London Health Sciences Centre and St. Joseph's Health Care, London

Building a better system together┬áA decision to merge what were once seven hospitals under two systems helped pave the way for London Health Sciences Centre and St. JosephÔÇÖs Health Care, London, to begin a wave of construction that continues today, Keith Regan learns.  Nearly a billion dollarsÔÇÖ worth of new construction and renovation is coming together on the London Health Sciences Centre (LHSC) and St. JosephÔÇÖs Health Care, London, campuses in Ontario, the result of decisions made several years ago to coordinate the resources of multiple hospital sites by enabling each hospital organization to focus on what it does best. Rather than continuing to compete, the hospitals came together, established roles for each institution, and have been focused since on building the infrastructure needed to carry out that mission, says David Crockett, integrated vice president of facilities management. ÔÇ£There was a decision made to collaborate, and now itÔÇÖs clear who does what and what the different priorities are,ÔÇØ Crockett says, adding that credit goes to the three women board chairs in 1997 who saw the need to find common ground rather than competing for limited resources. The system then leveraged internal cooperation into buy-in from other stakeholders, including the local community, the Ministry of Health, direct financial donors, and municipal, provincial and federal representatives who in turn have given the hospitals access to new financing and construction models. ÔÇ£If it hadnÔÇÖt been for the collaboration up front, we probably would have spent a lot more time negotiating and not actually building,ÔÇØ Crockett adds. Instead, the hospitals are now well into the second phase of a second milestone project, with more construction work still entering the pipeline as well.┬á The first group of projects, known as Milestone I, enabled significant consolidation across the network, with emergency rooms, critical care units and most high-technology department such as MRI and imaging all upgraded or renovated. This stage moved both organizations substantively to the aligned missions and roles. Milestone II is now well under way, with two phases currently under construction. When all related work is wrapped, the project will be worth close to $400 million, with the capstone projects bringing 700,000 square feet of new or renovated space online. The completion of that phase will enable the oldest hospital in the network, built in 1875, to be shuttered. The latest work is being done as an Infrastructure Ontario procurement project, with EllisDon Construction taking the role as construction manager at risk on the project while also being responsible for securing the $260 million financing for construction costs. Financing has come from a consortium of Bank of Nova Scotia, Canadian Imperial Bank of Commerce, Manufacturers Life Insurance, Pacific and Western Bank of Canada and Toronto Dominion Bank.The model has worked well so far, with construction starting in summer 2008 and three clinics that were scheduled to open in February and March 2009 all opening within 10 days of the original plan. Longer-term parts of the project remain on schedule as well, Crockett says. In addition to the unique model, the project is also the largest the hospital system has ever put out for bids at once, with the decision to bundle work helping to attract bids from a strong group of larger contracting firms and providing those builders with additional flexibility and opportunities to find cost savings of their own.┬á ┬á┬á┬á Keeping the schedule is important for more than the usual reasons of avoiding escalation costs. As parts of the master system plan come together, some 2,000 individual moves around the campus hinge on work being done on time. The hospitals worked extensively with consultants and internal staff to plan and schedule the various moves over the life of the project in a way that minimizes disruption to caregiving while ensuring that new and upgraded space is occupied and older space phased out of use as soon as possible. Some moves involve individual offices/clinics and may be done overnight or in a matter of days, while others, such as the migration of the perinatal and neonatal intensive care unit involving 600 staff, will unfold over a two- to three-month time frame before the space is open for care. ÔÇ£TheyÔÇÖll spend some time getting their staff oriented to the new space and becoming comfortable with the new facilities and equipment before they finish the move,ÔÇØ Crockett says. ÔÇ£When you look at all the pieces of the puzzle that are being moved around, itÔÇÖs quite an undertaking, and it takes a lot of cooperation, teamwork and communication to make it all work.ÔÇØAs a result of the second milestone group of projects, St. JosephÔÇÖs will see 200,000 square feet of renovated space, including new cataract suites, a new urology clinic, space for diabetes and endocrinology clinics, a 30-bed short-stay surgical center, modernized urgent care center, eye care center, endoscopy, gynecology and ENT clinic upgrades. On the LHSC side, immediate improvements will include a renovation of the ear, nose and throat clinic, renovation of an existing orthopedics and sports medicine clinic, a new 25-station dialysis center and a new fertility clinic. The phase 2 component will consolidate specialized laboratories, imaging, womenÔÇÖs and childrenÔÇÖs care, adult and childrenÔÇÖs acute mental health, additional beds for care and medical day procedures.In the future, the hospitals will put the finishing touches on its acute care infrastructure and then turn its attention to a specialized mental health facilities development on two sites. While still in the early planning and design stages, that project will be carried out under a design-build-finance-maintain model. ÔÇ£We try to remain flexible, and when we have a greenfield project where giving a general contractor some additional flexibility can enable them to introduce some innovations on the design and construction side, we want to do that,ÔÇØ says Crockett. The ongoing and upcoming work will add some 93 beds to the system, a 10 percent increase. ÔÇ£A lot of good things will happen as a result of this work, both for the community and our clinical caregivers,ÔÇØ Crockett says. ÔÇ£WeÔÇÖre essentially creating a new system with defined roles and the latest thinking in design and technology all at our caregiversÔÇÖ fingertips.ÔÇØ  ÔÇô Editorial research by Jim Rose┬á