Health care construction big business for Alabama companies

Five of the nation's 20 largest health care general contractors are based in Birmingham

UAB Medical West, a project of Brasfield & Gorrie, is set to open next year.

Five of the nation’s 20 largest general contractors ranked by dollar volume for completed health care projects last year are based in the Birmingham metro area. Two of those contractors are at the top of the Modern Healthcare magazine ranking list — Brasfield & Gorrie at No. 1 and Robins & Morton at No. 2. The other three — Hoar, M.J. Harris and Doster — are ranked Nos. 7, 16 and 18 respectively.

Here’s a look into the specialized world of health care construction and recent projects from several of Alabama’s largest health care builders.

Brasfield & Gorrie

The next Medical West replacement hospital, an affiliate of the UAB Health System, is being built by Brasfield & Gorrie and can be seen under construction off the I-459 Exit 1 in McCalla. The 35-acre campus will include a nine-story, 200-bed hospital with a central energy plant, five-story medical office building and parking deck. The new hospital is expected to open in 2024, says Ed Hauser, Brasfield & Gorrie regional vice president and division manager.

Special techniques used by project management include online systems for a workflow that uses digital dig boards to supplement physical signage. QR codes may be accessed by employees and trade contractors “to geolocate themselves in relation to existing and proposed utility lines,” Hauser says. “This process has created a safer and more productive job site.”

Like other Alabama-based top 20 health care contractors, Brasfield & Gorrie has a long history in hospital construction and often partners with repeat clients. The company has built health care facilities in 29 states.

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“Since our company was founded, we’ve completed more than 2,000 projects in Alabama,” Hauser says. “Over the past decade alone, we’ve generated more than $4.6 billion in revenue from nearly 500 projects across the seven-county Birmingham area.”

The company’s first project kicked off in 1969 when it negotiated a $6.2 million contract for all preconstruction and construction services for a major expansion to what was then East End Memorial Hospital in Birmingham. “The success of the project led to subsequent projects, and the relationship with the client continues to this day,” Hauser says. “With a collaborative team approach, we work to become an extension of the medical campus staff to foster a true partnering arrangement. Maintaining infection control, safety and uninterrupted campus operations are our primary focuses.”

Robins & Morton’s project at Marshall Medical Center South.

Robins & Morton

July marked the grand opening of the two-story vertical expansion of the Marshall Medical Center South bed tower in Boaz. The project, constructed by Robins & Morton, also includes a new hospital entrance featuring an atrium and a main concourse with coffee shop and foodservice. The bed tower addition was particularly complicated because it was built on top of the existing, operating hospital, says Mark Mattox, Robins & Morton vice president. “A hospital (in general) is challenging to build, but it is also very rewarding knowing that you’ve been part of constructing a complex building that is a vital part of the community,” he says.

Robins & Morton has built 1,700 projects in 38 states, including many in Alabama. While some of the largest contractors for health care construction are diversified in the types of construction they do, 86% of Robins & Morton’s revenue in 2022 was from health care projects, Mattox points out. “Health care is our main focus,” he says.

The company got its start with health care during a small renovation project at Shelby Baptist, completed in 1972. “Nearly every operations team member at Robins & Morton is an expert in health care construction due to the amount of experience they have as individuals and the experience we have as a company,” he says.

Robins & Morton prides itself upon its construction quality and continuous improvement initiatives, Mattox says. 

“When you’re coordinating100 to 200 or more construction workers and are trying to prevent disruptions to a health care campus, it can be challenging. That’s why it’s critical to establish the right culture. It’s important that our entire team, including our trade contractors, understand that we are guests on that campus and our actions are a direct reflection of our team.”

Hoar is building a new outpatient clinic at Russell Medical Center in Alexander City.

Hoar Construction

A new outpatient clinic, the Benjamin Russell Center for Advanced Care, is being built at Russell Medical in Alexander City. Construction of the two-story, 28,000-square-foot specialty care clinic began in February and is expected to be completed by April 2024. The facility is part of a plan to expand the hospital campus to include independent and assisted living options, says Owen Moore, director of business development at Hoar. “Seniors will be able to live there and have any needed medical services nearby,” he says.

Founded in 1940, Hoar completed its first major health care project, the $6.5 million Brookwood Ambulatory Care Center, in the 1980s, Moore says. The company’s Healthcare Division was established in 1991. “Since then, we’ve expanded our portfolio to build and renovate health care facilities big and small across the country,” he says.

To be successful, hospital construction requires an intense amount of preplanning and careful scheduling and materials procurement to meet deadlines, Moore says. “For active campuses, we have to coordinate with hospital stakeholders (doctors, nurses, etc.) to ensure phasing creates as little disruption as possible and that patient safety is our top priority,” he says.

Health care construction continues to be a strong division for the highly diversified Hoar, which builds both across the country and internationally, including in civic, government, education, hospitality, retail, industrial, office and multi-family sectors. Hoar is seeing more demand for rural hospitals, freestanding emergency rooms and medical office buildings, Moore says. “Existing facilities are renovating to keep up with demand and stay on top of technological advancements,” he says. “Behavioral health facilities are becoming a bigger priority as more emphasis is put on mental health.”

Doster is building a new outpatient clinic at UAB Hospital Highlands.

Doster Construction Co.

UAB Hospital Highlands in Birmingham has a new 18,000-square-foot outpatient clinic completed by Doster in May. Phase one of a two-phase interior health care renovation, the new clinic includes family medicine, imaging, geriatric and vein specialties. The second phase, a 9,000-square-foot sports medicine section, began in July and is set for completion by October, says Manny Norrell, Doster project director. “We often build in areas with ongoing operations, which can mean work after hours, on weekends or both,” he says. “Our team has to understand their surroundings and keep them in mind. In a critical environment, you could be one hallway away from sensitive work.”

Doster, which builds in 33 states, including Alabama, got its start in hospital construction in the 1970s with a renovation project at Carraway Methodist Medical Center in Birmingham. The success of that project lead to projects at other regional hospitals and the company’s targeting health care business, Norrell says. “Health care is our bread and butter.”

Because health care construction requires special expertise, most major projects are completed by general contractors with decades of experience, Norrell says. Numerous extra health care regulations, local, state and federal, must be followed, including those for indoor air quality, ADA regulations, life safety issues and fire safety. Other considerations include facility needs for medical gases, high power and low voltage.

“Outside the walls must be clean and nice, but behind the ceilings and walls are all sorts of ducts and conduits,” he says.

Norrell and other representatives of large general contractors believe demand for health care construction will remain strong because there will always be a need for health care, especially with the nation’s aging population.

“There is a shift in the industry from large traditional hospitals for new construction to small outpatient clinics closer to where patients live,” he says.

Kathy Hagood is a Homewood-based freelance contributor to Business Alabama.

This article appears in the September 2023 issue of Business Alabama.

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