2023 Vista Award winner

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Great vision can significantly benefit a major medical center construction project. Great timing helps, too. For proof, consider Piedmont Atlanta Hospital’s new 16-story, 905,000-square-foot Marcus Tower, which opened four months earlier than anticipated in 2020 as pandemic needs skyrocketed, adding 132 intensive care unit-capable beds when the community needed them most.

With Phase I of the project completed three years ago, the tower has debuted 12 state-of-the-art operating rooms (ORs), eight cardiac catheterization labs, four electrophysiology labs, three patient floors and other acute care services as well as a heart institute, heart and vascular center, blood bank, auditorium, helipad, plaza, 300-car parking garage, gift shop and two large trauma elevators.

The expansion of the tower also allowed Piedmont to construct the first organ recovery center in the state, created in partnership with LifeLink^® of Georgia, to serve the greater Atlanta community and beyond.

Phase II, expected to be finished in 2026, will comprise the sequential upfit of the remaining six patient floors, four additional ORs and potential expansion of the central energy plant. Once complete, the $450 million Marcus Tower will boast up to 408 universally sized patient rooms, easily adaptable from acute care to intensive care.

Synergistic teamwork

Piedmont, a private, nonprofit organization that includes 22 hospitals, worked closely since 2016 with several partners on the project, including Brasfield & Gorrie — a Birmingham, Ala.-headquartered construction firm — as well as the Atlanta offices of commercial real estate firm CBRE and architectural design firm HKS Inc. 

Fueled by synergistic teamwork and crews that were dedicated to working expanded schedules, the collaborators accelerated the completion of several tower floors. Hospital staff pitched in by offering input and testing equipment, and manufacturers helped by shipping goods and equipment earlier than slated. In all, over 1,200 people offered input on the project via meetings and workshops.

“This story of team organization and how they solved problems together represents the essence of the Vista Awards: teams rising to the occasion, particularly in the face of adversity, and collaboratively solving problems,” says Randy Regier, AIA, ACHA, chair of the Vista Awards task force that judged the award contestants. “The Piedmont collaborators were ahead of the curve by establishing good practices at the onset of the project and rallying to an early finish at the beginning of the pandemic.”

This project achieved more than updating an aging hospital campus. It bettered the patient experience, expanded patient capacity and enhanced staff productivity — all in multiple and meaningful ways. 

Given these accomplishments and the cooperation involved, it’s no surprise that this project was chosen as the winner of the American Society for Health Care Engineering’s (ASHE’s) 2023 Vista Award for new construction.

A premier destination

From the start, Marcus Tower was intended to serve as a premier destination for comprehensive cardiac care in the southeastern U.S., represent the heart of Piedmont Atlanta Hospital’s new master plan and operate as one of the largest health care facilities in the entire state. Benefiting from flexible and responsive planning, the innovative 16-story structure today stands as a testament to forward-thinking design, efficient coordination among collaborators and the power of cutting-edge technology. 

Patrick Battey, M.D., FACS, CEO at Piedmont Atlanta Hospital, explains that, following a year of campus planning, Piedmont Atlanta decided to create the tower addition based on several priorities.

“We needed to modernize an older campus,” he says. “But we also wanted to improve the patient experience and meet their increased demand, expand capacity for our nationally recognized neurological/stroke and transplant specialties, realize operational efficiencies for safe and quality care while being economically responsible, and demonstrate Piedmont Atlanta’s important role in providing quality health care to the surrounding community in Atlanta.” 

The tower’s location, adjacent to existing hospital buildings, required a plan that would accommodate three specific urban environments: the existing campus, the surrounding historic residential neighborhood and the commercial district. To fulfill these goals, the design had to be contemporary and easily identifiable yet harmonize with the materials, size and scale of older structures and nearby homes. Additionally, the project team was tasked with positioning the campus for future growth and abiding by Atlanta’s beltline overlay district zoning restrictions, which stress walkable accessibility and economic growth.

