[Case Study] MetroHealth Campus Transformation Project: Design & Construction in a Rapidly Changing Environment (4 of 4)

By Robert A. Hager, Esq. and Paula Selvaggio, RPLU


The Cogence Alliance Resource Committee has committed to “tell the story,” through various case studies, concerning how the use of collaborative design and construction methods is positively impacting the construction industry.  Our 4th article in this MetroHealth Campus Transformation Project series is based on an interview with Walter Jones, Senior Vice President for Campus Transformation, MetroHealth Hospital System discussing design and construction in a rapidly changing environment.

  1. Expect the Unexpected

What could possibly happen during the eight-year period between initial project planning and occupancy?  The short answer is “you’d be amazed.”  Much has changed over the last eight years.  Some pre-planning design and construction efforts are now moot.  People change their minds over time.  In addition, some personnel changes are inevitable.  Certainly, technology changes over time.  For example, telehealth operations have changed from a potential “option” to an absolute “necessity.”  Telehealth is now an embedded, routine, and accepted practice in all health systems.  It represents a major paradigm shift that was not obvious to project planners.  In addition, the global pandemic was not foreseeable by project planners eight years ago.  How do you anticipate unforeseen risk?  What steps are necessary to manage such risks?

  1. COVID-19 Impacts on the MetroHealth Project

There is an old adage that goes “timing is everything.”  This is especially true for the MetroHealth project.  The parking garage demolition began in December 2018.  All major construction bids and quotations were received by MetroHealth before the COVID-19 pandemic arrived in March, 2020.  The project planners were fortunate.

Nonetheless, project management became aware of the new “normal,” familiar with new surroundings and situations, and kept their eyes open for potential project impacts and delays.  There were no major supply chain delays on the project.  Two foreign manufacturers in Canada and Germany shut down for a week or two, but these delays did not have any material impact on the critical path of the project.  Certain regulatory permits were slower in delivery than expected, but eventually the materials were permitted to be transported across international borders.  Project management had to carefully work with Cleveland City Hall and Planning Commission members to proceed with caution during uncertain times.  By making safety of paramount importance, there were no outbreaks of COVID-19 on the jobsite.  In addition, the volume of COVID patients at MetroHealth was relatively low compared to other area hospitals.  Fortunately, commencement of construction prior to the pandemic and careful management of pandemic-related risks and issues allowed MetroHealth to proceed with the $1 billion project without experiencing any major time or cost impacts related to COVID-19.  An impressive accomplishment!

  1. The Value of a “Process Neutral” Design

Certain future operational needs and business strategies were unknown during the initial design of this project.  While we all would like to have a “crystal ball” to read the future, no one knew we would be experiencing a pandemic in 2020.  Once the crisis was identified, the question became:  “Is the hospital designed to accommodate a pandemic?”  MetroHealth was previously designated by the CDC as a hospital that may serve as an Ebola assessment hospital.  But COVID-19 was a different virus requiring a unique business strategy.  Appropriate steps were taken by MetroHealth to convert the Elisabeth Severance Prentiss Center for Skilled Nursing and Rehabilitation facility into a COVID-patient overflow facility.  Fortunately, the facility was not needed for this purpose.

One of the forward-thinking approaches used by project management was to employ a “process neutral” design.  In essence, a process neutral design allows for flexibility in future use of space by adopting standard, generic buildout plans which can be modified to suit the needs of various departments and patients.  For example, the patient rooms on floors 3-9 of the new hospital consist of mostly identical, standardized rooms capable of serving any type of patient.  All rooms can be used for different purposes such as intensive care units, dialysis units, etc.  One of the primary benefits of such process neutral design is that the hospital can easily move its staff and patients without having to move all of the beds and equipment necessary for such patient care.

Another beneficial design decision was to include “shell space” in the construction of for possible future expansion.  Initially, 400 patient beds were planned; however, now 500 patient beds are being provided.  Due to the uptick in volume, the hospital is able to meet current needs for private rooms by utilizing the previously undesignated shell space for additional patient rooms.

Another forward-thinking design consideration was to improve air quality especially in isolation rooms.  The HVAC system was upgraded with HEPA filtration and ultraviolet lighting was already a component of HVAC cooling coils.  By incorporating these components into the HVAC system, the hospital had the foresight to consider mass casualty design in the event that a patient would need a full, semi-private room for the entire length of stay.

One thing is certain:  change.  By incorporating a “process neutral” design, MetroHealth maintained flexibility to deal with the rapidly changing environment.


Substantial completion was achieved in July, 2022.  Patient occupancy is scheduled for October 15, 2022.  By January 2025, all remaining work on the main campus is expected to be complete.  The 5th and final article in this series will address MetroHealth’s transitional planning efforts.  Specifically, how MetroHealth plans to occupy, and operate the new facilities.  Exciting times ahead for the community!

By:       Robert A. Hager

September 14, 2022

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