The planning rubric “start with the end in mind” doesn’t normally involve skipping the steps in the middle. But that’s exactly what the University of North Carolina Health Care System (UNC HCS) did with a $200 million project consisting of a medical office building and 68-bed hospital. “This was originally supposed to be on the main campus, and really an extension of the main campus,“ says Ray Lafrenaye, vice president of facilities, planning, and development for UNC HCS. “We were going to add 68 beds to our main campus.”
Then, as Lafrenaye and his colleagues considered the bigger picture at the beginning of the design and planning phase in 2009, they weighed two external factors that influenced the direction they would take. They saw that UNC HCS’s long-term strategic plan called for the construction of a satellite hospital near the main campus 20 years in the future. They also realized that the high cost of building on campus would be prohibitive, so they changed plans.
“The decision was made to move up the timeline to build a satellite hospital campus now,” Lafrenaye says. The change in plans meant that Lafrenaye found himself shifting his focus from on-campus infrastructure to figuring out where this new campus would be located. The planned facility needed an accessible parcel of land of approximately 60 acres located near Interstate 40 and in Orange County—criteria that quickly narrowed down the options Lafrenaye and his real estate broker were considering to two pieces of land.
Once the site in Hillsborough was selected, Lafrenaye oversaw the purchase of 83 acres of land divided into three parcels: one 56-acre parcel to host the new hospital and two other parcels to accommodate future growth. Architect and construction manager selection processes soon followed, with architectural firm ZGF (formerly Zimmer Gunsul Frasca) and Skanska winning those roles.
Getting architecture and construction management partners in place might typically mean full speed ahead, but since Lafrenaye and his team were working on a Certificate of Need project, they needed to separate the process into phases instead of doing the whole complex as one project. The first phase was site enabling—preparing the site for the hospital. The second phase involved the facility’s core and shell. The medical office building was the project’s third phase, and the hospital itself comprised the fourth phase.
All phases of the project had to be completed before the hospital could open. The overlapping nature of each project’s timeline required Lafrenaye to manage an intricate network of sequential and concurrent processes. This posed a substantial timing challenge. “Treating each phase separately meant we had to engage different contractors at different times and string them out. We had to break it apart to be able to get the best pricing on the work,” Lafrenaye says.
Furthermore, the construction took place as the economy started to rebound from the recession, which added a budgetary hurdle. “Medical construction is a real specialty—it’s not something that any construction company can do,” Lafrenaye says. “And what happened during the recession is that some companies were offering prices just to stay alive, and then a lot of them went out of business anyway. Then when the economy started to pick up, there was a lesser amount of contractors out there. So prices weren’t nearly as favorable.”
UNC HCS may have been unfortunate in both the phasing and labor challenges that the Hillsborough project faced, but the institution got lucky in one key area: the person in charge.
Lafrenaye’s 40-year career prepared him to master the madness inherent in a task like this one. He started out as an apprentice electrician at age 17 at Rhode Island Hospital, working on intensive care units, acute care wings, research labs, and various maintenance and construction projects around the hospital. After getting his degree in electrical engineering, Lafrenaye continued to work at Rhode Island Hospital as an electrical engineer designing the same facilities he had once worked in, before moving up as a manager of the facilities he designed. Subsequent steps in his career ascended both the administrative ladder and the scope of responsibility in the design, planning, and development of medical facilities.
“At one time or another in my life time,” Lafrenaye says, “I have physically worked on, or designed, or managed every kind of facilities project that you could possibly do in major medical centers.”
Whether or not he would admit it, Lafrenaye’s experience at every level of medical center facilities allowed him to deliver on the project’s vision, even as the path to achieve that vision became increasingly complicated. The new, 270,000-square-foot complex in Hillsborough opened in July to complement UNC HCS’s existing facilities 11 miles away in Chapel Hill.