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CARE • DIGNITY • TRUTH • PARTICIPATION • PASSION
A Case Study In
INTEGRATED SUSTAINABILITY & PLANNING FOR
GROWTH
presented by:
Theuns Langenhoven & Chris Rudham
NETCARE CHRISTIAAN BARNARD MEMORIAL HOSPITAL
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CARE • DIGNITY • TRUTH • PARTICIPATION • PASSION
• Introduction: Project Ethos
• Key success factors
• Integrated
sustainability • Intelligent Façade
• Partitioning solution
• Mechanical installations
• Wet Services installations
• Electrical installations
• Water purification plant
• Planning for Growth • Organic growth
• Helistop
SYNOPSIS
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Netcare Values Design process:
Care – Ensuring best design principles to guarantee best and safest care and focus on infection control
Dignity – In design for patients, visitors, staff and doctors
Participation – Design committees, patient, doctors, staff and management involvement
Truth – transparency, expectations, affordability
Passion – Full dedication to providing a special, iconic legacy for the future of healthcare
INTRODUCTION:
The Project Ethos
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A world class flagship hospital that is not a citadel but a:
Timeless, “living building”
with a sense of its place in history & community which
Treats humanity and the environment with humility and respect
Recognises culture with exhibition, interpretative spaces & artwork
Acknowledges pioneers in
both community & health
INTRODUCTION:
The Project Ethos
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PROFESSOR CHRISTIAAN BARNARD
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NELSON MANDELA – MEANING OF FREEDOM
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ROBERT SOBUKWE (ON HUMANITY)
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HAMILTON NAKI – RENAME SQUARE
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ENTRANCE ARTWORKS : BY MARCO CIANFANELLI
“THRESHOLD” & BARNARD PORTRAIT
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Integrated Sustainability
Abridged technical brief
2009
• 254 Beds with (30%) ICU & High Care beds expandable to 356 beds without
single disruption to existing hospital or consulting suites.
• Functional flow ensuring operational efficiency – centres of excellence,
ward design.
• Level 1 design trauma facility with helicopter access
• Centres of excellence in:
• Cardiology
• Maternity
• Oncology
• Access to day hospital & ancillary medical care
• Modern, sustainable, efficient and maintainable plant throughout with
singe control and measurement and verification enabled
• Risk mitigation and renewables resources
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Integrated Sustainability
Key Success Factors
• Project programme with time for
Idea generation Desk top analysis & testing Life cycle costing Value management & engineering Client/sponsor approval Integration across all disciplines
• Leadership & teamwork with a solution focused orientation
2018
2009
• Early commitment
Integration & Growth opportunities reduce exponentially with time
• Client/Sponsor Commitment
Capex implications necessitate buy-in from all company divisions motivated by: o Corporate responsibility o Environment & sustainability o Life cycle costing o Space & cost benchmarking
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Capex & ROI decisions informed by: • Area & cost benchmarking by
bed & functional area • Life Cycle Costing (LCC) • Sustainability budget (in addition
to project budget)
Value Engineering & Management • Dynamic brief • VM Workshop attended by
• Client/Developer • Professional team • Medical equipment team • Technical services team • Commissioning team • Senior hospital management
team
Integrated Sustainability
Key Success Factors: Value Engineering
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Integrated Sustainability & Future Proofing
Mechanical installations - Summary
• Integrated Sustainability o Ventilated Double Façade
o Heat Recovery for Domestic Hot
Water Generation
o Exhaust Air Heat Recovery or
HVAC)
• Future Proofing o Spare capacity
o Plantroom organic growth space
Description Actual Capital cost Actual Annual Savings
Roof System R 1,287,386 R 194,016
8th Floor System R 147,933 R 27,619
1st Floor R 153,733 R 19,614
Total R 1,589,052 R 241,249
Description Cooling
Energy
(kWh)
Heating
Energy
(kWh)
Electrical
saving:
Cooling/
Heating
(kWh)
Running
Time
(hours)
Electric
power: extra
pumps & fan
(kWh)
Electrical
Energy Saving
(kWh)
Roof System
16,068.1 235,412.6 240,162.3
3,342 94,946.2 145,216.1
8th Floor
System 70,443.2 5,646.9 26,470.0
2,840 2,130.0 24,340.0
1st Floor
System 77,744.4 382.3 23,363.6
2,878 2,158.5 21,205.1
Total 164,255.9 241,441.9 289,995.9
9,060 99234.7 190,761.2
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Impact of a double skin façade.
Integrated Sustainability - Façade 2:
Why a Double Glazed Façade ?
Ceiling spandrel opaque
Vision section
Wall opaque
Solar heat trapped once it passes through outer skin
Single skin Double skin
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Reduce solar heat gain Ventilate the void when cooling
Heating Mode
Integrated Sustainability - Façade 3:
Cooling = ventilate void
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Improve thermal resistance Do not ventilate the void when
heating
Heating Mode
Integrated Sustainability - Façade 4:
Heating = do not ventilate void
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Integrated Sustainability - Façade 8:
Façade Void (during contruction)
Helical duct (to terrace)
Façade Void (external skin unglazed)
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Impact on Capital and Energy Cost.
0
5
10
15
20
25
30
35
HV
AC
En
ergy
R/m
²/an
Heating
Cooling
Intelligent Facade • Estimated Energy Savings R120,000
per annum • Estimated capital cost R800,000
Integrated Sustainability - Façade 9: Impact on capital cost and energy consumption
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Integrated Sustainability
Partitioning 1 – Why ?