The initiation of construction in the summer of 2016 involved blasting and excavating 145,000 cubic yards of rock and dirt followed by careful site shoring. The construction team made painstaking efforts to protect existing hospital structures, foundations and utility infrastructure.

Erecting an ultra-modern tower of this size and complexity required a massive, synchronized group effort from all players, including the Atlanta office of HKS; CBRE; Brasfield & Gorrie, the general contractor; Atlanta-based Uzun Case LLC, the structural engineers; and HPD LLC and TLC Engineering Solutions, the consulting engineers. 

Project success necessitated an integrated team approach, careful assessment of cost savings (including projected versus actual expenses), right-sizing the project area and incorporating flexibility in built areas, such as universal patient room design. Well-planned infrastructure was also prioritized.

“Mechanical, electrical and plumbing (MEP) systems played a huge role in the design of the facility, and decisions about these systems brought together the hospital facilities director, MEP engineers, subconsultants, architects and contractors to vet every decision,” says Travis Cowie, AIA, principal, senior project manager at HKS. “These decisions were measured against the facilities’ previous processes, first cost, return on investment, sustainability, constructability and life-cycle maintenance considerations. As the design of these systems moved into the construction phase, the MEP subconsultants worked through these systems with the design team to ensure real-time coordination. This level of coordination was maintained throughout construction.”

Shelled space throughout the building enabled the hospital to build out additional ORs and recovery areas during the COVID-19 pandemic and will allow for the future relocation of undersized patient units from the legacy building in Phase II, on target for completion in three years.

Close coordination

Phase I completion of Marcus Tower was achieved effectively, thanks to an exemplary partnership among all the various teams and professionals — including facilities personnel — involved in its planning, architecture and construction.

“Close coordination throughout the project allowed for changes to be studied and implemented in the most efficient way possible. Instead of each design discipline working in isolation, the team worked together to develop the best solution based on input from all relevant design parties,” says Jeff Milheizler, a structural engineer at Uzun Case. 

Remarkably, 400 physicians and staff — among them clinicians, facilities engineering, infection prevention and information technology groups — participated in five weeks of operational planning and user experience workshops to understand and define current and future state processes and learn about next and best practices to be incorporated into the tower’s design. Additionally, 543 patients and their families participated in design workshops and completed project-focused surveys online. Thirty-seven adjacent neighborhood associations and businesses partook in six neighborhood advisory council meetings.

“A cloud-based Revit model allowed the architect, design consultants, construction manager and subcontractors to work together on the model in real time. With the complexity of the building and its scale, this helped to minimize coordination issues and resulted in quicker drawing production, which led to a decrease in the construction schedule,” says Chad Waters, regional preconstruction director at Brasfield & Gorrie. 

The team also utilized online tools like BIM 360 by Autodesk Inc., San Francisco, and Bluebeam Studio by Bluebeam Inc., Pasadena, Calif., to maintain a constant line of communication between the design team and the entire project team, particularly owner representatives and project engineers. “Transparency and real-time collaboration made it possible to pivot when necessary and reduce delivery time,” says Camilla Moretti, AIA, ACHA, LSS GB, LEED AP BD+C, senior medical planner at HKS.

“We no longer had to schedule model transfers and spend hours uploading and downloading files and following up with a discussion clarifying which aspects of the project had changed,” says Mindy Goodroe, AIA, ACHA, EDAC, LSSYB, LEED AP BD+C, partner and senior medical planner at HKS. “We worked as one unified force, establishing trust among team members. This was vital when challenges arose.” 

For example, a crack in a transfer girder was observed during construction. The team brainstormed several remediation ideas and decided to wrap the entire beam with carbon fiber sheets and pressure-inject the crack with an epoxy compound. 

“On other projects, an issue like this would have been an opportunity to point fingers,” says Goodroe. “Because of the strong relationships that had been forged from the beginning, the reaction here was one of problem-solving.”

