Children’s Hospital New Orleans (CHNOLA) had an aging problem. The largest pediatric health services provider in Louisiana, it was operating out of a building constructed in 1955 and having trouble keeping up with the latest practices and technologies in healthcare. So in 2015 the hospital set out to bring itself up to date. What followed was a remarkable and complex $300 million renovation and expansion that, according to its designers, was about $250 million cheaper than it could have been.
David Deis is project director for the architecture firm EYP, which started working with the hospital in 2015. Back then, there were three options on the table: build an entirely new hospital, keep the existing hospital and add a new tower, or renovate.
The first option proved far too expensive. The second, though only half the cost of building from scratch, was still expensive, opposed by neighbors, and didn’t solve the issue of the existing facilities being outdated. So the hospital decided to renovate, updating older parts of the campus and building some new facilities to bring it up to modern standards. This was the most affordable option, but it was far from the easiest to pull off.
“We initially said 34 phases of construction, but it was a lot more than that,” Deis says.
To save $250 million, the renovations took place while the hospital was still operating. That meant new construction happened on top of existing parts of the building and departments were strategically relocated as new facilities were completed.
Construction began in 2017 and started with a new lobby. This was partly a logical construction move; the lobby is on the ground floor, after all. But it was also an attempt to give the hospital’s staff and patients a glimpse of what would eventually take the place of the outdated facility.
“We built the lobby as the jewel of the project to get people excited, to remind them what this was all about,” Deis says. “They could start to see what the transformation was going to look like. For the patients, the families, the clinicians, it got them on board for the long journey and pain of living through this step-by-step process.”
Those 34-plus phases of construction meant that much of CHNOLA’s daily operations were regularly in flux. New offices would finish construction on one part of the campus while clinics on another side were relocated from the old space.
EYP’s Jennifer Wilkinson, the senior project architect, says there were sometimes daily meetings with the contractors and hospital leadership about what was going where and how people should be navigating the space. This even involved regularly deciding which elevators would be used for construction staff and which would be reserved for clinicians and patients.
Determining how to maintain usable pathways through the hospital and between its floors became really key to the phasing, Wilkinson says, “and it also created more phases.”
There was also the additional challenge of the site’s location, next to a flood control levee along the Mississippi River. Seasonal increases in the river’s flow would sometimes threaten to overtop the levee and the U.S. Army Corps of Engineers would halt construction.
“The contractors are not even allowed to dig a trench to lay a pipe,” Deis says. “You can’t plan for that.” Hurricanes were also a regular concern.
The pandemic only increased the complexity of the project—and its phase count. Wilkinson says that as the hospital’s emergency department saw its caseload peak, construction had to be rescheduled and adjusted on the fly. The planned closure of a corridor for ductwork, for instance, would have greatly impeded CHNOLA’s pandemic response.
After five years of constant building, moving, and adapting, the hospital modernization was completed early last year. Deis says the turbulence and complexity might have been a challenge to most clients, but the hospital was unusually adaptable to the challenges of construction, especially during the pandemic.
“I think that because they deal with hurricanes on a yearly basis, emergency preparedness is their middle name, if you will. The pandemic was just another emergency to them,” he says. “This is a very resilient client.”