Turner Construction – Cleveland Clinic Cancer Building

The new Cancer Center at Cleveland Clinic aims to go beyond improving treatments, but to also provide holistic care for its patients. At $276 million - $190 million for construction – the project is a major addition to Cleveland Clinic’s campus and will help keep the nonprofit academic medical center ahead of its peers.

Once it opens in 2017, the facility will become the central building for cancer care on the main campus and replace Cleveland Clinic’s Taussig Cancer Institute, which is already the largest cancer program in Ohio. The Taussig Institute has more than 250 doctors, nurses and other healthcare professionals that provide advanced care to more than 14,000 cancer patients each year. The new cancer center, which has not yet been named, will allow Cleveland Clinic to expand its reach and cancer services even further. The building will enable Cleveland Clinic to organize multidisciplinary groups by disease and each team will have its own dedicated clinical practice area. Using this layout, the care team will be centered around the patient throughout their course of treatment.

The team behind the building of the new cancer center has an equally impressive history that spans the globe. Turner Construction has earned a reputation for successfully undertaking large, complex projects in a variety of fields, from data centers and healthcare buildings to the Indianapolis Zoo’s Simon Skjodt International Orangutan Center and Levi’s Stadium in Santa Clara, Calif., home of the San Francisco 49ers. Turner Construction has about 5,200 employees and oversees 1,500 projects each year.

Turner Construction broke ground on Cleveland Clinic’s cancer building project on Sept. 11, 2014. Of the facility’s $276 million estimated cost, $190 million is for the construction part of the project and the remainder is for the soft costs, such as furniture, fixtures, and medical equipment. The building will be seven stories tall with a full basement, encompassing a building area of 377,000 square feet.

During the planning process, Cleveland Clinic considered several new sites or expanding other buildings – including the existing Taussig Institute – before deciding to locate the new cancer center on the east side of the main campus due to the adjacency to the outpatient Crile Building and clinic surgeons, according to Owner’s Representative David Doren. After the new cancer facility opens, the Taussig Institute will be repurposed and backfilled with other services, Doren adds.

Consolidating Treatment

How doctors and medical professionals care for patients is driving many of the choices made in the new cancer center’s construction and layout. “The design of this building will make for a much better patient experience,” Doren says.

At present, many of the radiation services – including gamma knife and linear accelerator (LINAC) – are housed in separate buildings, meaning that patients frequently move between facilities. The new cancer center will change that by consolidating all the services in one structure. Further, the new facility will have six LINAC machines and expand the number of chemotherapy infusion rooms from 81 to 98. The number of exams rooms will also grow from 107 to 126. 

Having all the cancer services under the same roof will improve the overall experience for patients while also making the treatment process easier on their families. Having all services under one roof brings all the physicians and services to the patients, allowing for multidisciplinary care and enhanced communication with caregivers. “[Patients] could spend many days at the campus getting the treatment they need,” Doren says. “It’s a more accommodating environment for patients and family to be served in one location.”

A number of other amenities in the building are designed to improve the treatment process and boost the confidence of all cancer patients by assisting in maintaining a positive self-image throughout their treatment. The healing gardens on the north side of the building honors the campus’ master plan. They connect to the East Crile Mall and will serve as a calming element for building users. “Patients and families can step outside to a space for inner reflection when they need,” explains Jennifer Storey, project manager with Stantec Architecture, one of the two architectural design firms on the project, along with William Rawn Associates of Boston. The gardens will also be viewable from the chemotherapy infusion rooms, where patients spend hours at a time. “To have this green space to look out on will provide patients a distraction we hope will ease their stress while they are receiving treatment,” Storey adds.

The building features a glass design that allows the maximum amount of natural light in most every area. Although daylight has a calming effect, Turner Construction and the building’s designers are including shades and dimmers in rooms to control brightness for patients who are sensitive to light. Automatic solar sensors on the of the building will also be able to activate building shades.

Taking Shape

Construction of the building began last fall with the installation of the soil retention system and mass excavation of the basement, which included the removal of 75,000 cubic yards of soil and shale to make way for the start of the foundation concrete in December 2014. The structural steel erection commenced on April 15, 2015 as planned despite pouring large quantities of concrete foundation through an unusually challenging winter. The structural steel is approximately 60 percent complete as of early July, according to Cliff Kazmierczak, vice president and project executive of Turner Construction, and is expected to be topped out by Aug. 10.

Concrete pours on the metal deck will begin in late July and continue through fall as the building frame continues to take form. Around the perimeter of the building, underground utilities will be installed upon completion of the structural steel. Kazmierczak says the project will be substantially complete by December 2016.

February Delays

An unusually cold and harsh winter caused a number of early challenges in the cancer building’s construction. Crews were unable to pour concrete when temperatures were in the single digits. In order to maintain the construction schedule, Turner Construction had to carefully pick days when the temperatures were at a minimum of 25 F to make significant concrete pours, Kazmierczak said. Although February is the shortest month, it was the most difficult month for construction and nearly 17 days were lost due to the weather. Once March arrived, Turner was able to pick up the pace and provide additional crews to make up the time lost in February.

These setbacks during the winter prompted Turner Construction to rework portions of the project schedule to ensure it could begin erecting the structural steel of the building on April 15 as originally planned. To meet this goal, Turner Construction resequenced some of the work and increased manpower to improve productivity.

At the onset of the project, the high water table complicated the mass excavation work. The water table at the site is 18 feet below grade but the basement level is 35 feet below grade, which required pre-planning to prevent water from flowing into the excavated area.

Turner Construction had to dewater the area to keep the water table below the basement level to allow for both the pouring of the hydraulic slab and the foundation walls. Even at this point in the project, water is still being pumped out to prevent it from infiltrating the basement during construction. Once the perimeter waterproofing, the building structure, steel frame and slab-on-metal deck are in place, the water table will gradually be allowed to return to its normal level.

The site now has about 85 people working on the building, but Kazmierczak expects that will grow to as many as 235 when interior work begins in early 2016.

Kazmierczak explains that a good preconstruction effort helped Turner Construction account for several of the challenges it has encountered during the construction process. The company brought in 10 design/assist contractors at the beginning of the process to help in the planning and development details of the project, identify areas where Turner Construction could improve productivity and bring valuable ideas to the project.  

“Through this collaborative process with the entire team, we overcame a lot of issues that could have adversely affected the project,” Kazmierczak says. 

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