2016 Heavy Commercial Winner

Health City is a 107,000-sq.-ft. hospital built on Grand Cayman Island in the Caribbean. It is one of the first ICF hospitals in the world, and is just the first phase of a massive development that is anticipated to eventually include more than three million sq. ft. of medical, retirement, residential, commercial, retail, and mixed-use facilities.

Most remarkably for the health care industry, it was built to U.S. hospital standards in half the time and budget.

Designers began by looking at the how a hospital should function from the patient’s point of view, and then worked out the structure based on these parameters. The design was done using 3D BIM with clash detection software which kept costs to a minimum and located the blockouts for ductwork and pipes in the ICF walls.

Ryan Smith, construction and facilities manager for Health City Development, says, “Since the building is designed for clinical functionality, it gave way to a more rectangular design for each ‘pod’ of the building. We utilized landscape ‘corridors’ to bring natural light to every patient room, the main spine corridor offices, and work station rooms. We even have natural light in the operating rooms.”

He continues, “This created some complexity in how to
accomplish this while maintaining the efficiency of cost and schedule. [Fortunately] utilization of the ICF allowed this to be overcome.”

For example, ICF walls in the radiology department eliminated the need for lead shielding.

In the Caribbean, severe storms are always a concern, and ICFs allow the building to serve as a hurricane shelter. Smith says hurricane-rated windows are more secure in ICF walls as they are positively attached to the concrete core. As part of this philosophy, the imposing main entry is built with ICFs as well, including the two-story window wall. Smith says, “If we had used typical block or concrete construction this would have taken a tremendous amount of formwork and time.”

Built on previously undeveloped land some distance from the nearest town, getting material, equipment, utilities, and labor to the site was a major challenge.

It also allowed significant energy savings. The original HVAC was sized using heat loss calculations based on similar hospitals in climates that matched that of the Cayman Islands. After six months of operation, it was clear that it should be downsized to provide better comfort and lower energy usage. In the hot, humid Caribbean environment, with cooling needed every day of the year, electrical costs were projected at US$2.1 million annually. After the first year of operation, though, the actual costs were US$1,446,536, a savings of 31%. and second year costs were even lower. Smith says, “We feel very strongly this is due to the ICF building envelope and the detailed Building Management System that allows us to control the HVAC system in enough detail to maximize the ICF envelope benefits.”

Tall walls, dozens of windows and the massive scale of the project were just a few obstacles this team successfully overcame.

In the United States, a hospital the size of Health City typically takes 18-24 months to build. Here, the schedule had a start-to-finish time of only 12 months, so innovative construction techniques were used throughout. The contractor and delivery team had an aggressive budget challenge as well. The same type facility in the U.S. typically runs $1,000,000 per bed. Health City Cayman’s hospital came in at $424,000 per bed. They provided the same facility (same code requirements, design parameters for Florida healthcare, etc.) for less than half the cost!

Smith says, “The aggressive schedule and budget were facilitated via a few innovative ideas. First was the utilization of the ICF system.” Second, the project was design-build, which allowed for the construction and design teams to work together to improve functionality, construction speed, and reduce cost. Third, they used pre-built components, such as prefabricated bathroom pods, to increase speed of construction. These were fabricated at the same time as the ICF structure was being erected, and shipped to the island 100% complete. The units were then craned into place, connected to the utilities and the internal walls built around them. Smith says, “This reduced the amount of time sub-trades would normally take completing 54 patient bathrooms in a small space.”

There were other challenges as well. No one on the island had built a building of this size and complexity utilizing ICF. The contractors coordinated carefully with governmental agencies to recruit and train the right help locally and get work permits for any additional expertise not available on the island.

Health City was built on undeveloped land in a relatively remote region where nearly all materials and equipment need to be imported. This was a major hurdle. Project scheduling needed to include procurement planning and the time involved shipping to such a remote location.

Smith says, “We had to bring all utilities to the site, coordinating with utility companies and their master plan. Construction water had to be trucked in and storage tanks built. Temporary electrical systems were required, as the local regulatory agency does not allow energizing partial electrical panels.”

This project used Fox Blocks ICFs, which are manufactured on-island.

The state-of-the-art facility performs life-saving operations on disadvantaged children throughout the Caribbean and Central America.

Despite the tight budget, the hospital is remarkably green. Rain water is harvested for non-potable use. Sewage is treated onsite and the effluent used for irrigation. The hospital produces its own medical grade oxygen onsite, and a 1.2 MW solar farm is scheduled for installation this year.

They have also implemented an aggressive recycling program, processing all medical waste onsite. In the first year of operation, they diverted approximately 60% of the waste away from the island landfill.

The project met the aggressive schedule and budget, and opened in February 2014.

Smith says, “The project build was a complete success, and has received immense international press in the United States, Caribbean, and India. More than 2,000 people have visited the hospital from different health systems, governments, NGO’s, private companies, and insurance companies.

He continues, “One of the main aspects of the story of Health City is the building, how we built it, the costs, and the speed. ICF is not well known outside construction circles and the amount of people that we toured during and after construction were amazed at the ICF product and what we did with it. I cannot count the times people would ask during a tour ‘why doesn’t everyone build with ICF?’ It helps to further the entire story of how Health City is changing healthcare delivery from construction to unprecedented clinical outcomes.”

The hospital achieved JCI International accreditation within a year of operation, and completed the first two artificial heart surgeries in the Caribbean. The hospital has partnered with a foundation to give 100 free heart surgery a year to children from the hardest hit economic regions in the area, mostly from Haiti, Guatemala, and Honduras.

Smith says, “We are unaware of another ICF-built hospital… We feel this is a breakthrough project from delivery method to construction techniques such as ICF.”

As for the construction team, they’re just breaking ground for the next phase, which includes a 118-unit ICF apartment complex, a 20,000-sq.-ft commercial center, and 185-room hotel, all designed with ICF.

Project Statistics

Location: Grand Cayman, Cayman Islands
Type: Hospital
Size: 107,000 sq. ft. (floor)
ICF Use: 67,000 sq. ft.
Cost: US$46 million
Total Construction: 12 months
ICF Installation time: 108 days


Construction Team

Owner: Health City Cayman Islands, Ltd
Construction Manager/Developer: Consulting Services Ltd.
General Contractor: Cayman Healthcare Construction Group
ICF Installer: Clan Construction
Architect: Studio+
Form Distributor: Flowers Blocks
ICF System: Fox Blocks

Fast Facts

  • First known ICF hospital
  • Built to U.S. standards at half the time and budget
  • Significant press in U.S. Caribbean and India
  • 2,000 visitors from health care industry and NGOs
  • 1st Phase of anticipated 3-million-sq.-ft. ICF development



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