywall in North Little Rock, Ark. “Subs don’t like doing this
generally, but the GCs push the coordina-tion
on them as it makes jobs progress so
much more smoothly.”

Even with coordination, it seems, projects
can be bumpy in Tim Cadenhead’s view
(commercial manager at Sides Drywall in
Auburn, Ala.). “We think we are ready to
hang [wallboard], we have worked out all
the problems, and then there will be some
other product or assembly that needs to be
installed in the wall.” Gibson agrees: “The
biggest problem we have with hospitals is
the work is never ever finished because of
all the items that have to be put in the

Hitting the Brakes

This need for close scheduling with other
trades impacts production rate, as do a
number of other factors. “Productivity is
not as high as in normal construction jobs,”
notes Bob Heimerl, president of Mowery Thomason Inc. in Anaheim, Calif.
“There are too many in wall accessories
that have to be dealt with and cut
around.” As Miguel Candelaria, presi-dent
of MA&O Construction Services
Inc. in Atlanta, says so colorfully, “With
tenant work, you open up a can of
‘Whoop-Ass’ and get it done, standing
up stud and hanging up board right
behind it because you have to move fast
to come in on budget. In a health care
setting, though, it’s not the same.”

Ron Molleur, vice president at EL.
Crane and Sons in Hutto, Texas, adds,
“You can’t flow as easily when operating
in a health-care facility that is in use
because you are always working around
ongoing operations and their schedule moving to another area or stop-ping
work. You also have to work cleaner
and do more cleaning. So there’s a lot
of close coordination with the health care

All of which, of course, influences pricing.
Kevin Corcoran, president of the
Corcoran Company in Ft. Collins,
Colo., notes: “Our production levels are
about three times slower above the ceiling,
and for the whole project, about 20
percent slower. Gibson sees eye-to-eye
with these figures. “The above-ceiling
and behind-wall work generally cost two
to three times regular commercial building
projects. But as long as you budget
for this extra work and don’t go into
these health-care projects thinking they
are the same as any another construction,
you will stay in business. No matter
what the economy is doing, it seems
health care facilities are always being
built or remodeled.”

“We have to price high,” agrees Hoffman,
“as these health care facilities are
25 to 30 percent slower than office work
and never make as much money as one

During the bidding, another thing to
look out for, according to Heimerl, is
“existing conditions that are not immediately
apparent when looking at a job,
especially above the ceilings, and which
may hamper productivity. There is so
much ductwork and so many pipes, etc.
penetrating a new wall area that it may
be very difficult to put in a firewall.
You’ll have to piece and patch and sometimes
even go to a lathe and plaster system
to seal it off. So we make sure to
investigate thoroughly before bidding.”

“Without knowing these kind of
details,” explains Molleur, the project
will not be done and lowball bidders will
fall on their face. I have had to go in
many times and take over a job when
the first bidder didn’t know what he was
getting into. It doesn’t help anyone.”

Kealoha advises that you “make sure you
bid everything carefully, as health care Next to Godliness
facilities require a lot of specialty items,
such as lead liners in X-ray rooms. They
usually have different types of ceilings
for different rooms with different prices.
You have to use different gauge of studs
for certain areas and water resistant
board, so you have to make sure you
have the correct quantities in the correct
area. Then you have to match up your
labor, because after 9 feet, everything is
in pieces. The bottom 9 feet of board
take five minutes to put up, and the last
2 feet with all the pipes etc., take an
hour. And then you have to create the
UL-rated firewalls in the corridors,
meaning the drywall has to go all the
way up. This is Varsity level drywall, not
for the 14-and-under league.”

Two contractors interviewed had the
smarts to recognize that hospitals are the
big league, saying, “They are very difficult
and we are a small company,” and
“We steer away from hospitals because
of the regulations and inspectors who
enforce them. They are so particular that
it is very hard to make any money.”

“All in all,” concludes Candelaria,
“health care is a very profitable business
as long as you make sure you have all
your RFIs answered up front. It’s expecting
miracles, but labor is the most
expensive commodity and can send a
project plus or minus unless you create
an efficient operating environment.”

Next to Godliness

Touched upon briefly earlier, is the subject of cleanliness. This extends into Design Pitfalls to Avoid
keeping distractions to a minimum.
According to Heimerl, “In remodeling,
you are in a working hospital, so cleanliness
is of extreme importance and minimizing
disruption of their activity is a
prime concern. We are often stopped
from working because of noise when we
are adjacent to an operating room, surgical
lab, etc. So our scheduled work
hours may find us installing track
anchors, rotor drilling or doing shots
and pins in the middle of the night. We
try to schedule noise-generating work
early. We make sure to call out overtime
in the bid documents, especially when
we know we will be working adjacent to,
above or below a surgical room. They
will often handle it on a time ticket,
because they may have an emergency
surgery that comes in and ask us to stop
our work for a period of time.”

On the noise issue, Corcoran adds:
“Reducing distraction is not easy, of
course, because you distract them just by
being there. Avoiding any sort of power
overload and outage or communication
system failure is especially important,
obviously. But an experienced GC will
insist on weekly meetings to discuss anything
that the hospital staff has attention
on, any noises they may have heard, etc.
We always use separate entrances, completely
removed from the regular
entrance. The trickiest times are when
we are ready for the tie-ins between a
new wing and an existing hallway. The
GC has to make sure work is done at the
right time—which may not be the
nighttime in a hospital, because the
patients are trying to sleep then.

