By AIA Contract Documents, February 14, 2020
The 300,000-square-foot MHP Medical Center in Shelbyville, Indiana was one of the first post Affordable Care Act facilities to be completed in the United States when it was opened in 2017. The facility, built by Major Health Partners (MHP), meets the Centers for Medicare & Medicaid Services (CMS) standards for funding and reimbursements and is one of the first hospitals in Indiana to implement a complete electronic medical record for its patients. Today, it ranks among the best for inpatient satisfaction in Central Indiana.
The hospital’s continued high performance is in part due to MHP’s early focus on designing a facility that is patient centric, operationally flexible and disaster ready—all in an energy-efficient environment.
MHP’s new estimated $89 million healthcare facility was constructed utilizing a conventional design-bid-build procurement.
Early on in the conceptual planning for the new facility, MHP looked for advice and guidance from its executive architect, Richard Alan Fetz, AIA, to develop a predesign package that satisfied all desired objectives (i.e., patient-centric, operational flexibility, disaster readiness and energy-efficiency).
From how patients and medical personnel move through the hospital to the ability to adaptable workspaces, the hospital is designed to adapt as needed by occupants. The building is also designed to add an additional 140,000 square feet if needed for future growth. Even more impressive is the hospital’s disaster preparedness. Not only is the structure designed to take a direct hit by a tornado, it also includes an innovative structural window film that can withstand extremely high wind events and power generators capable of running the entire hospital (not just life safety and critical branches). Even the mechanical penthouse is protected by structural louvers to the protect the air handlers in case of severe weather events.
Once designed, the MHP team developed the request for proposal (RFP) and a quality-based process with a scoring system for selection of the architect, engineers and the contractor.
“We had a scorecard that helped us select the best team for the job,” said Fetz. “We knew with our tight budget and timeline that we would need a well-coordinated team. It’s one of the reasons that our scorecard included a requirement that the president/CEO of the construction company participate in the interview process. We felt that that participation helped form the necessary attributes of commitment, communication and collaboration.”
“Another requirement was the use of AIA construction contracts and forms. “Our RFP specified the use of AIA documents throughout largely because MHP trusts these documents to cover all areas of responsibility. Vice President Jeff Williams has a long history with AIA documents, and championed the use of them instead of custom agreements.”
Every agreement, whether architect or engineering consultant, began with the B101-Owner/Architect Agreement. Unlike many healthcare owners, MHP wanted to contract separately with the architect and engineering consultants, particularly the mechanical, electrical and plumbing (MEP) contractors to provide flexibility and innovation in delivering the most cost effective, energy efficient solution.
Fetz added, “We wanted the MEP design engineer
, in particular, to be able to speak freely and not be tethered by the architect.”
MHP saved money on the project, according to Fetz, by using the AIA standard documents with minor modifications to suit the unique aspects of this project. He noted that many owners for healthcare projects look to attorneys to develop construction agreements, which can cost upwards of $40,000 to $80,000 for typical construction agreement.
“A large hospital project might have 10 different agreements—at $40,000 a contract, that’s $400,000. That will buy a lot of construction,” said Fetz. “More importantly, since these documents are typically not written by attorneys with construction experience, the documents will often have holes that can cause problems down the road. For this project, we had a defined amount of money to build as much as we could. The AIA standard contract documents, which are written by attorneys knowledgeable about construction, saved considerable cost on this project.”
Of note, besides the B101-Owner/Architect Agreement, MHP relied on several AIA forms to manage the project during construction such as Forms G702 & G703 Contractor’s Application & Certificate for Payment and the G701-2017 Change Order form to name a few. These documents also set a necessary foundation for collaboration when issues arose and as the owner and project team strived to meet the defined project goals.
One of the unique aspects of the MHP Medical Center design was the emphasis on energy efficiency. The MHP/architect and engineering agreements specified an ENERGY STAR score of 90 or above. The Department of Energy’s ENERGY STAR program provides tools and resources for strategic energy management.
Fetz recalled, “Our target was an aggressive ENERGY STAR goal of 95 or higher. Fortunately, our engineers were big proponents of this program. And once again, the standard contract documents helped build consensus and save money.”
For instance, during the design, CMTA Consulting Engineers, the mechanical contractor for the project, recommended added insulation to meet the energy goals, but the architect, BSA LifeStructures disagreed because of budget concerns. With help from an independent cost estimator, the two came to an agreement about additional insulation and equipment sizing that met the project goals.
“The AIA agreements stress coordination and ultimately,” Fetz continued, “we were able to get an open conversation between the architect and engineer to find a solution that worked. A large part of our success was the input from the independent cost estimator—an investment that I highly recommend on projects such as this—and our architects and MEP engineers.”
Thanks to a great design, good planning, collaboration and sound contract documents, the MHP Medical Center achieved an ENERGY STAR score of 97 when it opened in 2017 and it was built to an almost unheard of $248 per square foot (norm was around $400 per square foot in the area). The ENERGY STAR score is now 99 because the MEP team continued to tweak the electronic heating and cooling controls.
More importantly, the facility continues to meet MHP’s patient-first, operational flexibility and disaster readiness objectives.
In 1890, the original Major Hospital was built by Alfred Major as a home for his family. While Alfred died of typhoid fever in March 1889 while the elaborate mansion was under construction, his son, William, completed the home and moved in. He and his wife moved in the house in 1890. William died in 1915 and in his will specified that after the death of his wife, their home be given to the City of Shelbyville to be used as a hospital.
However, Mrs. Major, an invalid suffering from arthritis, wanted the property turned into a hospital as a memorial to her husband while she was still living.
With a room in the facility, she watched the renovation of the home into a hospital. She lived in the hospital, greeting guests from her rocking chair in the parlor, until her death on Christmas Day, 1929.
The rocking chair of Mrs. Major is on display in the hospital’s main lobby. A stone arch structure salvaged from the original mansion is also incorporated into the entry vestibule.