Case Study

Navigating Hospital Expansion: From Vision to Reality

Hospital Expansion Project: How Building Commissioning, the Owner’s Project Requirements, and Data Analytics Technology Changed the Build


With the demand of patient care rising, a notable cancer center in Florida needed to expand. As the largest single build in their organization, this hospital expansion project required engineering expertise. Key factors contributing to their success included masterplanning with Owner’s Project Requirements, complete building commissioning, and data analytics.


  • Synergy guided this cancer center with multiple previous projects where the Owner’s Project Requirements (OPR) process helped the hospital clarify and define projects from the beginning.
  • Clear and open communication between teams will alleviate minor frustrations with installation details.
  • Any major equipment should be inspected on site with specs in hand and reviewed with a fine-tooth comb.
  • Data revealed multiple errors which in turn has saved months of troubleshooting building performance issues and has helped the owner hold the design and construction team responsible
  • If the BAS contractor is not directed with clear instructions on how the BAS is to be organized according to the OPR, the results will miss the mark.

Expansion Hospital Case Study

A notable cancer hospital in Florida experienced over 10% yearly growth since inception in the 1980s. With rapid growth came new challenges such as exceeding their footprint, inefficient existing facilities, and outgrowing their current space.

Oftentimes, portfolios that house multiple buildings do not realize when they are over capacity. Unfortunately, it can be too late when organizations realize they’ve overloaded their assets and facility. Existing infrastructure cannot always support multiple additions and renovations. Intentional dialogue and planning needs to occur around how much load is running vs how much capacity. Is the chilled water supply temperature low enough? If it was designed for 45 and the asset can only put out 48, then it is losing capacity. Other examples, connecting a new sterilizer that demands a certain amount of steam, or changing the use of space, which may need more or less outdoor air. It is essential to take all these requirements into consideration, but oftentimes concerns are shelved or put on the back-burner with the assumption that the infrastructure can support the renovation. The bottom line, in order to maintain their standard of exceptional care, this cancer center needed to expand. The hospital purchased property and began master planning. 

Existing infrastructure cannot always support multiple additions and renovations.

Synergy has helped other healthcare clients expand their organizations through new construction by providing thorough master planning alongside Owner’s Project Requirements (OPR). Synergy guided this cancer center with multiple previous projects where the OPR process helped the hospital clarify and define projects from the beginning. Synergy upheld accountability across all teams from Key Stakeholders to design/construction so project expectations are met. Without an OPR, projects run the risk of relying on assumptions rather than documented project expectations.

Synergy has been supporting healthcare providers for years with thorough building commissioning. Our commissioning process is modeled after BCxA’s best practices which reduces the amount of change orders, project punch lists, and overall project costs, while improving the final project delivery.

Owner’s Project Requirements

Ensuring project objectives and maintaining accountability through project completion

An Owner’s Project Requirements (OPR) document is more than a stagnant piece of paper. It acts as a live document that provides accountability across all hands involved in a project. Whether projects are large or small, an OPR is a map to project success. For a project of this complexity and magnitude, an OPR was imperative.

An example of a project without an OPR: A hospital wants to install a new MRI. The imaging team has certain requirements that they need for the equipment, but it’s not documented anywhere. The architect meets with the design engineer and they assume the infrastructure can support the new install. They move forward with the project and everyone assumes they are on the same page for project completion. However, the project goals were not mapped out and there was a lack of accountability across teams. The infrastructure could not support the remodel which ended in multiple change orders and delays. The project was completed after a long delay, but with unhappy end users and team. 

The OPR creates strategic alignment across all users for a mutually beneficial end-product.

Navigating Hospital Expansion: From Vision to Reality

An OPR reverses poor communication and outlines everything from planning to occupancy. Teams such as the imaging team would be invited to the OPR workshop to verbally communicate their requirements that would be tangibly documented. This information would be validated and verified by the architects and engineers and that the infrastructure could support the install while ensuring it met the Owner’s intent for the project. The OPR is a strategic alignment across all users for a mutually beneficial end-product.

Energy Efficiency Goals: The OPR required an energy model be provided by the design engineer. This allowed the teams to set energy efficiency goals for the operations and systems and provided tighter controls for the quality of equipment that would be selected. The HVAC design and model selections were based on meeting the energy goals. Outlining energy goals at the beginning clarified the engineer’s design requirements because they knew what energy designs they were targeting.

Avoiding Change Orders: During an OPR review, one of Synergy’s engineers identified a few areas of the project that were not meeting the OPR. The slop sink that was designed for the 3rd floor mechanical room had been omitted in the drawings. This was a small error in design, but an important component for the mechanical team who would be utilizing the space in cleaning up their tools and equipment. Had this not been caught in a timely manner, it would’ve resulted in a change order.

Operating Room (OR) Turndown: When there are multiple details in a project, it’s understandable that some things get missed. The design engineers and contractors had forgotten that the Owner requested an OR turndown which reduces the airflow at night while the space is unoccupied. This small detail has the potential to save money associated with energy reduction. Through tracking the live OPR document, Synergy ensured the Owner’s requirement for OR Turndown was met.

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