“When dealing with life-safety issues,”
continues Corcoran, “people cannot be
exposed to any forms of bacteria, so we
are extra careful about mold, especially
in open construction, when the rapid
pace of construction has work being
done on insulation and drywall before
the building has been made completely
tight. Moisture does penetrate these
buildings, and we have had every issue
hit us. We worked on a hospital a couple
of years back in which the roof was
almost complete but had not been
sealed around the perimeter. We had
one of those late spring storms that
dumped a load of wet snow on the roof.
The snow came in through the mechanical
shaft and we had to pull out a lot of
drywall and insulation and treat the
track with bleach before we could
rebuild. The mold had not appeared yet,
but we knew it would, and so acted,
with the owner’s and GC’s blessing.

“The more-subtle mold problem is gypsum
drywall absorbing moisture from
the air. Even though we are in a semiarid
environment, we have to be careful
about hanging moist board when
installing board without a mechanical
system to circulate air all the time. Board
picks up moisture and the guys can feel
the board is heavier. When this happens,
we either bring in fresh board or hang
the board on one side and allow it to dry
using fans to circulate the air.

“In the early days, before the idea of
speeding up the building process hit,
nobody ever hung wallboard before it
had dried out completely. But now, they
push the limit with fast track and hope
that they can keep it dry, but it does not
always work.

“We also ensure all the dust is vacuumed
out of nooks and crannies before we
start to hang board and after finishing.
It’s about cleaning as you go to create a
sterile environment, much like we used
to do in clean rooms for high tech companies.”

Design Pitfalls to Avoid

Mold is not the only hazard to keep on
one’s radar according to some contractors.
“Architects who specialize in hospitals
are savvy to the requirements and
problems,” notes Heimerl, “but every
now and then we run into an architect
who has not done much hospital work.
We are caught in the middle of his learning
curve, because what he has drawn
does not meet the state’s requirements.
We try to nip this shortfall in the bud
with RFIs during the bidding stage, clarifying
possible conflicts in the drawings.

What’s Harder than Hospitals?
“Hospitals may be among the hardest projects,” admits Kealoha, “but the hardest project we have had to face was the local observatory. It’s hard to breathe at 10,000 feet, so your production rate is way down—you have to supply oxygen tanks for the guys working there. And whatever you bring up during the day you have to store away at night, as the wind picks up in the evening and blows everything away: You build a scaf-fold in the morning, you have to tear it down at the end of every day and take it back down to the storage area at 6,000 feet. And it’s a long commute each day, but it’s a good way to quit smoking.”

“In California, seismic concerns are paramount,
and regulations and inspections
are very stringent. We cannot change
plans or details materially without
approval—basically, we have to put in
every bolt, nut and screw on the drawing,
because the inspector will surely count
them and insist we follow the drawings.
When an application that is drawn does
not work, we need to take it up with the
inspector and architect in the field and
receive a revised detail on it. With all the
flip tracks and movement requirements,
for instance, the head of wall (where the
wall meets the underside of the slab
above) sometimes becomes confusing,
and architects will sometimes mix and
match things that don’t work in practice.”

“A key problem is the walls are not
designed deep enough to take all the
piping from the oxygen and water etc.
and have them cross each other,” notes
Cadenhead. “If you have a 2.5-inch vent
and a 1-inch water supply, that makes
3.5-inches. If you then take up 1.5 inches
with your bridging reinforcement
for light gauge metal framing and
then add backing co support a counter
or a piece of equipment, the wall is
becoming very crowded.

“So architects design the walls too thin,
but they also spec gauge metal that is not
heavy enough to support everything that
needs to be mounted to the wall. Once
the wall has been cut to pieces with all
the penetrations, it has lost its integrity
and strength. Oftentimes, we
SHEETROCK a patient or operating room
and have to make between 8 and 10
penetrations in a sheet of drywall to
accommodate the different piping and
implements in the walls. When this
kind of a wall has been installed, we
sometimes end up furring out one wall
and building another to increase the
depth and strength of the wall.”

Heimerl makes the same point about
heavier studs: “Hospital walls are completely
different structures compared to
office walls that merely separate one room
from another. In a hospital, the walls also
include all the medical equipment and
needs that require a lot of backing and
support systems for cabinetry and accessories
that hang on the walk. This calls for
heavier stud—16-gauge compared to
most other areas that may just require a
20-gauge. But it gets to be quite a mix
and match of stud requirement based on
what the wall is supporting.”

Highlighting another difference in
health care facilities, Molleur points out:
“They require higher quality paint,
epoxy instead of latex, so health care
workers can clean the walls regularly.
Ceiling tiles standards are more rigid,
too, requiring no off gassing or shedding
of fibers.”

The Payoff

There are rewards, of course, to working
in the health-care environment, which
quicken the pulse and perk up interest,
as Corcoran explains: “These health care
projects raise the bar on everybody’s performance,
with little room for error. The
fire requirements, for instance, are strenuous.
A patient can be in surgery when
a fire breaks out. The space has to be safe
enough so that the patient can be stabilized
before being moved away from the
fire. So we do our own fire caulking and
fire spraying. Medical is very critical, and
we enjoy the challenge, making sure we
are doing it right.

“There is also a lot of welcome integration
and coordination with other trades
to make everything fit together smoothly,
And we find that GCs working in
healthcare are extremely professional,
otherwise they would not be invited to
do these projects. They are great to work
with and understand what it takes.

“Lastly, there is a lot of pride working in
a health care facility, because you know
you’re contributing to a worthwhile purpose.”

About the Author

Steven Ferry is a freelance writer based
in Clearwater, Fla.

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