Attachment 1 - Solicitation Narrative 06232023.pdf

Warm Springs Healthcare & Wellness Center

Phase 1 Modernization

June 28, 2023

Design Build Solicitation

Warm Springs Healthcare & Wellness Center - Phase 1 Modernization

CONTENTS

INTRODUCTION

Project Scope

Project Overview

PROCESS / PROGRAM

Process

Program Requirements

Phasing & Staging

Evidence Based Design

Biophilic Design

SPACE

2018 Master Plan

Typical Spaces

Circulation

Space Utilization

Flexibility

Overall Layout Plan

POD C Remodel Plan

New Addition Plan

Exterior (East & North) Elevation

GENERAL NARRATIVES

Sustainability (Guiding Principles)

Architectural

Mechanical

Plumbing & Fire Protection

Electrical

CONCEPT RENDERINGS

Exterior

Interior (Main Corridor & Waiting)

Interior (Team Room & Pharmacy)

Introduction

The following package is a summary of the Warm Springs Modernization Phase 1. This summary is intended as information only.

PROJECT SCOPE

Project location: Warm Springs Health and Wellness Center (WSHWC)

Site Information: The WSHWC is located at 1270 Kot-Num Rd Warm Springs, OR 97761. The site is approximately 19-acres of relatively flat land with a steep slope to the south.

Building Area: The existing Main Clinic is approximately 36,000 SF.

Area of Work: The new addition is approximately 18,067sf. The renovation of Pod C is approximately 6,800sf.

This Project is to design the building expansion for the new Primary Care, Diabetes Management, and Pharmacy departments. Preliminary designs of the building expansion suggest the most feasible area of the expansion to be constructed along the southeast corner of the existing clinic, within the existing property boundaries and parking lot. The proposed renovations in the existing clinic will be for the Specialty Care, Podiatry, Ear Nose and Throat, Lab, and Imaging departments located in Pod C.

PROJECT OVERVIEW

In 1992 construction began on the WSHWC with construction being completed in approximately

18 months. The purpose of this design effort is to address the acute need for increased healthcare services at the Warm Springs Health and Wellness Center. The Primary Care and Pharmacy departments are operating under severely cramped conditions. Additionally, the current layout of exam rooms and patient flow through the facility is dated and suboptimal. The Facility Master Plan details prioritized project phasing developed during the planning stage of this project, resulting in the proposed expansion and remodel of the existing clinic.

This project’s ‘Building Package’ is at the Design Development phase. Planning and code review shall be compliant with Oregon Building Standards, including local & county compliance.

Additional codes noted in IHS A/E guide shall also be incorporated, any code more restrictive shall be implemented in the final building solution

Beyond the Phase 1 efforts for this project. As with every healthy organization, the Warm Springs

Healthcare and Wellness Center needs to grow and will experience on going change in the next decade and beyond. The overriding purpose of any Master Plan is to create a framework that enables WSHCC to successfully plan for growth and change, while providing the flexibility to deal with the unexpected. Any Master Plan should also express a connection to the surroundings, the local settings, and to the opportunities for creating a place that is engaging, functional and healing.

PROCESS

Most architectural firms follow the philosophy of William Pena. In his book Problem Seeking he defines Programming as a five-step process: establishing goals; collecting and analyzing the facts, testing the concepts, determining the needs, and stating the problem. It is the process leading to a statement of an architectural problem and the requirements to be met in offering a solution.

Programming is the process of information gathering, assimilation, and decision making to provide a Road Map towards building solutions. This is a graphical representation of the process to develop the road map. The architectural design team can provide the guidance and coordination necessary to create the processes, gather the information, and provide a Program of Requirements document that will facilitate the design of highly complex buildings.

Designing the hospital is a process that takes the program and envisions solutions to the owner’s needs from concept, through schematic design, to final approval of the design development.

The Conceptual Design phase follows Programming, and is often considered as part of the Programming phase. The Conceptual

Design allows the designer to test basic assumptions concerning the overall organization of the facility and layout of its individual spaces by type.

