As we begin a new year, builders are still grappling with the pressures of the last four years, including building more and faster with tighter budgets and a smaller workforce. These challenges are most evident in the healthcare construction sector, as the need for more patient care spaces continues its upward trend across the country.

In late 2021, healthcare construction leader Robins & Morton embarked on a four-story, 372,400-square-foot hospital and medical office building project with long-term client AdventHealth in the Tampa, Florida, suburb of Riverview.

The facility was set to become the first full-service hospital in Riverview, and data indicated that the construction venture was well-timed. From 2017 to 2023, the city’s population grew by 26.4%, and healthcare close to home had never been more critical. To meet its goals, AdventHealth needed to use every tool available to build the hospital rapidly and economically. Construction partner Robins & Morton and architect HuntonBrady collaborated with the AdventHealth staff to construct a facility that maximized available space and embraced a prototypical design. The hospital recently opened to patients in October 2024.

As the operations manager for the project, I had the opportunity to see how teamwork and innovation resulted in an extraordinary project, overcoming speed-to-market pressures, flexible space needs and labor shortages. Here are the four strategies that most directly influenced its success.

Prototypical Design

One of the most striking aspects of the AdventHealth Riverview project is its signature curved design. Although the hospital would open with 82 beds, it needed room for future expansion. This project called for HuntonBrady’s 200-bed model, which is part of AdventHealth’s suite of prototypical designs. To accommodate future expansion, the crescent-shaped building features long, straight wings on the backside of the radius to house beds.

Another distinct advantage of the structure’s design is the uniform exterior wall that it provides. The column-base spans were increased to 31 feet, allowing a wider footprint and more usable space inside the configuration. Larger rooms often benefit patient satisfaction scores and improve physician recruitment.

There was also another strategic advantage to upsizing and optimizing the spaces: the creation of flexible space. There are different regulations for the required size of healthcare rooms based on their purposes. When all rooms exceed those minimum requirements, the spaces can be more flexible in the future and can be converted into different types of rooms as needed.

Tilt-Wall Construction

The use of tilt-wall construction was one of the most significant contributors to this project’s success. The method involves pouring multi-story concrete panels within 50 feet of their final location and then tilting them upright with a large crane. By using a tilt-wall approach for large portions of the facility’s structure, the team was able to expedite construction and mitigate the cost impacts of a full steel structure.

Tilt-wall construction requires more space than other methods, and it took detailed coordination and impeccable orchestration to execute it seamlessly on the AdventHealth Riverview project. Structures that use the tilt-wall process have traditionally been more angular, so erecting and bracing panels in such a sequence that it accommodated the signature curved radius of the building was a notable feat.

The four-story panels topped out at 64 feet—nearly the height of two school buses stacked upright. Additional stacked panels formed the stairwell, reaching the highest point of the building at 79 feet. The panel erection sequence took only 18 days, and once each section of the wall was upright, all the work for the trades could be released, further speeding up interior work.

In addition to being cost-effective, the concrete structure was also a strategic choice for the hospital’s coastal location in the Tampa Bay area, specifically because it hardens the skin for hurricane resilience.

Prefabrication

To amplify productivity, Robins & Morton used collaborative schedule management tools paired with prefabrication. Many of the “usual suspects” were prefabricated—such as ductwork, glass and glazing, PVC pipes, and electrical runs and kitting — but the AdventHealth Riverview team also used several larger-scale solutions.

These included the installation of shower pods in patient rooms and the use of pre-manufactured concrete precast floor joists and ceiling beam soffits. But perhaps the system most advantageous to the schedule was the use of prefabricated operating room (OR) ceilings.

Traditional “stick built” OR ceilings contain lights, air quality equipment, filters, and more, all essential to maintaining a sterile environment. Coordinating the systems among multiple trades with independent installation can be challenging and time consuming. Because there was extremely limited above-ceiling space, the install-and-go nature of prefabricated OR ceilings proved to be a distinct advantage to the productivity of the construction team, allowing installation in a fraction of the time.

In-house MEP Management

As construction came to a close, the project team began working with the commissioning agent to evaluate the new facility’s systems. Although commissioning often extends for months after the completion of a project, AdventHealth Riverview’s commissioning wrapped up just three weeks after the project’s completion.

The efficient commissioning process was due not only to excellent documentation throughout the project, but also to having an onsite mechanical, electrical, and plumbing (MEP) manager.

As the complexity of MEP grows in healthcare facilities, it’s becoming more beneficial for general contractors to employ MEP experts on staff. They are able to assist with the direct coordination of MEP trades, as well as leading equipment installation and communication, while also supporting the integration of the MEP scopes with a “total project” mindset.

With 35% to 40% of a typical healthcare facility’s construction cost stemming from the MEP portions of the project, seamless execution is a tremendous schedule and budget advantage for our clients. That was never more evident than at the AdventHealth Riverview project.

We’re living in a new era of the construction industry—one marked by an increasing labor shortage and the need for every building to accommodate rapidly changing technology and patient and provider needs. Project teams must work with their clients to reimagine the design and construction process to be more labor-efficient, budget-friendly, and expedient.

Through practices such as prefabricating, hiring in-house expertise, and using innovative construction methods, we can continue to meet the demand for much-needed access to care in our communities.

Todd Watson, Division Manager at Robins & Morton. An integral part of the growth and success of the Florida division since he joined the company in 2002, for the past 22 years, he has directly contributed to the success of more than $1.6 billion worth of projects.