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Ideally situated on a hillside overlooking Royalton Road and Interstate 77, this newest location for MetroHealth at 9200 Treeworth Blvd. in Brecksville offers outstanding visibility to the thousands of motorists passing by each day. Built on 24 acres, the two-story, 72,000-square-foot MetroHealth Brecksville Health & Surgery Center brings a wealth of services to Cuyahoga County’s south side, and features the system’s fourth emergency room.

Building the new facility required extensive cooperation with public and private partners. The site, spanning two municipality’s borders, and coordinating with the state’s department of transportation was just the beginning. Add to that the roosting season of endangered bats that had to be respected, and the project was off to a stimulating start.

Even before acquiring a number of HealthSpan’s locations in Cuyahoga County, MetroHealth was looking at expansion plans and identified this site along with one in Middleburg Heights. Brecksville was programmed to be built first, but with the site’s challenges, Middleburg was completed first in 2013. The Middleburg Heights project served as a template for design, which was adapted to create a unique building for the communities of Brecksville/Broadview Heights.

“This was to be MetroHealth’s most southeastern location in the county, significantly expanding our presence in the community,” explains Walter Jones Jr., senior vice president of Campus Transformation, MetroHealth System (MHS). “What we didn’t realize was that in addition to wetland concerns, we also had to time our construction to avoid the roosting season of endangered bats.”

A Request for Qualifications was issued in 2013 for a development partner for the project, and Signet Development was selected. Working well with MetroHealth and the project team, Signet stayed on throughout the project as owner’s representative.

“Every project has a unique set of goals, objectives and challenges,” says Jerel Klue, principal and managing director of Signet Development. “Our expertise lies in creating a customized, comprehensive approach for each partner and each project. And this project was no different – it had more than its fair share of challenges.”

The first situation to be addressed was that the site was entirely in Brecksville, but couldn’t be accessed without a new entrance road which would need to be located in Broadview Heights. “Working collaboratively with the two municipalities, our team structured an income tax sharing approach that worked for both cities,” explains Klue. One of the results of the agreement is Treeworth Boulevard, a cul-de-sac from Royalton Road to the edge of the city border, which is where MetroHealth’s property begins.

RTA even played a part, extending its route 35 bus line to the new cul-de-sac. “They were great to work with,” says Richard Mayer, director of construction management for MetroHealth. “Coincidently, the 35 bus route also travels down West 25th Street, passing right by the main MetroHealth campus.” “For our patients who utilize public transportation, this is great to have a route connecting both,” recalls Jones.

Work also had to be coordinated with ODOT (Ohio Department of Transportation), as a new interchange was being constructed for I-77, just east of the sloping project site, along with the construction of road and infrastructure improvements along SR-82.

Signet and the MetroHealth team collaborated on a creative financing solution for the project, which resulted in bonds being issued by the Cleveland-Cuyahoga County Port Authority, according to Klue.

As 2014 wound down, a Request for Qualifications was issued for a design team. The team of CBLH Design and Perspectus Architecture came together and was awarded the design package.

“Leadership from the two firms had been in discussion for some time in regard to working together,” says Marc Bittinger, principal of CBLH Design. “MetroHealth was the ideal client for this collaboration and benefited from the talent pools of both firms.”

“This is the first time our firms have worked together,” explains Salvatore Rini, principal at Perspectus Architecture. “Understanding what teaming arrangement would be in the best interest of MHS was the basis of our firms collaborating. Both firms have a long history working with MHS and CBLH has a long history working with Signet, which madeour collaboration an easy choice.”

In their joint effort, CBLH Design was the lead and architect of record and focused on the exterior design, while Perspectus was the design architect and focused on the medical planning and interiors. “My main role on the project was working with the individual user groups during programming and setting the design concept during schematic design,” Rini says.

“With an aggressive time schedule, we realized we needed to separate the bid documents into multiple bid packages,” says Jeff Valus, principal for CBLH Design.

The first priority to be dealt with were the bats. The heavily wooded site needed to be cleared of potential bat-roosting habitats before the end of the regulated season on April 30, so a tree-cutting-only bid package was released first. “It started with a site package to clear the site, then followed by a foundation package, core and shell, interiors and then a landscaping package,” recalls Valus.

Through a public solicitation process, Donley’s was ultimately engaged as the construction manager at risk and began construction May 12, 2015.

“Our responsibility started then with the removal of the timber and then the civil aspect,” explains Jay Waddell, senior project manager with Donley’s Inc. “More than 60,000 cubic yards of earth were moved to transform the sloping topography to a level footprint for the building and adjacent site development. Drainage was sloped away, protective measures were installed, and the permanent retention basins constructed to gather all site run-off including one temporary basin north of the site.”

“With a 60-foot difference in elevation from top of the site to the wetlands, we needed to be able to reroute the site water around the building to the rain garden, prior to being discharged into the wetlands,” explains Valus. A helipad is located just northeast of the building, close to the emergency room. Underground snow-melting systems keep the path clear during the winter months. Originally envisioned for the roof of the hospital, cost savings in structural steel and operational advantages for craft safety helped to determine the alternate location.

Averaging 75 workers on the project, the total ran up to as many as 115 at one point. “We had a very aggressive schedule,” says Waddell, “from the day of our first foundation installation on July 21, to substantial completion on June 30. The building was constructed in just less than 12 months.” Donley’s, working through an active outreach and engagement process with MetroHealth, was able to engage greater than 35% diversity participation in its contracted work, while also exceeding the project’s workforce goals.