During Schematic Design, the initial programming information is translated into a well-designed building in terms of size and character. This includes room-by-room floor plans, first detailing of the exterior design identifying character and materials, and description of infrastructure components. During the Schematic

Design the programming effort continues to further develop and refine the overall project and equipment needs.

The Design Development phase serves as a bridge between

Schematic Design and the final phases of design. After the Owner has approved the final design, the designer will produce

Construction Documents and Specifications. These are the documents used for obtaining construction contract bids.

This process graphic assumes a traditional Design-Bid-Build

Project Delivery

PROCESS (ALT Design/Build) Design-Bid-Build (DBB) is probably what would be viewed as the more traditional building process. The process outlined on the previous page followed this method. The benefit of utilizing this traditional design process through Design Development is maximizing the User involvement and then providing a level of detail to procure a price that has limited outside influences.

Beginning with the Design-Build at the Construction Documents, also assures that key design elements are incorporated in the next phase.

Also requires following submittal requirements of the IHS A/E guide

PROGRAM REQUIREMENTS

The primary and detailed requirements are referenced in the PJD/

POR. The following a summary extracted from that documentation.

This includes a high level overview of the intended departments and target areas. Adjustments to the overall space is expected due to the nature of unforeseen existing conditions and elements that may come out of newer codes or discovery.

Existing POD C—Remodel

• Specialty Care

• Audiology

• Podiatry

• General Propose/Flex

• Imaging

• Lab

Building Addition

• Primary Care

• Pharmacy

Circulation & Support Spaces

Space Allocation Designed Area Allowable Area Difference

Total Dept Gross 13,491 15,606 -2,115

Circulation 3,000 3,121 -121

Mechanical 1,149 2,247 -1,098

TOTAL 17,640 20,975 -3,334

Building Expansion

PROJECT PHASING

Phasing will be a critical aspect of both the building addition and remodel. The very nature of healthcare and services to community can not be interrupted. The following approach is currently a recommendation forward. The final phasing should be coordinated closely with IHS and the service unit:

A. Phase 0.5: Site Improvements, ie parking expansion and infrastructure improvements

B. Phase 1.1: Building addition.

C. Phase 1.1a: Primary Care & Pharmacy move into new space

D. Phase 1.2: Specialty Care, Lab Remodel & Imaging Remodel

E. Phase 1.3: Final POD C Remodel at Staff Workroom

PROJECT STAGING

During construction, it is understood that there will be a need for the design-builder to stage their construction. The current area that is clear of patients, staff and is fairly level is just north of the new parking. Once construction is completed, it is understood that the area would be restored to its pre-construction status. Noted below is an alternate area that should be coordinated with the facility.

EVIDENCE BASED DESIGN

Evidence-based design (EBD) is the process of constructing a building or physical environment based on scientific research to achieve the best possible outcomes. Evidence-based design is especially important in evidence-based medicine, where research has shown that environment design can affect patient outcomes.

EBD Workshop On July 22, 2021, JSRa, IHS and the Warm Springs Service Unit conducted an EBD Workshop. This Design Charrette workshop was an intensive, hands-on and fun workshop that brought people from different disciplines and backgrounds together to explore design options for the Warm Springs Health & Wellness Center modernization. This process implemented the best of evidence-based design (EBD) while assuring functionality of each department.

The EBD ideas were an overview to capture key elements. This list is not inclusive of all topics that were discussed. Primary purpose was to open a dialog with the stakeholders and stimulate a collaborative effort.

EBD Results

The concepts portion of the workshop facilitated discussion There were several items during the workshop that were critical to the project team. The following is the results list:

• Same Handed Rooms

• Natural Light

• Smaller Waiting Areas

• Separate Staff Circulation

• Connection to Nature/ Biophilic Design

• Central Work Area

• Integrated Behavioral Health Support

• Integrated Diabetes Management

During the SD review, the next step the team took was to select the item(s) that can be measured. This item(s) will be captured in the DD expanding on the element for study and research. The measured item(s) shall be traced through Construction Documents to the end of construction. The final step is for the owner to select an independent researcher to collect data.

