It would be a long wait.

Ten years would pass before the building had new owners, a new name—Grandview Medical Center—and an approval for Brasfield & Gorrie to resume work.

But completing the hospital’s build-out was more than a matter of the contractor simply picking up where it had left off. While time largely stood still at the hospital’s hilltop site, the rest of the world had moved on.

The new owners’ vision for Grandview as a full-service hospital differed from that of the original owners, requiring substantial revisions to interior layouts, including varying retrofits to five completed floors. Building code changes meant that the as-yet-uncertified building systems would likely have to undergo modifications and upgrades. And because many subcontractors from the original project were either out of business or booked up, a new team would have to be assembled.

The building itself provided a mix of challenges. Though the exterior appeared to have weathered the intervening years relatively well, the HVAC system had been cannibalized by the original owner over the years to keep the interior conditioned until the property’s fate was determined. There’d even been talk of demolition at one point.

Rough Prize

“A rough prize ready to be developed” is how Keith Granger, Grandview Medical Center president and CEO, characterizes the building at its acquisition. “It had been developed around a great concept and located on an attractive, accessible site surrounded by fast-growing neighborhoods.”

In early 2013, following a lengthy effort to secure state approvals, the hospital project gradually came back to life. As Nashville-based ESA Architects revamped the interior design, Brasfield & Gorrie began assessing the building’s overall condition, dusting off stacks of dated as-built documents to verify what was in place and whether it could be retained as is, modified or removed.

“It was a case of ‘what can we keep, and what do we have to tear out,’” says senior project manager Susan Stabler.

Fortunately, time was on the side of the project team, thanks to a decade’s worth of now-proven technology-based design and construction management tools. What was novel in 2003 is now in everyday use, and all of it would prove instrumental in helping fast-forward the project toward a planned late 2015 opening.

Building information modeling was among the first of the new tools put to work, with the development of a 3D model based on the structural as-built documents. Interior laser scanners helped fill in unmapped locations and types of mechanical systems, complementing field verifications of the as-built plans. The combined data yielded a complete, detailed base-structural model that was then handed off to the MEP trades.

“The thoroughness of our subcontractors’ assessments showed that there was a lot of life left in the HVAC systems after 10 years,” Stabler says. “Some pieces of equipment had to be rebuilt, but that was much better than our initial fear of having to replace several major components.”

To verify the 3D model of the building’s 250,000-sq ft skin provided by ESA Architects and evaluate its condition, Brasfield & Gorrie tapped one of the newest construction technologies of all—lightweight drones. They took high-resolution images and video that were then embedded into a virtual model and inspected by the cladding consultant.

“We were able to examine every inch of the exterior quickly and efficiently,” Stabler says. “Mainly routine maintenance was all that was needed—some recaulking of the precast and a few broken glass panes.”

As work got underway, the advent of wireless communication, electronic construction documents, iPads and other paperless management tools benefited communication across the 15-acre jobsite, particularly as Grandview’s design began to evolve. Instead of printing up 150 sets of documents for each new batch of updates, addenda and revisions were uploaded to 150 iPads in a matter of hours.

“Document control had cost us about $1 million when the project was stopped,” Robison says. “After we got going again, we spent a total of about $70,000.” He adds that the virtually instant communication afforded by the 15-acre site’s Wi-Fi network helped expedite the processing and resolution of requests for information, minimizing the amount of rework needed.

Another coordination benefit was the Last Planner scheduling tool, which helped trades synchronize their work and avoid disrupting other tasks. This was particularly important as more than 100 subs at one point were working on the hospital build-out and two concurrent projects: a  220,000-sq-ft medical office building and a 2,900-space parking deck.

Corrective Procedures

Just as a patient’s overall health can help speed recovery from surgery, the Grandview Medical Center contributed to its own revival. Because the facility had been originally designed to accommodate structured cabling and leading-edge medical equipment, the team avoided many of the difficulties in retrofitting and updating such a technically complex facility.

According to ESA project manager Craig Holloway, floor-to-floor heights in the diagnostic areas were sufficient to accommodate modern diagnostic imaging systems.

“We did have to locate the larger imaging equipment in their original locations, as the structural path for their installation had already been set,” Holloway says. “Most of the lower-floor clerical areas were completely gutted so that we could implement Grandview’s planning standards.”

Some changes to Grandview’s infrastructure were more complicated than others. Revamped layouts required cutting a 5,000-sq-ft section of 6-in.-thick concrete slab in the building’s first-floor kitchen and drilling more than 500 cores on the 10th floor to reroute plumbing connections. One of the five originally completed patient floors was also gutted to create space for an intensive-care unit and mechanical systems.

Though cost control is critical in every project, Grandview’s mix of new and retrofit activities continually presented a number of “moving targets” to contend with, not all of which could be planned for. At the project’s outset, Brasfield & Gorrie’s team developed a replacement allowance for component failures during the construction phase, calculating a figure between the best-case scenario of minimal rework and the worst one of full replacement.

“We came within 0.5% of our estimate,” Stabler says.

Robison adds that the project’s organization likewise helped maximize trade resources, with multiple subcontractors in the same trade working on different parts of the project. “That ensured an immediate back-up resource if a subcontractor in another part of the project needed short-term help,” he says.

Having separate management teams assigned to specific floors also provided more direct control over the work, instilling some friendly internal competition on beating schedules as well.

“I think there were even some bets involved,” Robison says with a laugh.

The ultimate winner was Grandview Medical Center, which welcomed its first patients in early October 2015, six months ahead of schedule, and for a total cost of $280 million, including the medical office building and garage.

“It’s exceeded our best hopes,” Granger says of the once “rough prize,” adding that the building “has worked beautifully.”

Though technology may have played a leading role in the hospital’s revival and successful completion, Ed Hauser, Brasfield & Gorrie vice president and division manager, asserts that the true “star” was collaboration across the project team.

“There was a recipe for this project to not go well, and we made sure it didn’t happen,” he says. “The level of trust was pretty incredible.”