CM client says of CANCO, 'We're In This Together'

CM client says of CANCO, 'We're In This Together' Carl A. Nelson & Company was selected as construction manager agent in 2010 when Davis County Hospital & Clinics decided to finished an expansion project that began in 2000 and had to be shut down due to cost and schedule issues. The completed facility included a new, expanded emergency department. CANCO photo

6 months, 3 weeks ago

By Craig T. Neises
cneises@carlanelsonco.com

BLOOMFIELD, Iowa — As the new millennium dawned, Davis County Hospital & Clinics undertook plans to expand medical services by adding a surgical suite, pharmacy and medical office building.

Unfortunately, due to budget constraints and schedule overruns, construction ended before all aspects of the proposed project were completed. The hospital cut its losses and shut down construction with the office building left as an empty shell, hoping to try again another day.

That day arrived in 2009, when hospital officials engaged Carl A. Nelson & Company (CANCO) to be construction manager on a project to pick up where the earlier work left off and produce a value-added finished product.

“I see it as, we’re in this together, because we have to have a partner. Because we don’t build buildings. We take care of people. And so, we need a partner who can help us figure out how to build that building, or remodel that building, or add on to the building.”

— Veronica Fuhs, CEO
Davis County Hospital & Clinics

And the relationship has continued since, into a master planning process that was nearing completion before the COVID-19 pandemic.

“They understand where we’re at, always asking about what our needs are,” Rodney Day, the hospital’s director of ancillary services said of the CANCO project team leaders he has worked with. “We’ve done a lot with our own guys internally. We’re a not-for-profit hospital, we’re watching every dollar.

“But all we have to do is pick up the phone and give them a call, and we know they’re going to be here.”

Davis County Hospital & Clinics serves Bloomfield and Davis County (population 8,900 in 2019), as well as surrounding areas of rural southern Iowa and northern Missouri. With its team of eight local providers, a range of visiting specialists and an array of outpatient services, DCHC continues to see an increase in patient volumes.

Services include emergency care, surgery, lab, diagnostic imaging, primary care through Davis County Medical Associates, and specialty care such as allergy, cardiology, dermatology, orthopedics, pulmonology and urology, as well as physical, occupational and speech therapy. All that means area residents can receive care and treatment close to home, without having to make the two-hour drive to either Des Moines or the University of Iowa in Iowa City.

Much of the hospital and clinics’ present-day capacity was achieved through the construction project in 2010, when the hospital was able to finish the shell space to relocate acute care, hospice, pharmacy, construct a new and expanded emergency department, add MRI and more.

As a public hospital, project delivery options for the work in 2010 were limited, but previous experience made seeking an alternative desirable. So, for its second try at a successful project, the hospital chose construction management. Construction Management Agency (CMa) is a delivery method available to public hospitals in Iowa where the construction manager is selected based on qualifications and acts as an agent of the Owner.

A CMa contract was awarded to Carl A. Nelson & Company, which came on board in 2009 to lead the planning and construction. With CANCO in the CM role, the hospital was able to achieve its project goals and have the kind success it did not enjoy in the previous attempt.

“I can tell you, not only has the quality been there,” former Davis County CEO Deb Herzberg said in 2012, near the time of the project’s completion, “but the experience with Carl A. Nelson has been top-notch.”

What new CEO Veronica Fuhs described as Carl A. Nelson & Company’s “proven track record,” meant that when the time came in 2018 to initiate a master planning process to consider the hospital’s future, there was no question about contracting with CANCO again.

“If COVID had not come around,” Day said, “we’d be in the midst of construction right now.”

Instead, the pandemic meant work on the master planning process came to a screeching halt in 2020 and has yet to resume.

In the interim, an internal feasibility study was started with auditors to determine a budget, as well as what type of plan — be it new construction, renovation, service adjustments or a combination — would be sustainable based on available finances and staffing.

Throughout, the needs that led to seeking a new master plan haven’t disappeared, and in some cases have become more acute. For instance, in a hospital where portions of the building date to the late 1940s, there is plenty of room, but that room doesn’t meet current needs or standards of care, with the focus shifting more and more to outpatient services. At the same time, Fuhs said, the rural health clinic has run out of room to keep up with demand, while the range of specialists cannot be expanded for the same reason.

Former Davis County Hospital & Clinics CEO Deb Herzberg spoke in 2012 about Carl A. Nelson & Company's role in completing a successful expansion project.

Work led by Carl A. Nelson & Company during a 2010 project at Davis County Hospital & Clinics included finishing out the interior of the new Emergency Department, and adding permanent facilities for MRI services. (CANCO photos)

“We think we could get it there, but we’ve got to figure out what’s the best way to go so we’re not wasting money,” she said.

Through all the uncertainty, Fuhs said, the team from CANCO has continued to be a go-to resource for questions without pushing pre-conceived solutions or even having the promise that a project ever will materialize. But when progress can resume (or possibly begin anew, Fuhs and Day said, with a vastly different set of priorities due to the impacts of the pandemic), being able to count on that relationship is viewed as being key to the hospital’s ability to be successful no matter what shape its plans may take.

“I see it as, we’re in this together,” Fuhs said of working with Carl A. Nelson & Company, “because we have to have a partner. Because we don’t build buildings. We take care of people. And so, we need a partner who can help us figure out how to build that building, or remodel that building, or add on to the building.”