This data collection is then accomplished approximately 6 months after occupancy.

Measured Items

The following Items were noted to be expanded on as measured items. These elements shall be documented during each stage of the Design-Build process. The final results shall be documented by an independent third party six months after occupancy

• Decrease patient wait times & increase staff efficiencies. Utilizing at a minimum the following design elements:

Same Handed Rooms

Central Work Area

BIOPHILIC DESIGN

The biophilia hypothesis proposes that most humans have an innate love of nature—we long for it and without connecting with it, our health could suffer. So, biophilic design is an applied solution to appease this desire for nature by integrating natural elements and processes into the built environment.

Nature in the Space

• Visual Connection with Nature

• Non-Visual Connection with Nature

• Non-rhythmic Sensory Stimuli

• Thermal and Airflow Variability

• Presence of Water

• Dynamic and Diffuse Light

• Connection with Natural Systems

• Biomorphic Forms and Patterns

• Material Connection with Nature

• Complexity and Order

• Prospect

• Refuge

• Mystery

Biophilic Results

All of the concepts of Biophilic Design may not be practicable or applicable to Healthcare

Design. It is important to use these approaches to nature both inside and outside of the space.

Connecting to nature is the first line of defense for well being. This connection should be evident in the final design solution.

Warm Springs Healthcare & Wellness Center - Phase 1 Modernization 2018 MASTER PLAN

TYPICAL EXAM

TYPICAL SPACES

The PJD/POR and the FGI have set minimum requirements for the spaces. The typical spaces utilized for the existing remodel and new addition are based on the following minimums. This sample list covers the common areas, reference the full space planning outlined in the POR/PJD, Drawings and BOD.

Corridors .................................................... 6’ Wide

Corridor (Gurney Traffic) ........................ 8’ Wide

Exam Rooms ............................................. 125sf

Treatment Rooms .................................... 150sf

Restrooms (Single Occupant) ............... 54sf

TYPICAL SPACES

TYPICAL TREATMENT

Warm Springs Healthcare & Wellness Center - Phase 1 Modernization CIRCULATION

CIRCULATION CONCEPT

One of the biggest challenges to patients at any healthcare facility is navigating the typical maze. This can create a level of anxiety as soon as the patient enters the facility. The initial approach for circulation and way finding at the addition was to create a central spline or a primary circulation path.

Immediately upon entering the facility, waiting for the key areas is made available to the patient. This waiting is for the Pharmacy and Primary Care. Also at the main entrance is an opportunity for an information desk. This primary circulation will also connect to the existing facility for the existing and renovated ‘Pods’. This includes the Phase 1 renovation of Pod C. Finally by creating a dual purpose circulation and waiting, the education and traditional healing is placed front, creating an awareness of the importance of these functions to the patient and community as a whole.

In an effort to promote staff safety and ease of circulation, an offboard circulation was created. This connects the areas that are generally only accessed by the staff, creating another level of safety. Finally, support circulation that is common to both the patient and staff is handled through controlled access.

Warm Springs Healthcare & Wellness Center - Phase 1 Modernization SPACE UTILIZATION

• Space zoning to centralize like functions (service, diagnostic and treatment, administrative, public).

• Development of a flexible and a universal space module

(to accommodate changes to diagnostic and treatment modalities while minimizing operational disruption and cost).

• Development of a space planning module (to enable growth and change for all functions).

• Segregation of service and public traffic.

• Accommodation for mobile technologies that are conveniently located for patient access and proximate to related Departments (e.g. Radiology, Clinics, etc).

• Planning/design that promotes patient privacy and dignity.