As MetroHealth began both the Middleburg and the Brecksville facilities, they seized opportunities to not only create a new branding for themselves, but also considered how best to deliver services – both today and into the future.

For expediency sake, the building is laid out with the emergency room closest to the entrance drive. The ambulance approach and the emergency entrance are the first things you see as you enter.

Other entries and exits were all planned with the patients in mind. If you are coming for ambulatory surgery, your waiting room and reception are literally steps away from the lobby entrance. Once you’ve completed surgery or other treatments, a canopied exit is available directly out back, so patients maintain privacy and don’t need to go back through the lobby. At the south end of the building, patients and family can enter from either the west or east parking lots into a glasswalled, two-story lobby area known as “The Lantern” for its luminescent quality at night.

“The main lobby takes the ‘lantern’ image that was developed as a brand for the Middleburg facility,” says Rini, “and incorporates it into the two-story entry which becomes the focal point of both interior and exterior while maintaining the brand in a new way.”

“It certainly helps with the wayfinding,” says Bittinger. “With the great visibility of this site, I’m always surprised the site wasn’t developed earlier.”

“Another interesting element used outside the building is the Centria metal panel rainscreen system,” relates Valus. “Depending on where you’re situated on the site, you are likely to experience a unique effect of the varied appearance of the metal panels.”

“Walking into the space, the quality design establishes the level of care patients are about to receive,” explains Grace Ondrejka with Perspectus Architecture. “With two stories of glass walls, the room is filled with natural daylight, and seating was intentionally pulled out of the surrounding departments and placed in the lobby for a brighter waiting environment.” In the lobby, seating ranges from upholstered pieces to large collaborative work surfaces with bar-height chairs. Outlets, both USB and 110 volt, are available for people to use their laptops or charge their phones. Carpeting, Novawall absorptive wall panels and a white noise system all work to control acoustics in this large, open area.

Inside, all functions of the property can be accessed conveniently from the lobby. The reception, surgery center, pharmacy, community room and food service are all available immediately adjacent on the first floor. The lobby can even serve as a pre-function area for the community room. Elevators are available here as well to access all the primary care physicians on the second floor.

The ambulatory surgery area provides 10 prep/recovery areas as well as eight clinical decision units, and three operating rooms. Specialized rooms provide for CAT scan, mammography, ultrasound, automated breast ultrasound and x-ray. Two additional procedure rooms, one additional operating room, an MRI room and an additional x-ray room have been shelled out for future use. As the population of this community grows, and as technology continues to develop, it will be easy for MetroHealth to add increased capacity utilizing the latest, most advanced technology available at the time in these ready-to-be-built-out areas.

Surgical suites are state-of-the-art with all equipment supported by boom arms from the ceiling. LED surgical lighting provides needed intensity without the heat typically produced in last generation fixtures. Gas lines, vacuum lines and electrical supplies are also placed on boom arms, lessening the possibility of tripping hazards in the operating room. Easy-toclean Marmoleum floors predominate in the surgical areas of the building. Adjacent to the emergency department is the in-house lab, making it very convenient for dropping off samples. Two blood drawing rooms are also located in the lab area.

On the second floor, a separate check-in desk serves the primary care department. In the primary care physician’s offices, “MHS wanted to implement a care model that focused on the patient – more specifically, physician time with the patient,” explains Rini. “The physician offices are located within the exam areas, providing more one-on-one time between patient and physician.”

“The 26 exam and treatment rooms all feature a prefabricated wet counter/workstation, as well as a prefabricated work station,” Waddell says. “Rough-in for blocking, plumbing, electrical and data was completed and then the wall finishes were installed. A rack/rail system was then installed and the units were hung, similar to hanging a TV on a mount – real slick, while saving a lot of install and follow-up labor.” Eight additional bays are available for patient infusion.

Large, attractive, barn-style sliding doors save space in the combination exam rooms/doctor’s offices and are gasketed for acoustical privacy.

Also located on the second floor is the 8,000-square-foot enclosed mechanical room. Instead of using rooftop units and screening them, all equipment is enclosed in an extension to the second floor offices. In addition to saving on the cost of equipment, maintenance people love to work in the enclosed space, which they keep immaculately clean. “We have a very happy maintenance staff here,” Jones adds.

As a testament to MetroHealth’s vision, when the open house was held on July 30, an estimated 2,500-plus interested visitors came to tour the building.

“Like all projects of this size and these schedule requirements, a strong commitment of team and purpose is required,” Waddell says. “The feeling of ‘we will do this’ was a belief of the design, CM, owner and subcontractor professionals from the very start to the end.”

“This really was a great collaboration with CBLH and Perspectus working together,” Bittinger adds. “It really benefitted the project.”

“This was an extremely synergistic experience, unique in that we had two excellent design firms working collaboratively with Signet and Donley’s, complemented by our own project management staff,” Mayer says.

“It was impressive the way that this entire team worked together,” recalls Klue. “This was a real public-private partnership – and that’s what it took to make this project a reality.”

“My hope,” Rini says, “is that people understand that the Cleveland area not only has the best health systems in the country, but also has the best healthcare design firms in the country.”

Properties Magazine October 2016 PDF