New Parkland Hospital designed for greater safety, efficiency

For the past four years, Parkland Health & Hospital System, the Dallas area's publicly financed safety net provider, has been in constant turmoil. Yet support for construction of a massive $1.27 billion replacement hospital, funded by a voter-approved tax hike, never wavered.

Work continued on the new 2.5 million-square-foot campus even as quality and safety concerns led the CMS to threaten to end reimbursement for the hospital's Medicare and Medicaid patients, which jeopardized about $450 million a year in payments.

Local officials say support for replacing the outdated 769-bed Parkland Hospital with a brand new 862-bed facility remained strong despite outrage over those lapses and more. “The old Parkland was built in 1954 and is woefully inadequate for modern healthcare,” said Dallas County Judge Clay Jenkins, the presiding officer of the County Commissions Court that oversees Parkland operations.

The new hospital, which will be completed this summer, was designed to overcome some of the problems that led to the safety concerns. The patient rooms are all identical. Architects operated under the “same-handed room” patient-safety concept that is based on the premise that, in an emergency, staff knows where everything is no matter what room they are in.

Other small patient-safety elements include hands-free doors for infection control. Instead of knobs, there are metal triangles that open a door when pressed downward. Bare hands aren't necessary to do the job.

The growth in size flew in the face of conventional wisdom for construction projects in an era where admissions are declining, many procedures are being moved to outpatient settings and routine care is being decentralized. Yet the local community understood that Parkland remains the area's main teaching and safety net hospital, training about 55% of the region's doctors. “We need to be the mother ship,” said Lou Saksen, senior vice president for new Parkland construction.

One more reason for the size of the project is that the rooms are bigger. Units in the new burn center, for instance, have grown to 260 square feet, an 85% increase over the space allotted in existing burn intensive-care rooms. There will also be more of them, increasing to 12 intensive-care beds from nine and 18 acute-care beds from 17.

Departments have also been located for greater efficiency. Imaging is on the second floor sandwiched by the first-floor emergency department and third-floor operating rooms. Adjacencies were also taken into consideration when placing a rapid-response laboratory between the ED and intensive-care unit to provide quick results for tests performed on crashing patients.

“It's really light years ahead of the old facility, which was one wing built on top of another,” said Michael Darrouzet, executive vice president and CEO of the Dallas County Medical Society. The easy-to-navigate layout replaces the maze that exists at the current hospital and will be immediately noticed by the public, he said.

Voters also recognized the replacement facility had to be large to accommodate the region's ongoing population boom. They voted overwhelmingly in favor of the $747 million bond issue, which covered about 60% of the cost of the new facility. The Dallas-Fort Worth area now has 6.81 million residents after adding 108,112 people between June 30, 2012, and July 1, 2013, according to the U.S. Census.

In the middle of the construction project, though, with controversy swirling around the hospital's safety record, the county tapped attorney Debbie Dudley Branson to head its board of trustees. Local officials give her much of the credit for stabilizing Parkland's operations and keeping public support for the construction project on track.

For her efforts, Modern Healthcare selected Branson as 2014 Trustee of the Year for not-for-profit health systems. “I would not pretend to ignore the pain that occurred,” said Darrouzet, who also serves on the Parkland Foundation board. “There was tremendous pain and anxiety, but that's when strong leadership will survive and Debbie Branson did a tremendous job.”

One area where the safety setbacks affected the hospital's efforts was in outside fundraising, which slowed markedly as people waited for resolution of the troubles with the CMS. But with those troubles on the backburner, the public, particularly physicians, have renewed their financial support.

Darrouzet said Dallas County doctors have donated about $2 million to the cause through separate fundraising campaigns by internists, obstetrician-gynecologists and surgeons. “They're putting their money where their hearts are,” he said.

Another $500,000 was raised for the project from taxpayers who voluntarily added donations though their property tax bills. The new hospital's lobby window features a tree pattern that up close reveals the names of those taxpayers etched into the glass. Taxpayers also benefited from $680 million of the bonds receiving a 35% federal subsidy on interest payments courtesy of the 2009 federal stimulus act.

But as the project nears completion, county officials worry that medical practice trends may undercut some of the demand that had been originally anticipated. Jenkins acknowledged there needs to be more local primary clinics and that the Southeast Dallas region needs a Level 3 trauma center. “The move for medicine is to push more care out into the community,” he said. “As a system, we have to look at ways to do that.”

But Darrouzet said a decentralized model was looked at and rejected during the initial study of the project. Moreover, there is symbolic value for having the hospital as large as it is. “It says, 'We believe in healthcare for everyone,' ” he said.

The new facility has been called “Parkland 3.0” in reference to the original hospital that opened in 1894 and the existing building that opened in October 1954. It is designed for flexibility, so an area can be adapted quickly for different functions to adjust to changing demographics and healthcare trends.

“The building is all modular—everything is the same except for the colors,” Saksen said. “People are questioning where healthcare is going. When we were designing this, we had even less of an idea.”

Andrew Quirk, senior vice president and national director of the Skanska USA Building Healthcare Center of Excellence, acknowledged the challenges Saksen's team faced, and he said they turned out a well-executed project.

“When you think back to when the facility was designed, the amount of uncertainty around this was unreal,” said Quirk, whose Parsippany, N.J.-based company was not involved with the project. “But they kept moving right along to design and build. That took a lot of guts to do that.”

The recession worked in Parkland's favor as companies desperate for work submitted low bids for the initial phases of the project. The $44 million architect contract was awarded to a joint venture between Omaha, Neb.-based HDR and Dallas-based Corgan Associates. A $46 million construction-management contract went to a joint venture formed by four local companies.

“I don't remember seeing any construction cranes in Dallas when we put this job out to bid in 2010,” Saksen said. “This has been a stimulus package for construction projects in the Dallas metroplex.”

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