• Enabling of operational efficiency :

• Centralization of functions

• Selection of materials and systems

• Reduced redundancy (space, equipment, and FTEs)

• Leverage scarce resources (physicians, nursing, technicians, therapists, etc)

• Promotion of a healing environmental (addressing light, view, sound, green space, etc)

Warm Springs Healthcare & Wellness Center - Phase 1 Modernization FLEXIBILITY

FUTURE PHASING

The Warm Springs Clinic is on an existing site. There is room to grow without impacting the current facility.

Beyond the space needs is to embrace the existing cultural design. The existing facility captured the Warm

Springs symbology of the 3 teepees. Moving forward the addition reflected the traditions of the culture. The wave at the front represents the rivers in the region, the high main entry reflects the scaffolds for traditional fishing on the rivers, and the traditional healing/ education is a modern built teepee reflecting the tribe’s logo.

The future phases continue this them of the river and fishing. By expanding beyond the north end, this allows for direct access to the future services in this addition.

There are also opportunities to create new access drives and future parking to the southeast. If future traffic warrants a greater distance, new drive access can be accommodated.

In an effort to keep even the Phase I expansion flexible, the orientation allows for modest growth east and north.

Warm Springs Healthcare & Wellness Center - Phase 1 Modernization OVERALL PLAN

Warm Springs Healthcare & Wellness Center - Phase 1 Modernization POD C REMODEL PLAN

Warm Springs Healthcare & Wellness Center - Phase 1 Modernization NEW ADDITION PLAN

EAST ELEVATION

EXTERIOR ELEVATIONS

NORTH ELEVATION

BUILDING SECTION

Sustainability The project will be pursuing U.S. Green Building Council (USGBC) Leadership in Energy and Environmental Design (LEED) LEED BD+C: New Construction and Major Renovation v4.1. Project materials and the design shall recommend best practices for sustainability. Back check is included as a

LEED check list targeting Silver for the project. A narrative is included based on the IHS A/E guide for guiding principles. Included in the BOD are the minutes from the Sustainability Charrette conducted on October 10, 2021 and the LEED Charette on July 19, 2022.

Typically, the LEED check list does not have a narrative column. The modified list shown here includes notes for team during the review and selection charette of potential points. There are items important to the facility and community.

These are noted below:

• Bike Racks

• 20% renewable energy (Combination of Roof

Top and Parking as required to achieve benchmark)

• Water conservation

• Electric power stations for GSA & Staff vehicles

• Geothermal heating-cooling source

• Indoor air quality

• Insulation/Energy Efficiency.

Architectural Narratives The design main objective is to incorporate colors and textures that reflect the Warm Springs culture. The quality of materials and finishes specified for this project also achieve and exceed the high-middle standard of construction healthcare. All finishes shall be cleanable/scrubbable for long term health and maintenance. Use of fabrics that are absorbent is discourage and soft vinyl with cleanable surfaces is required.

Exterior Finish Types:

Walls:

Stone Base Veneer (similar to existing)

Metal Siding

Faux Wood Siding/EIFS

Curtain Wall/Glazing

Roof:

Standing Seam Metal Roof (exposed sloped roofs)

PVC Single Ply Membrane (flat roofs)

Interior Finish Types:

Flooring:

Seamless Flooring (Exam Rooms / Patient Care Spaces)

Luxury Vinyl ‘plank’ Flooring (Waiting Areas & Corridors)

Sealed Concrete & VCT (Maintenance Areas)

Wall Base:

Rubber Base

Walls:

5/8” type ‘X’ Gypsum Board over 3-5/8” metal studs.

Final finish shall be Latex Paint with key spaces incorporating accent colors.

Doors & Frames:

Solid Core Wood Doors, painted Hollow Metal Frames

Hollow Metal Doors & Frames (Exterior)

Window:

Aluminum Storefront

Window Sills:

Solid Surface

Window Treatments:

Roll-up mecho shades.

Equipment: The medical equipment is a stand alone document and should be referenced separately.

