Building against a hospital that cannot close

Healthcare construction is not harder than other construction because of the building. It is harder because the client cannot stop, and every hour of the schedule is negotiated with people whose actual job is treating patients.

Containment is a schedule item, not a line item

Every penetration through the existing envelope happened under negative-pressure containment, with the clinical team notified a fortnight ahead. That is not primarily a cost, it is a sequencing constraint, and treating it as a cost is how these jobs go wrong.

Why the structure changed

The original scheme was cast-in-place concrete. Months of formwork against an occupied wall made that untenable, so the pavilion became structural steel with composite deck. Eleven weeks to close the frame instead of six months of noise against a surgical suite.