Memorial Hermann Health Care

Sticking to the plan About five years ago, Memorial Hermann launched a massive building boom pegged to the systemÔÇÖs 100-year anniversary. Well over $1 billion worth of projects got done on schedule, and Keith Regan reports on the keys to that success story.  Memorial Hermann officially came into being in the 1990s when two large Houston-area hospital networks merged into a single not-for-profit network of urban and suburban healthcare facilities.  Today the system is widely recognized for its acute and specialty care services. In 2007 the system logged 131,752 inpatient admissions, more than a half million outpatient visits, and delivered more than 25,000 babies. The system operates seven cancer centers that have been cited for their excellence and has won national recognition for its stroke treatment facility. Several years before the first hospital in the system was slated to mark 100 years of service to the community, Memorial Hermann embarked on an ambitious building program that boosted the amount of ongoing projects as high as $1.4 billion at its peak. With the centennial anniversary coming in 2007, many of the projects had target completion dates during or before that year. According to David Wilkerson, the systemÔÇÖs director of architecture and construction, all the building and renovation projects pegged to be done by the anniversary date were done on time, on budget and according to the original design, a direct result of senior leadershipÔÇÖs belief that it had to stick by the decision to keep projects on track. ÔÇ£Different owners have different attitudes about schedule and budget, but for us they were both fixed in stone,ÔÇØ Wilkerson says. ÔÇ£We made it clear from the outset that the contractors couldnÔÇÖt ask for more money or for extensions of time. In my opinion, it actually makes decisions easier as projects are under way because you now have a framework to work within. If you start to let contractors know that maybe they can get more time or add cost, thatÔÇÖs what will happen. For us, they were fixed and we stuck by them.ÔÇØThat decision did force some others to be made along way. In one case, the size of a project was scaled back before work began. ÔÇ£We were able to downsize the project without really changing the program of it,ÔÇØ Wilkerson notes. The building growth was driven by a long and steady expansion of the population in the area the system serves, with the oil-based economy continuing to grow even as the rest of the country teeters on the brink of recession. To help expedite projects, Memorial Hermann used prototype designs when possible, developing a model community hospital building that it used in two suburban locationsÔÇöSugar Land and KatyÔÇöas well as a prototype medical plaza, or professional medical building, a design it used a half-dozen times with slight variations to match local topography and other conditions. That approach also enabled the projects, all of which were handled through a traditional design-bid-build process, to move along faster. Speed was key for another reason: Memorial Hermann managed to get into the construction market before the region went on a building spree that continues today. Because the market was less volatile than it is today, the design-bid-build process enabled the system to drive project savings that it would have had to surrender with a more aggressive approach. Each project was also put out to competitive bids at each stage, a decision the systemÔÇÖs board made to assure the public that no favoritism was taking place. In all, the system completed renovations or construction of five hospitals, seven medical plazas and 14 outpatient facilities, such as imaging centers, day surgeries and specialty clinics. The largest project done in that time frame was the only one the system knew would not be ready in time for the 2007 centennial. The $117 million Heart and Vascular Institute at the Texas Medical Center campus was a challenge because it was built on a small and odd-shaped parcel of land near the entrance to the medical campus, which has always been fronted by a more historical building. ÔÇ£There was a lot of sensitivity to preserving the historic appearance, and I think the project truly did accomplish that,ÔÇØ Wilkerson says. The resulting structure is a triangular-shaped building with a curved-glass front with an outside fountain that helps create a focused entranceway to the campus. ÔÇ£ItÔÇÖs a building that would never be built by a community hospital, except for the fact that it was all you could do on that corner and on that site.ÔÇØ The project was funded along with the others through a capital campaign the nonprofit system ran in conjunction with its 100th anniversary. Another surge in building projects is already being evaluated by the systemÔÇÖs board of directors as the expansion continues to meet the needs of the Houston areaÔÇÖs population. A challenge for the system is dealing with the large number of uninsured patients who come through the doors each year, Wilkerson notes, with the region having the highest percentage of uninsured people in the United States. As those new building projects get under way, the same management approach and philosophy will be in place. WilkersonÔÇÖs office will continue to manage projects closely, using outside project management consultants on larger projects but keeping a close eye on all the work with regular meetings to keep driving home the need to stay ÔÇ£on schedule, on budget and on scope.ÔÇØ ÔÇ£When you have the support from the senior leadership to stick to your guns, it makes it a lot easier to manage projects,ÔÇØ says Wilkerson, who was in the midst of helping the system prepare for the arrival of Hurricane Ike in the South Texas area. ÔÇ£It really helps when you can be clear about expectations and pass that down to the architects, designers and contractors you work with. Everyone appreciates knowing theyÔÇÖre on the same page.ÔÇØ ┬á