Mechanical Narratives

IHS has given the design team direction to design a DX air handling units system with electric reheat variable air volume (VAV) supply terminals following the recommendations on system type based on the life cycle cost analysis produced for the project; the design development documents reflect this type of system.

The DX system will consist of VAV supply terminals, two DX air handling units, and one DX air handling that will be used as a dedicated outside air systems (DOAS) during pandemic switchover. Ventilation outside air per room will be provided based on the current adopted versions of the

International Mechanical Code for non-medical space and 2021 ASHRAE

170 for outpatient Spaces.

Pandemic Switchover system

It has been requested the design team provide an area within the exam suite where rooms normally provided with supply air and return air goes back to the air handling units can be switched to 100% exhaust. In this switchover room area, the return air path from the room to air handling units will be completely closed and all air from the room will be exhausted out of the building. A DOAS will provide all the supply air directly from the outdoors (100% outside air.) Control dampers within the exhaust duct to each room will modulate to maintain the rooms at -0.01 in wg to the corridor outside of the room. The DOAS will provide make up air to the corridor outside of the switch rooms to keep the corridor neutral to spaces outside of it.

LEED for mechanical systems

The following has been included in the design of the HVAC for the purposes of achieving at a minimum LEED silver certification:

Ventilation to each room has been increased to 30% above ASHRAE 62.1.

A high efficiency HVAC system has been designed for the project.

HVAC zones have been selected to at least 50% of occupants have control over room temperature. Normally unoccupied space are not taken into consideration.

Seismic Event Design

It has been determined by the structural engineer that this building is classified as seismic category D which requires mechanical/electrical/plumbing/fire protection (MEPFP) system seismic bracing. A seismic engineer must be contracted to provide professional engineered and stamped drawings for

MEPFP systems that identify all components requiring bracing, identify products and materials required, specify installation methods, and review the installation of the seismic braced systems. Bernhard as the MEPFP engineer of record will not design any aspect of the seismic bracing systems.

Controls

The existing campus energy management system (EMS) is Reliable; IHS is requiring the new addition control system be an extension of the existing Reliable system.

The controls contractor will be required to update the existing system with the latest software version. The controls scope for this project will be providing full control of all air handling units, VAV supply terminals, exhaust fans, and isolation rooms/areas per design engineer provided control sequences that comply with the latest adopted version of ASHRAE 90.1 and the

International Energy Code and maximizing energy efficiency.

Plumbing & Fire Protection Narratives Water

A new dedicated water main will be provided to the new addition with the main entering the mechanical room and proceeded through a reduced pressure zone backflow preventer.

Hot water to the new addition will be provided by a new hot water system consisting of a flat panel solar hot water heater (providing 30% of the hot water demand) and an electric hot water heater (providing the remaining

70% and full back up), master thermostatic mixing valve, and hot water return pump all located in the mechanical room. Total anticipated annual thermal output required by water heating system is 54,900 kBtu where 17,520 kBtu is to be handled by the solar water heater; refer to solar water heater feasibility document for further information.

Solar Domestic Hot Water Heating

As per the requirements of the project, the feasibility of utilizing a solar hot water heater for at least 30% of the new addition domestic hot water heating was evaluated. The evaluation was based on the available budget and the life cycle cost using a 40-year payback period (requirements of the feasibility study are based on the 2019 AE Design Guide.) The evaluation for use of using a solar hot water heater yielding a 12-year payback; a solar water heating system will be included in the project. Refer to solar hot water heater evaluation document for details of the evaluation.

LEED for plumbing systems

The following has been included in the design of the plumbing system for the purposes of achieving at a minimum LEED silver certification:

Low flow toilets and lavatory/handwashing sink faucets.

Flow meters for domestic cold and hot water systems.

Fire Protection

The new addition is to be fully sprinklered. The building is to be connected to the existing fire protection site water distribution. The new addition branch main will enter the mechanical room where the fire riser will be located; an exterior door to the mechanical room is recommended for servicing equipment, but not required. The fire department connection will be located on the site as required to accommodate site layout of the fire truck route.

