MD Anderson Cancer Center Alkek Expansion

The Challenge

The main challenges on the project were how to keep a busy cancer hospital operational and thriving, while minimizing traffic disruption in this urban setting during major construction work. Along with these issues was the need to communicate with the various project stakeholders, keeping the hospital, construction, and architectural staff in alignment with the scheduled work. 

As if this project was not complicated enough, the hospital was surrounded on all four sides by large buildings and bustling streets in the Texas Medical Center—the largest concentration of healthcare facilities in the world. The snug project site left no room for even one tower crane, when a project of this scope would typically require three. The team was faced with finding the space to house the crane, creating a schedule to expedite construction with just the use of one crane and assembling and disassembling it in a safe and inconspicuous manner.

Building a significant expansion within an active hospital occupied by patients with compromised immune systems presented additional obstacles, such as noise mitigation and infection control issues, as well as providing safe demolition and vibration control. In addition to the 12-story vertical expansion, the project incorporated a structural steel horizontal expansion that was built simultaneously, requiring creative scheduling for the different trades to complete the job. Furthermore, the team was charged with planning for hurricane weather conditions, which are prevalent in this part of the country.

The How

Faced with numerous obstacles, the design and construction team had to think of absolutely everything to ensure that patient care would not be compromised during a complex expansion and renovation project. Although the challenges were formidable, the following measurable areas of team pre-planning and follow-through comprised the right prescription for success:

• The design-build team of McCarthy/HKS was hired in the project’s pre-design stage to participate in end-user meetings and perform preconstruction services, including estimating, constructability reviews and value engineering services. The team’s presence during design meetings helped the integrated team truly understand the hospital’s needs and ensured the hospital was fully informed of changes that would impact the project’s budget, scope and schedule.
• More than doubling the hospital’s elevation, McCarthy’s solution-oriented approach enabled the team to find a way to increase the tower’s size from 10 floors to 12 and match the building’s facade with the 20-year-old structure. Glass fiber reinforced concrete (GFRC) was used for the building skin, enabling the foundation to support the weight of the additional floors while staying within the existing budget. To complement the existing precast concrete, several GFRC materials were studied at the factory to achieve a seamless design.
• With more than 750 planned shutdowns of electrical, plumbing, medical gas, HVAC, security and fire alarm systems needing to occur during construction, the team had to work swiftly to extend services to the new floors while ensuring continual operation within the hospital. Due to the complexity of the system integration and the potential impact to the hospital, the many shutdowns were conducted in small spurts and doses. Although this complicated the project schedule, this method allowed workers to complete sensitive work in an unobtrusive manner.
• Developing strong relationships and regular communication with hospital helped maintain ongoing operations within the hospital throughout construction. Project managers took time to get to know the nurses, visitors and maintenance staff, providing them with contact information and communicating with them daily about current and upcoming construction work. A weekly hospital planning meeting between the renovation work manager and representatives from each internal department further alerted hospital staff of upcoming construction work. It also gave them ample time to collaborate with the construction team to mitigate any impacts.
• For approximately two years, the building team worked 24/7 to complete a large amount of renovation work inside the hospital that could not occur during the day. Noisy work such as jack-hammering was conducted in 15-minute spurts, with breaks in between.
• To further eliminate noise and vibration during construction, the 12th floor of the existing building was closed during construction, creating a buffer between the upper and lower floors. The team also attached the concrete delivery pipe to a tower crane mast alongside the existing building instead of running it through the inside of the hospital. This solution allowed for constant access to the pipe and separated it from the existing hospital structure, thereby reducing vibration.
• Another innovative construction solution was the tower crane’s placement and use. Situated among the largest concentration of healthcare facilities in the world, there was no space outside the Alkek Hospital to station a tower crane. To mitigate this challenge, the design-build team crafted a novel idea allowing for placement of the crane in an unused elevator shaft of the existing building. After cutting a hole in the roof, the construction team lifted sections of the tower crane through the shaft piece by piece, facing obstacles including sight visibility, noise control and wind resistance. 
• Since they only had room for one crane, construction personnel had to devise the best sequence for not only a concrete vertical expansion, but also a structural steel horizontal expansion that housed five additional elevators and lobby space to service all 24 levels of the facility upon completion. The team determined the concrete work had to be completed during the day, followed by building the steel structure at night. The different trades successfully utilized the crane day and night for 20 months.

The Outcome

Motivated by MD Anderson Cancer Center’s mission to “end cancer everywhere,” McCarthy, in close collaboration with HKS and other key team members, successfully completed this project ahead of schedule. McCarthy did it within budget, taking the client’s expectations to new heights, literally.

The design and construction team never forgot the experiences the patients and their families were going through were significantly more difficult than anything they would encounter during the three-year project. That motivation was enough to go above and beyond to help ensure business as usual conditions for the hospital staff without the imposition of extraneous construction issues.

Preparing for catastrophic weather conditions well in advance serves as an outstanding example of this approach. A hurricane did strike during construction— Hurricane Ike —but the team’s pre-planning and coordination successfully weathered the storm without any impact to patients and hospital staff.

The collaborative team spirit between the design-build team and MD Anderson allowed McCarthy to test various design and construction concepts and arrive at the most cost-effective solution for meeting the Cancer Center’s patient-centered design and programmatic requirements. The project team effectively realized the strategic impact this life-saving facility would have not only on the staff, but also on the patients and their families dealing with cancer. The result is a comforting, world-class clinical cancer care hospital providing hope for a healthier tomorrow to more patients than ever before.