Perhaps the biggest test of teamwork came during the final months of Phase I construction when the COVID-19 pandemic hit. The crew rallied to complete the build-out of the patient floors earlier than scheduled, creating more beds for sick patients at a crucial time (see sidebar on page 22).

Exceeding expectations 

Complementing the Atlanta skyline with its sleek, curvilinear appearance, Marcus Tower has garnered rave reviews from patients, staff and the public alike since opening its doors three years ago.

“The building design and spaces within them are inviting, which creates a great healing atmosphere,” says Suraj Soudagar, principal, project executive and medical equipment planner at IMEG Corp., a Naperville, Ill.-based engineering firm that consulted on the project. “The tower’s high-end technology coupled with its amazing personnel make it an unbelievable experience.”

Patients and their loved ones especially appreciate the improved surgical waiting experience. “Before Marcus Tower, during a patient and family experience workshop, a visitor told us they recalled sitting in an outdated waiting room staring at a tube TV and wondering whether the equipment the surgical team was using was also outdated,” Goodroe says. “The new space where surgical families gather is daylit and comfortable — balancing privacy with access to the surgical staff — and adjacent to the grand lobby, which has areas of interest such as a cafe, a gift shop and a sacred space. Family members get real-time updates through their phones, too.”

In tandem with the opening of Marcus Tower, the hospital rolled out its “Piedmont Way” philosophy: “Lead with human, create uplifting moments, enrich with technology, anticipate needs and connect the journey.”

“This set of values allowed us as a team, with this transformational project at a prime corner and gateway entry to the campus, to reimagine how a hospital and the spaces designed to support care can engage and represent the community it serves,” Battey says. “Marcus Tower is prepared to respond to future community needs. For instance, new patient rooms are designed to serve acute care and intensive care patients, which gives the hospital the flexibility to adapt rooms for different acuity levels.”

Lessons learned

Other hospitals planning expansions and modernizations can learn much from the project team’s efforts.

“One of the key takeaways we recommend is to identify partners early,” Goodroe says. “We followed integrated project delivery methodologies, which demonstrate stewardship of the client’s resources. This requires selecting key team members — especially the program manager, architect and general contractor — as early in the process as possible. Additionally, bringing vendor partners, subcontractors and design consultants on early provides real-time feedback on design and pricing, resulting in less waste, such as rework and redesign. Lean design tools such as pull-planning, the creation of component teams and target value design result in better collaboration and communication among team members.”

It’s also worthwhile to create a project charter and wish list. The former captures the essence of the project into a succinct document. Key performance indicators that aligned with Piedmont’s vision for quality, safety and service; talent; strategic growth; and stewardship — the four anchors of the organization — were developed, tracked and shared quarterly through project performance updates. The charter and guiding principles were used to prioritize items from Piedmont’s wish list (including the helipad and auditorium) and incorporate them into the project as cost-saving opportunities were identified through component team collaboration. 

Budget control was equally essential. The wish list items and design team-recommended changes outside of the original scope were priced and given a priority ranking by the expansion leadership team. Once contingency funds became available, through team collaboration, these items were approved for inclusion into the project.

“What’s more, we learned that it’s vital to include many stakeholders in your project,” Goodroe says. “We benefited from the program manager, architect and contractor all being brought on early in the process and the fact that over 1,200 people — including patients, staff, neighbors and leadership — provided input through operational improvement and design workshops, and advisory meetings.”

Many hospitals are accustomed to working virtually post-pandemic, but gathering in person whenever possible was crucial on the tower project, especially to ensure stakeholder inclusion and buy-in. 

“One of the main reasons we were able to obtain tremendous participation from clinical staff during the design process was because all design workshops, key room mock-ups, integrated design and construction team meetings, and vendor presentations convened within what we called ‘the big room,’” Goodroe says. “Design process workshops included upwards of 40 stakeholders in person with several additional team members online.”