Electrical Narratives Advanced Metering:

Advanced digital metering system will be provided within incoming service entrance switchboard ‘SES-MDP’ and Essential Distribution Panel ‘EDP’. The trip units on the distribution circuit breakers will be interconnected to the digital meters to monitor each feeder. The advanced meters will be interfaced into the building management system for real time monitoring and recording historical demand use

New Essential Emergency Power:

A new 125KW/156KVA, 277/480V-3Phase- 4Wire emergency standby propane generator within an acoustically treated enclosure located on the site will be provided. The enclosure will have a horizontal air intake with a vertical radiator exhaust with a critical silencer exhaust will be provided within the enclosure. A panelboard will be provided within the enclosure to support the generator battery charger, battery heater, block heater, enclosure lighting and a GFCI weatherproof duplex receptacle.

The generator will source a 200A, 277/480V-3Phase-4Wire solid neutral open transition automatic transfer switch with maintenance bypass located within the Phase 1 electrical room. Transfer switch will feed an essential; emergency

277/480V distribution panelboard. The distribution panel will feed (2) branch circuit panelboards, a Life Safety panelboard and a Critical Branch panelboard.

The Life Safety panel will provide branch circuits feeding Phase 1 277V egress lighting circuits and a Phase 1 dry-type transformer 480V- 120/208V. The transformer secondary will feed a 120/208V-3Phase-4Wire Life Safety branch panelboard to feed Phase 1 IDF panelboard, fire alarm and security access system and the emergency generator panelboard.

Lighting inverters sourced from the Life Safety branch will be provided serving the life safety lighting including the exit signage and exterior egress lighting to prevent the facility from going totally dark until the emergency generator comes online.

The Critical Branch panelboard will feed a Phase 1 dry-type transformer 480V

-120/208V. The transformer secondary will feed a 120/208V-3Phase- 4Wire branch circuit panelboard providing branch circuits to the pharmacy refrigerators and freezers, workstation computers.

Empty conduits will be stubbed out and capped from the Life Safety and

Critical Branch panelboards for future campus distribution system.

The Phase 1 277/480V essential emergency panelboard will back feed the existing 30KVA, 480V-120/208V dry-type transformer presently feeding existing emergency branch circuit panelboard 2E1 and 2E2.

Arc Flash/Coordination Study

In compliance with NFPA 70E 2018, Article 130 Work Involving Electrical

Hazards an Arc Flash/Coordination study will be conducted and current

NFPA and OSHA Arc Flash Labels provided on all electrical equipment that may need examination, adjustment, service or maintenance while energized, creating the potential for an arc flash incident to occur.

The study will be conducted by the awarded manufacturer for the electrical distribution components based on the approved submittal components being provided. The manufacturer will furnish the required labels with the electrical contractor placing the labels on the electrical distribution components.

On-Site Renewable Energy

A solar PV parking canopy system will be provided with the total capacity of producing a minimum of 20% of the annual electrical demand load of the Phase 1 expansion. Each section of canopy shall be provided with a weatherproof solar PV transformerless inverter with an output of 277/480V-

3Phase-4Wire. LED lighting beneath the parking canopies will be provided with the solar PV canopies. A meter will be provided to monitor the output of the solar PV system and interfaced into the building management system for monitoring and reporting. An interconnection agreement with

Pacific Power will be required prior to bringing the PV System online.

Ten Class 2 electric vehicle chargers will be provided under the solar PV parking canopies across from the patient drop off lane. Each Class 2 charger will be sourced from a dedicated

60A, 208V-1Phase branch circuit sourced from branch circuit panelboard ‘EVC’.

Warm Springs Healthcare & Wellness Center - Phase 1 Modernization Exterior Concepts

Warm Springs Healthcare & Wellness Center - Phase 1 Modernization Interior (Main Corridor & Waiting)

Warm Springs Healthcare & Wellness Center - Phase 1 Modernization Interior (Team Room & Pharmacy)