By Jeff Monzu, M.SAME, and Pete Yakowicz, P.E., M.SAME
Completed in 1950, the 12-story Omaha VA Medical Center was, after several decades, straining to continue providing all the services demanded of it. The Nebraska-Western Iowa Healthcare System of the Department of Veterans Affairs (VA) had tried for many years to procure federal funding to upgrade the aging facility, but it proved challenging.
The prescription to completing the necessary upgrades instead would come in the form of innovative project delivery and a commitment to working collaboratively and creatively.
Public-private partnerships, which combine resources from both public and private sources and similarly share risk, have been increasingly leveraged by state and federal entities since 2010. They have been used extensively to deliver major infrastructure projects such as highway and transportation improvements, and in August 2020, the VA completed the Omaha VA Ambulatory Care Center, the department’s first healthcare project delivered through a public-private partnership.
The new 157,216-ft2 facility is connected to the medical center, relieving the main hospital of the most common outpatient services. It houses eight primary-care clinics (including one exclusively for female veterans), one specialty care clinic, a radiology department, and an ambulatory surgery suite with five operating rooms. Supporting the ambulatory surgery are a prep/recovery unit, laboratory, and satellite pharmacy.
THE VALUE OF PARTNERSHIP
In 2010, Congress budgeted $56 million to fund the design process of a replacement medical center for what was then a 60-year-old hospital in Omaha. However, the project never materialized because VA’s limited available funding for major projects was applied to other priorities.
Throughout, the funding for the design process remained allocated, and in 2016 local business leaders and philanthropists formed the Veterans Ambulatory Care Development Corporation (VACDC). This team worked with bipartisan Congressional representatives to pass the Communities Helping Invest through Property and Improvements Needed (CHIP-IN) for Veterans Act of 2016. The legislation allowed for the donation of $30 million in private dollars to fund and expedite the project.
Unlike previous VA healthcare projects, the design and construction work took place concurrently. The entire project team collaborated with doctors, clinical staff, and leadership to apply performance specifications and project-tailored criteria rather than the universal standards used for most VA healthcare projects.
Another departure from previous VA healthcare projects was that delivery was managed by the private sector. Wanting their donations to streamline the delivery process and optimize project value, the donors built in the condition that the VA yield control. The result was a state-of-the-art ambulatory care center delivered in 36 months, roughly 16 months ahead of comparable projects, and ultimately saving the department about $34 million.
CREATING FLEXIBILITY FOR DESIGN
The VA maintains universal design criteria for its facilities, but since this project would weave between public and private delivery, that criteria was adjusted, creating flexibility for innovative design and construction. Well-versed in the VA’s universal design criteria as well as private sector standards for healthcare project delivery, Omaha-based LEO A DALY partnered with VACDC to identify the most applicable aspects from both.
For instance, standard VA criteria universally requires that all curtain walls be visually simple and linear. However, the symbolic architecture conceived in early sketches was a prime mover, and so delivery had to accommodate design features outside the specifications typically prescribed. As a result, the new medical center features a signature curtain wall on the north façade that is neither visually simple nor perfectly linear and perpendicular. It is a transparent curtain wall with segments extending in two dimensions, creating the visual analog of a windblown American flag to symbolize freedom and acknowledge the sacrifice of military veterans.
The flag wall is one of the facility’s three hallmark architectural features. Another is an interior limestone wall that serves a physical security role in separating public spaces from secure clinical areas. The layers present in this design feature symbolize the sediment tracked home from foreign soil, and the alternating periods of peace and war. The third hallmark feature is another signature curtain wall that forms the west façade. A kaleidoscope of colored glazing runs the length of a connecting corridor to the original hospital. Each hue and pattern was designed to conjure the multicolored ribbon bars worn by military servicemen and women. The colored film specified by designers also contributes to the wall’s blast resistance.
These architectural features were considered “sacred” among members of the project team, including designers, contractors, and VACDC. The delivery method allowed for the features to be “protected” through each phase.
INTEGRATION & COLLABORATION
A notable benefit that grew out of the project’s unique delivery approach was the virtually seamless integration of design and construction. A typical VA project rigorously delineates the two, with contractors becoming involved months after design is complete. However, for this project, the general contractor (McCarthy Building Companies) was selected by VACDC concurrent to design, allowing builders to join the project conversation early on to maximize value.
Conversations took place throughout the timeline, which served to inform design decisions as well as construction phasing. Subcontractors and fabricators were interviewed by both LEO A DALY and McCarthy before beginning work. As the architecture developed, designers were able to ensure that fabricators and subcontractors had the tooling and expertise to perform work adequately, within budget, and, in most cases, ahead of schedule.
A good example of this partnership is exemplified by the decision to use 63-ft steel columns for the superstructure. The design initially called for two column lengths, one 26-ft and another 37-ft, which would have to be stacked and assembled. Through a collaborative process, a decision was reached to combine the two into a single column that both cut time and labor and enhanced the speed of construction. The structural design documents were modified to accommodate, which simplified fabrication and reduced the time and labor required to construct on site.
Another example of the strength of partnership on the project is the signature flag curtain wall. Toward the end of design, McCarthy brought in Architectural Wall Systems as a subcontractor to manufacture it. Close coordination ensued. As a “sacred” element of the design, the folded appearance of the curtain wall needed to meet high architectural standards. At the same time, the wall’s structural gridwork had to meet engineering thresholds to resist a multitude of forces. It also needed to mate precisely with the facility’s underlying steel superstructure.
SERVING THOSE WHO SERVED
The merits of alternative delivery for VA healthcare projects continue to gain steam. A second public-private partnership is underway in Tulsa, Okla. And in December 2020, the Government Accountability Office released a report recommending that the VA share lessons learned from the Omaha VA Ambulatory Care Center for similar ventures in the future.
For the veteran community served by the Omaha VA Medical Center, the new ambulatory care center fulfills a commitment “to care for him who shall have borne the battle” and more importantly, a faithful community’s pledge to overcome the obstacles that might have impeded that commitment.
Jeff Monzu, M.SAME, is Vice President and Market Sector Leader – Healthcare, and Pete Yakowicz, P.E., M.SAME, is Vice President and National Director of Veterans Affairs Programs, LEO A DALY. They can be reached at firstname.lastname@example.org; and email@example.com.
[This article first published in the May-June 2021 issue of The Military Engineer.]