• Flexibility: o Add or change with
minimal noise &
disruption
• Sustainabilty o Overcomes functional &
technical obsolescence
o Reusable components
(H-frames)
• Time & cost savings: o No drying time for
brickwork & plaster
o Saving off-sets extra
capex
o LCC = significant cost
benefit
• Practicality o NCBMH is 16 storey
building where access
for wet trade works is
problematic
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Integrated Sustainability
Partitioning 2 – How? & Lessons learned
• Firewalls in brick: o Drywall detailing
problematic
o Drywall fire sealing difficult
• Design & prebafricate
supports: o Door H-Frames: for heavy
doors, fire doors and sliding
doors
o Sanitary fittings
• Sequence of work changes: 1. Wet trades: screeds &
brickwork & plaster
2. Ceiling services
3. Drywall framing
4. Prefabricated H-frames for
doors and sanware
• Programme changes as a result
both:
o Documentation
o Construction
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Integrated Sustainability
Wet Services 1
• Flexibility: o Reusable components (H-
frames; composite water
pipe, fittings, brassware,
etc)
• Sustainability o Heat recovery for hot
water
o Sterilized hot water
recovery from autoclaves
and renal care
o Desalination plant
• Time & cost savings: o Capex & opex savings
Slide background: Plumbing Africa magazine - February 2017 Vol
2
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Integrated Sustainability & Future Proofing
Electrical 1 - Summary
• Sustainability
• Hospital transformers
• Luminaire selection and
lighting systems
• Load monitoring confirms
efficiencies exceed design
estimates by +/- 30%
• Green initiative:
o Standby Generator
installation – noise
suppression
• Future proofing:
o Electrical system designed
for the future expansion
o Plantrooms sized for the
expansion
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Integrated Sustainability & Future Proofing
Electrical 2 – Extra Low Loss Transformers
o Additional capital cost for the Dry Type (not oil filled)
Extra Low Loss transformers: R243 174
o The savings due to reduced losses estimated at
R48 999/annum (excluding escalation in electricity
costs)
o Simple payback period: 5 years
Transformer Type Transformer
Size
Fixed
Losses
Variable
Losses
kVA P0 (kW) Pk (kW)
1600 2.80 14.50
2000 3.60 18.00
1600 1.60 13.00
2000 1.90 15.50
Standard Dry Type
Transformer
Extra Low Loss
Transformer
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Integrated Sustainability & Future Proofing
Electrical 3 – Luminares & lighting systems
Luminaire selection: • LED used to the maximum:
o prices were coming down
o efficiency is going up
• LED lights except T5 recessed 600 x 600
and 1200 x 600mm which was more energy
efficient at that stage
LED Bump Rail Lighting (Night & Emergency)
LED Lighting to the Theatre Corridor
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Integrated Sustainability & Future Proofing
Desalination Plant - Background
Background
• Non-viable at project start
• Became viable to mitigate “Day
Zero” scenario risks
• NCBMH Daily demand: 100 000
litres
• Also address the needs of all
Netcare Western Cape facilities
• Total capital cost: +/- R 7 million.
Raw water source – basement
sump:
• “Fresh” water from Table Mountain
side – but dry during drought.
• Underground tidal water –but high
TDS silt-laden salty water.
Capacity:
• 400kL per day
• Tanker filling point
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Integrated Sustainability & Future Proofing
Desalination Plant - Challenges
• Variable Total Dissolved Solids
(TDS): 4500 - 15000ppm (in drought
conditions). Solution : plant operating
pressures increase from 12 Bar to >
40 Bar.
• Basement Location: posing height
restrictions as well as complexity in
rigging the plant into restricted location
via difficult access route. Solution:
bespoke design.
• Programme:
• 90 Day time frame available to
March 2019 completion date.
• Statutory compliance with: o City of Cape Town, Department
of Water & Sanitation
o Department Environmental
Affairs
o Marine and Coastal
Management
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Integrated Sustainability & Future Prooofing
Desalination Plant – Components
Reverse Osmosis System
The Reverse Osmosis System in place and connected with the balance of the plant
Carbon and sand filters
Level -1: 400kL/day Desalination plant
Level -2: 50kL Buffer tanks
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Future Proofing
Helistop Background • Requirement for fully licensed Helistop as
required for a full Level 1 Trauma Facility
• Assists City of Cape Town in bidding for world
class events
Some key definitions • Heliport, Helistop vs Emergency landing zone
Approval process: • Land Management & Town Planning
• National Ports Authority – leading lights & flight
path
• Cape Town Disaster Management – no fly zone
• Civil Aviation Authority
Programme • Complete “roof feature” in Phase 1 Hospital
Opening by December 2016
• Complete Helistop construction during Phase 2
– by December 2017
• Procure and fit out 2018
• Commissioning and flight training 2019 with full
operations now imminent
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Future Proofing
Organic Growth
Background • Grow from 254 beds at opening to 356
beds once fully developed
• Seemless growth with minimal impact on
operations during construction
• Mitigate technical obsolescence
• Obviate functional obsolescence
Solutions • 8th Floor parking designed to
accommodate future ward
• Organic growth space on floors
immediately adjacent to areas likely to
expand (theatres, plant rooms, ICU’s &
Wards)
• Flexible and re-usable buiiding
components (partitioning, wet services,
Phase 2 – Add Hybrid Lab
Phase 2 – Radiotherapy bunker
Phase 2 – Add 2 Theatres
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Future Proofing
Organic Growth (10th Floor)
Future Expansion
Future Expansion
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….and thank you to our
project team…
THANK YOU