By: Nicole Imeson

After New York closed on March 13th, 2020, Chris Pell, a Senior Associate at JB&B in New York City, was working in his home office for a week when he received a call to commission a 1,024-bed Alternate Care Facility (tent hospital) at the athletic facilities of SUNY Old Westbury, a University on Long Island, NY. The project included four large tents and the university's gym, each equipped with nurses' stations, bathrooms, showers, medical gas, and associated mechanical, plumbing, and electrical infrastructure. In just 28 days, the AECOM-led design-build team completed the facility, including designing, constructing, and commissioning. 

"Day one we showed up, there was an empty gym and empty baseball fields, and day 28, there were four tents, which along with the gym had been converted into space for over 1,000 hospital beds," explained Pell.

Ensuring the operational functionality of all systems and components is crucial for healthcare facilities to meet the requirements of diverse healthcare teams. As an emergency response to the COVID pandemic, the facility had to prepare to treat illnesses of varying severities, prioritize infection control, and ensure the safety of staff and patients as the COVID response progressed.

Team Building

Due to the extremely tight timeframe, the team quickly adapted to expedite tasks. Various components operate independently during construction projects, and teams may isolate themselves with distinct goals. Collaboration can prevent errors, reduce rework, boost productivity, and enhance morale on-site, but it takes time to get to know everyone, understand their roles, strengths and weaknesses, to form a cohesive unit. However, on a 28-day project, team building must occur almost immediately for efficient work. "The normal team building process, that you usually have the luxury of at least weeks, if not months, to unfold; that happened in the span of hours to maybe a day here," explained Pell. 

The project's success hinged on the full functionality of equipment operation and system interconnections within the critical facility. Unlike a conventional healthcare project with consistent equipment in each patient room, the Old Westbury project required the team to use available equipment, resulting in slight differences in the equipment serving each space despite similar usage and operation. Commissioning providers had to dynamically adjust functional tests to accommodate minor variations between manufacturers and equipment performance. 

"Early consistent involvement from someone with a commissioning mindset was hugely important to the project," explained Pell. The commissioning provider acts as a bridge between silos for various disciplines as they examine the big picture and commission various individual scopes and interconnections between disciplines. The commissioning team at Old Westbury collaborated with designers to identify operational or constructability issues and made changes on the fly, allowing contractors to focus on building. 

To meet the project deadline, most of the team, including design to commissioning, were physically present on-site throughout construction and in constant communication with the remainder of the design team working remotely. A workforce of up to 500 people worked around the clock to complete the project. They operated in two 10-hour shifts, with two hours between each shift for sanitization. This occurred during the early stages of COVID-19, before much was known about its transmission, severity, or lasting impact. 

A United Mission

The project thrived on a major asset: everyone united around the common goal of creating a facility for COVID-19 patients. This common purpose naturally brought the team together at the project's outset. Guided by a mission directive from FEMA (Federal Emergency Management Agency) and USACE (the US Army Corps of Engineers), the project leaders employed a military mindset of physical and mental resilience, staying focused to complete the project. They also drew on their experience in rapidly mobilizing large-scale operations to keep the team on track. Failure was not an option. 

The project sharpened the focus on priorities — save your ammo for the shots that count. There was no room for egos or disputes; the primary concern was finishing the project and providing a functional facility for healthcare teams to treat patients effectively. All parties had to engage in transparent and open communication to ensure value for the end user, address arising problems, find solutions, and comprehend the reasonable timeframes for each task, ensuring the project's continuous progression. Accountability from every team member also played a role in building trust and ensuring the fulfillment of commitments. 

In a traditional healthcare project, the facility is expected to operate for decades, with each healthcare department dependent on having the necessary infrastructure in the right locations. However, those departments can be excluded from design and construction, often only visiting the site after the space is complete. At that point, revising device locations or room orientations can be challenging and costly. Involving healthcare end users early in the process can help eliminate rework by understanding how they plan to use the space and where value can be added. "The mission from USACE allowed us to focus on the singular mission and cut through some of the red tape that can often bog down traditional healthcare projects," explained Pell.

Same Place, Same Time

In the digital age, post-COVID, we've transitioned to virtual meetings, project management software, and emails as the primary means of communication. While these tools can be effective, this project underscored that "there's no replacement for the boots on the ground because, without that, this would never have worked, especially in a complex building like a healthcare environment. The design engineers, the architect, everybody was all there in the same space, looking at the same things, speaking the same language", explained Pell. Most healthcare projects take years to complete and lack the budget to have the entire team on-site full-time. However, the Old Westbury ACF tents project reinforced that bringing everyone together at critical points in the project was more beneficial in resolving conflicts that span multiple disciplines quickly and efficiently. 

The BCxA Best Practices outlines the fundamental principles of commissioning, which apply to various types of buildings. However, healthcare projects require additional considerations because of the criticality of their life safety systems, concerns for patient safety, and continuous 24/7 operation. American Society of Healthcare Engineering (ASHE) and the BCxA are partnering to promote building commissioning and create educational tools for members of both organizations. This partnership includes the revision of ASHE's Health Facility Commissioning Handbook.