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									Parkland Hospital Project
for the Dallas Council of Engineering Companies

Parkland Health & Hospital System
Walter Jones, SVP Facilities
Monday, September 29, 2008

                                             PARKLAND TODAY

   42,788 adult inpatient visits 1
   16,252 deliveries 1
   254,405 clinic patient visits 1
   13,524 Surgeries (750 cases per OR) 1
   142,723 emergency department visits 1
1 FY   2007

                                                         FACILITY EVALUATION

The hospital’s construction is based on the design of a hospital from an era
that is inadequate for modern needs based on studies performed since 2001.
    •   Jonathan Bailey and Associates
    •   Odell
    •   Nash Lipsey Burch
    •   PwC
    •   HKS
    •   Centex
    •   SOM
    •   Carter Burgess
    •   Karlsberger

                                                            FACILITY EVALUATION

The hospital’s construction is based on the design of a hospital from an era
that is inadequate for modern needs.
    • Structural grids are too small for optimal organization of workflow and to
      accommodate new technology
    • Floor to floor heights too low for today’s standards
    • Majority of building from 1950’s, latest area from 1985
    • Expansion in place and circulation options are limited by narrow width of
      floor plates
    • Mechanical/electric/plumbing systems will need major replacement within
      10 years
    • Existing plumbing inadequate on inpatient units (communal showers and
    • Existing directly adjacent land inadequate for expansion needs

    •   SOURCE HKS 2002                                                       4
                                                                          FACILITY EVALUATION

The hospital’s construction is based on the design of a hospital from an era
that is inadequate for modern needs.

    •   Limited access                             •   Outpatient services are distributed
    •   Visibility of key entrances is poor            up into bed towers
    •   Complex site circulation                   •   Support services are fragmented on
    •   Way finding unclear                            and off campus
    •   Inconvenient outpatient parking            •   Numerous departments have space
    •   Parking and staging for ED is not              well below today’s standards
        efficient                                  •   Public areas for waiting and
    •   Patient and staff circulation is blended       reception are cramped and
    •   Major thoroughfares are small                  inefficient
    •   Elevator service is slow                   •   Patient care workflow routes are
    •   No clear hierarchy of circulation              compromised by excessive travel
    •   County prisoner management needs to            distances
        be revamped                                •   Resident and student teaching space
    •   Building zoning is fragmented                  is insufficient and poorly located
    SOURCE HKS 2002
                                                   •   On-call support space for house staff   5
                                                       is fragmented
                                                           TIMELINE OF EVENTS

July 2001       PHHS commenced planning effort with PwC, HKS,
                Centex Construction
March 2002      Special Board Meeting (approved planning
October 2002    Special Board Meeting (selected Hospital
                Replacement as best alternative)
November 2002 Board unanimously approved resolutions to
              replace hospital
March 2003      Board approved RFP for detailed Master Plan
June 2003       Board approved the firm, Skidmore, Owings, &
                Merrill (SOM) for detailed master planning

                                                          TIMELINE OF EVENTS

July 2004      SOM completes draft master facility plan
July 2005      The Dallas County Commissioners Court established the
               Dallas County Hospital District Blue Ribbon Master
               Capital Plan Advisory Committee (Blue Ribbon Panel)
July 2006      Parkland began a long range Strategic Planning effort to
               provide direction for the development of the services,
               operating model, best practices and facilities necessary
               to fulfill its mandate, mission and vision into the future.
January 2007   The final strategic model was recommended by the Blue
               Ribbon Panel and approved by the Board
March 2007     The operating model and assumptions were created

                                                           TIMELINE OF EVENTS

June 2007       Blue Ribbon Panel recommended the replacement of
                Parkland Hospital to Commissioners Court
July 2007       Board of Managers approved the plan for hospital
August 2007     Board of Managers presented their recommendation to
                        the Commissioners Court
September 2007 Skidmore Owings Merrill presented the 2004
               draft Master Facility Plan to the Strategic
               Planning Committee of the Board
November 2007 The Master Facility Plan was presented to
              the Core Strategy Group (liaison between the
              Blue Ribbon Panel and the Board)
November 2007 The Master Facility Site Plan was approved
              by the Board

                                                                     MASTER FACILITY PLAN

On March 14, 2008, the Blue Ribbon Panel recommended that Parkland pursue
completion of the total master facility plan project (hospitals, clinics and office
buildings and parking) with estimated total project costs of $1,371 million.

On June 24, 2008, the DCHD Board of Managers approved a revised project—which
meets the requirements of the Blue Ribbon Panel recommendation—calling for new
campus on the north side of Harry Hines Blvd. by using a single efficient hospital,
moving space to lowest cost facilities, maximizing surface parking, which reduced
estimated total project costs by $100 million to $1,271 million.

                                                                     Conceptual master plan by SOM
                                                                          Project Scope

New Replacement Hospital
  862 adult beds, 1.68 million square feet, completed April 2014             $ 1,053 million (83%)

     Adult bed complement:      Completed            Shelled       Total
            Current                   675                 0         675
            Proposed                  816               46          862*
            Capacity Increase         141 (21%)         46          187 (28%)

Clinic Buildings
   387,000 square feet, open April 2014                                           105 million ( 8%)
Office Buildings
   269,000 square feet, open January 2011                                          50 million ( 4%)
Parking (2,035 new garage spaces, 2,800 new surface spaces)                        42 million ( 3%)
Net Land Purchases, Sales, Demolition, etc.                                        21 million ( 2%)

                         Total Project Costs                                 $ 1,271 million

    *862 beds, plus 60 beds for an expanded PMR service and 46 beds for enhanced inpatient services, equals
    the 968 beds per the PwC/Blue Ribbon Panel study—location which is yet determined. The new
    replacement hospital also includes 117 newborn and 96 NNICU beds and is included in the project’s cost.
                                                                                 Project Scope
                                                                                      PROPOSED FINANCING

                      G. O. Bond Proceeds:
                       Series 2009                                 $   534 million
                       Series 2011 or 2012                            163 million
                      Revenue Bond Proceeds                             42 million
                      Philanthropy                                     150 million
                      Interest on Bond Proceeds                         32 million
                      Future Cash (Note 1)                             100 million
                      Cash Reserves                                    250 million
                      Total Project Costs                          $ 1,271 million

                      G. O. Bond Size                              $ 705 million
                      Revenue Bond Size                               42 million
                      Total Bonds                                  $ 747 million
                      G. O. Bond Tax Support                         2.5 cents

                      Tax on Median Homeowner (Note 2) $ 46.24

Note 1 - Future cash of $100 million in excess of operating cash reserves would be required to be transferred
  to the project fund prior to beginning construction on the $105 million clinic buildings.
Note 2- Includes operations tax support of 1 cent beginning in 2014; median home value = $132,000.
                                                              Project Scope
                                                                 PROPOSED SCHEDULE

  2008          2009          2010         2011        2012         2013         2014

                                         New Replacement Hospital

                             Office Building

                                                              Clinic Buildings

Bond election
                         Parking                                            Parking
         Initial Bond sale              Bond sale

           Program             Design          Construct        Move In

                                             Current Activities

•Operational Planning – Karlsberger Healthcare Consultants
•Functional Programming - Karlsberger Healthcare Consultants

                                    Next Steps

•Bond Election – November 4, 2008
•Select program manager
 Architect
 Construction manager
 Specialty consultants


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