Lastly, the team members can testify to the value of incorporating design technology. “Virtual reality, cardboard mock-ups and a fully constructed patient room were used to work through operational changes and inform the construction process,” Goodroe says. “This provided an opportunity to collect the voice of the customer using their terms and language.”

One-of-a-kind experience

Battey is honored that his hospital was chosen as the 2023 recipient of the Vista Award for new construction. He credits the innovative and integrated design and construction delivery process with making this project worthy of distinction.

“Each team member brought deep expertise and respect for each other’s unique perspectives, which helped create memorable, efficient and flexible spaces that could be built within budget and on schedule. The creation and early opening of Marcus Tower would not have been possible without the incredible partnership, hard work and commitment of the integrated project leaders,” Battey says. 

Anthony Montalto, AIA, partner and chief design officer at HKS, attributes the integrated and collaborative team approach to the project’s success and this industry accolade. “Being recognized by ASHE with a Vista Award reinforces that the results are transformational and positively impactful,” he says.

Regier, the Vista task force chair, notes that it’s rare, especially on a larger project, to remain unified around what’s best for the project. “But it was evident that the team was committed to being integrated in their problem-solving, whether it be through finding efficiencies in planning with stakeholders to constant feedback on cost and schedule benefits,” he says. “This type of relationship enabled them to problem-solve around, for example, removing 600 feet of skin on the existing hospital to connect the Marcus Tower while maintaining hospital operations.”

Goodroe says, “Receiving the Vista Award is an amazing honor that we will all cherish, along with memories of our one-of-a-kind project experience.”

COVID-19 dictates early opening

When the coronavirus first hit in early 2020, health care organizations and hospitals scrambled to keep up with patient surges. Piedmont Atlanta Hospital was no exception, but it had an ace in the hole: Its Marcus Tower, under construction since 2016, was able to open four months early. That meant 132 additional beds were made available just in time.

“At that time, the world was experiencing labor issues and supply chain problems that brought many construction projects to a complete halt,” says Mindy Goodroe, AIA, ACHA, EDAC, LSSYB, LEED AP BD+C, partner and senior medical planner at HKS Inc. “But the same collaborative and integrated approach that drove our tower project from the beginning enabled us to prioritize issues and areas of the tower that could be used to serve the greater community during the pandemic. General contractor Brasfield & Gorrie, Birmingham, Ala., was able to stage construction activity and protect the team to complete the work safely and early.”

Goodroe notes that the project’s efficient design and build hardened the community’s resilience to the COVID-19 crisis. And streamlined production processes helped increase intensive care unit (ICU) utilization and enable the strategic addition of building components like a high-tech auditorium capable of hosting virtual events for both the public and health care communities.

“We received the request in March 2020 to activate ICU floors six, seven and eight in the new tower due to the pandemic outbreak. With the help of the entire team, we were able to bring those floors online three months early, in July versus September,” says David Hajjar, LEED AP BD+C, operations manager at Brasfield & Gorrie. “We did this by accelerating the completion of final finishes, commissioning, systems programming and final inspections. We worked with vendors to expedite the final medical equipment delivery and installation.” 

About the 2023 Vista Award

The following served on the task force that chose the 2023 American Society for Health Care Engineering Vista Award honoree for new construction:

• Randy Regier (chair), AIA, ACHA, president, Taylor Design, Irvine, Calif.
• Jason Piper, administrative director of planning, design and construction at AdventHealth Mid-America Region, Overland Park, Kan.
• Randy Keiser, vice president at Turner Construction Company, Nashville, Tenn.
• Mark Chrisman, PE, health sector executive and principal at Henderson Engineers Inc., Lenexa, Kan.
• Ravi Raman, PE, president at Ram-Tech Engineers PC, Syracuse, N.Y.

The task force did not select winners in the renovation and infrastructure categories.

Erik J. Martin is a freelance writer based in Oak Lawn, Ill.