While constructing the Altru Health System Replacement Hospital in Grand Forks, North Dakota, the PCL Construction team faces the challenge of keeping an existing hospital operational while constructing a new seven-story replacement hospital a mere 12 feet from the existing building at the closest point.

The team is addressing these challenges head on while keeping patient care front and center of every decision.

“When planning or discussing upcoming work with our clients, we must first consider what’s best for the patients. Maintaining that mindset helps us determine the correct course of action,” says Jon Stoeckman, senior superintendent of the Altru Hospital project. “Patient care must be the first priority. It’s the top priority for our client, and it’s the top priority for us.”

The current and the new hospitals are separate buildings, but many of their major systems are linked. Because hospitals must stay operational, they have what is called N + 1 redundancy, meaning they have enough power for their current needs and an additional full amount of that need. This redundancy has been crucial during construction, which has required turning off the current hospital's power system six times, the steam system eight times, the water system four times, and the underground pneumatic tube system, which connects the current hospital to the cancer center across the campus, 10 times. The tube system is a hidden but important function of the hospital, as it quickly transports test results and medicine to different parts of the hospital.

“This project requires touching all of the major systems that affect current patient care,” says Stoeckman. Each shutdown requires considerable planning and communication between the owner, facility staff, risk management personnel, designer, subcontractors and the PCL team.

“We have to ask ourselves, ‘How will we do it? Are we certain of the downstream effects? How do we validate those things?’” he adds. “With hospitals, failure of a system isn’t just an inconvenience. All of the systems have redundancies built in.”

With generators supplying temporary power during shutdowns, the existing hospital has yet to experience an interruption in its power supply. Shutdowns are scheduled for times when imaging and surgeries are less frequent. Before switching back to permanent power, the team communicates with the surgery department to ensure an emergency operation isn’t underway. 

Preserving accessibility to the hospital by helicopters, ambulances and patients arriving by car is also critical during hospital construction.

The team also carefully planned the layout of the construction site due to its proximity to the existing hospital. This included arranging construction traffic to ensure it stayed away from those arriving at the hospital for care.

“The main entrance, emergency department, ambulance drop-off and helipad are accessible from the south and east, so we directed construction traffic to enter from the north and west. We also maintain open lines of communication with the hospital to prevent potential issues,” said Stoeckman.

Another crucial consideration was the placement of the mobile cranes. "We had to ensure that our crane wouldn't interfere with the helicopter's path to and from the helipad," explains Trent Johnson, PCL's district manager who oversees operations throughout the Midwest.

Safety is the top priority of every PCL project, and the Altru Health System Replacement Hospital exemplifies this commitment.

According to Johnson, PCL’s culture of safety has prepared the team for this mission-critical project. The team recently celebrated 1.5 million worker hours completed on the new hospital without a single recordable incident after 28 months of construction.

"It certainly heightens our desire to ensure that not only our employees and subcontractors are safe, but also the patients, staff, and visitors,” Johnson says. “We want to ensure that their experiences are not affected by the work we are completing.” 

Stoeckman sums it up well. “On a typical project, you have a lot of financially driven conversations when trying to learn an owner’s priorities. You can associate potential impacts with costs, run the math, provide options, and the client can decide. You can’t do that here. You can’t put a cost on someone’s life. You must have the mindset that patient care is the number one priority, and nothing we do can impact that.”

The success of the Altru Replacement Hospital project can be attributed to the focused efforts on maintaining the existing hospital's operations and prioritizing patient care.