Kaleida Health

Healthcare construction is a vital part of primary patient care at Kaleida Health, an outstanding hospital group, as John OÔÇÖHanlon discoversBuffalo, New York, is a favored city from the point of view of healthcare, and not only if you are sick, because who doesnÔÇÖt appreciate having hospitals and medical research equal to the best in the US right on their doorstep? Kaleida Health is the largest healthcare provider in Western New York, with five major hospitals: Buffalo General, DeGraff Memorial Hospital, Millard Fillmore Gates Circle Hospital, Millard Fillmore Suburban and the outstanding Women and ChildrenÔÇÖs Hospital of Buffalo (WCHOB).During the coming century, Kaleida will fill an even more pivotal role than it does now. The Buffalo Niagara Medical Campus, which occupies a huge block of land in the city center and houses Buffalo General, the Roswell Park Cancer Institute, and facilities belonging to the University of Buffalo, is set to become the ÔÇ£medical corridorÔÇØ for the entire area.Mickey Mariacher is KaleidaÔÇÖs director of facility planning and construction. ItÔÇÖs rare enough to find a woman in a job like MariacherÔÇÖs, but she was born to it, she says. Her father built the Niagara Falls observation tower back in 1960, and as a small child she lived and breathed construction. ÔÇ£To me, that was what a real job was. I canÔÇÖt imagine doing anything else,ÔÇØ she says. Her sister and four brothers all found other ways to make a living, but Mariacher took a degree in English before entering the construction arena, gaining an MBA at UB along the way.She started out in estimating and project management for a regional construction firm before moving to Buffalo-based Cannon Design, one of the countryÔÇÖs top five healthcare design groups. As project manager for Kaleida HealthÔÇÖs $60 million expansion of Millard Fillmore Suburban hospital, Mariacher led the Cannon Design team. When it turned into a construction project in 2006, Kaleida hired her. ÔÇ£They said they saw in me a person with the necessary skills in controlling budgets and schedules. ItÔÇÖs unusual for a hospital to have someone with my skills on its staff unless itÔÇÖs planning to do several hundred millions of dollars worth of work or unless it has an internal construction group.ÔÇØKaleida Health has formed its own construction company and hires union labor directly from the union halls. When she was hired, one of her goals was to help this company run like any other construction company, instituting a format for estimating, project management and schedule control. Since that time the group has completed dozens of projects, from $50,000 upward, using KaleidaÔÇÖs own resources exclusively. A good exampleÔÇöat an aggregate cost of $22 millionÔÇöwas the installation of nine cardiac catheterization laboratories, six of them at BGH and three at Millard Fillmore Gates Circle Hospital. ÔÇ£We did all of that in-house. Some people at Kaleida were unsure if such a large job ought not to be outsourced. By the time it was done, though, everyone was convinced. They found they got more bang for their buck by being able to eliminate the general contractor and the construction manager.ÔÇØ Kaleida takes the environment very seriously, but compliance with best practice is often expensive, and the payback in terms of operational costs is long term. Yes, Mariacher admits, there does sometimes have to be a compromise, but her story is surprising. ÔÇ£The first thing to hit the floor when we looked at saving money was LEED certification.ÔÇØItÔÇÖs becoming widely recognized that the fees and paperwork needed for LEED are putting people off. ÔÇ£On a $200 million project, youÔÇÖre liable to spend $200,000 just so that at the end of the job you get a plaque. ItÔÇÖs more important to us to take that money and put it into verifiable green design elements. Maybe we could upgrade the type of windows weÔÇÖre using, for example.ÔÇØSo donÔÇÖt ask the LEED question; rather, focus on KaleidaÔÇÖs 30 percent ÔÇ£better than codeÔÇØ target, which beat the industryÔÇÖs environmental performance standards by a third or more by using thermal and lighting management, solar power and other innovative practices. After all, she says, you shouldnÔÇÖt have to proclaim that you are environmentally friendly any more than that you drive safely. ÔÇ£All design should be green, sustainable, environmentally responsible and eco-friendly. It should be automatic that we design this way.ÔÇØ Did she say $200 million? Well, they wonÔÇÖt be doing this one in-house. The planned 10-plus story Global Vascular Institute on the Buffalo campus demonstrates all the best practices in sustainability, planning, scheduling and cost control and for once deserves the overworked epithet ÔÇ£innovative.ÔÇØ ThatÔÇÖs because it was designed from the bottom up. ÔÇ£The first person to work on you when you come to the hospital is the architect.ÔÇØ So helping the patient is the designerÔÇÖs first objective, Mariacher believes. Helping the doctors comes next. The new facility will have everything heart patients expect, including emergency rooms, operating theaters, an intensive care unit and cardiovascular labs. The real innovation is that it draws together three disparate functions that will deliver more value by working together and sharing costs by ÔÇ£going vertical.ÔÇØAbove the hospitalÔÇÖs facilities there are two floors occupied by the Jacobs Neurology Institute and funded out of a $10 million foundation from the Jacobs family. Above that, four floors will be occupied by the University of Buffalo, which asked to be included in the project when it learned of it, though well into Cannon DesignÔÇÖs planning stage. ÔÇ£The crazy thing was that that this didnÔÇÖt throw out the design,ÔÇØ says Mariacher. ÔÇ£We told the structural engineers that the building is probably going to be four stories higher than specified, so please allow for that. WeÔÇÖre still on track to start work in 2009, even though the building is getting taller.ÔÇØSimilar university, research and clinical collaborations elsewhere have dramatically improved healthcare while generating tremendous economic benefits. However, this will be the first multidimensional medical institute focused on the full spectrum of vascular healthcare. The dynamics of the building will throw together researchers, academics and practitioners who used to work in glorious isolation. The spin-off for patient care is clear. For example, the neurology and cardiac labs on two floors are joined by a central atrium in which doctors can meet to share ideas.Mariacher rejoices in having women and minorities on the hospitalÔÇÖs workforce. She takes every opportunity to talk to schools and colleges about the rewards of her job. With her values and enthusiasm being spread to students who are about to embark on their careers, maybe weÔÇÖll see more people in healthcare construction with the know-how to take a project andÔÇöwith any budget, standard, or ultimate goalÔÇömake it excellent. ÔÇô Editorial research by Vincent Kielty┬á