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Bayhealth – Total Care

The Bayhealth Total Care Center, a 48,500 square foot, two-story facility, was designed to serve the rapidly growing population along Route 9 in Delaware. This innovative center combines an emergency department and outpatient clinic under one roof, eliminating self-triage and ensuring patients receive appropriate care without unnecessary costs. Despite an aggressive 13-month schedule, material and supply delays, and unforeseen challenges, the design-build team delivered the project on time, safely, and with the highest quality. The team utilized LEAN construction techniques, including “Big Rooms” and pull-planning, to foster a collaborative and team-oriented approach. These techniques enabled the team to deliver the project on schedule efficiently while fostering accountability among all team members.






Milton, DE






December 2022

"Wohlsen understood our unique requirements as a healthcare organization and worked diligently to deliver them."

Louis Garzarella, Senior Director, Facilities Management and Real Estate for Bayhealth

A First for Delaware

The surrounding area along Route 9 in Delaware has one of the fastest-growing populations in the state. As the population continues to increase, a need developed for high-quality healthcare services that would serve the future and current community. Bayhealth is committed to improving access to top-quality healthcare services for all Delaware Residents. They partnered with Wohlsen to build the new Total Care center as part of their commitment. Total care is a unique hybrid model that features an emergency department and an outpatient medical office building in one facility; it is the first of its kind in Delaware. This new facility eliminates the need for patients to self-triage as they receive a medical screening exam upon arrival that determines the necessary level of care. Only patients who need the emergency room will be admitted. Others will be treated via the outpatient clinic. Patients will only be billed for what they need, which prevents someone from receiving a possible ER-level bill for something that could have been handled via an outpatient clinic.

From Ground Up via Design-Build

Bayhealth’s new Total Care center was built via design-build delivery with Environments for Health Architecture (E4H). The new two-story, 48,500-square-foot building was designed to accommodate the unique hybrid emergency department and outpatient model. Half of the first floor of the building is home to the emergency department, which consists of ten exam rooms and two trauma bays that can each be split into two exam rooms if needed. Outside the emergency department is an ambulance bay and patient drop-off, providing quick and convenient access to the ED without needing to go through other center areas. On the other half of the first floor is an imaging space for CT scans and a laboratory. The laboratory features all the equipment one would find in a hospital laboratory and is open 24/7 to support the needs of the emergency department and outpatient clinic. On the second floor of the building are areas designated for specialty care doctors, like neurosurgeons, orthopedic surgeons, cardiologists, oncologists, and more. Also, on the second floor is shell space for future expansion.

Tight Schedule: No Problem

The Wohlsen team working on the Bayhealth project faced a tight 13-month schedule. They knew that to be successful, they would need to optimize wherever possible to meet aggressive milestones. The team heavily utilized the LEAN construction concept of pull-planning to work through the project’s various components, optimizing the schedule. Using a reverse approach, the team identified the project’s completion date and then worked backward to determine when each task should be completed. As they worked through the tasks and milestones, the team discussed task dependencies and handoffs between the different trades and stakeholders. This process helped identify potential bottlenecks and areas that required extensive coordination. It also helped to establish an overall sequence of tasks and allowed the team to find opportunities to create overlaps where tasks from different trades could be performed simultaneously. To help the project team visualize the project schedule, they placed sticky notes on a board organized in the reverse planning sequence, each representing a different task. As the project progressed, each team member “pulled” the next job from the planning board as they started working on it. By utilizing pull planning, the Wohlsen team was able to deliver the beautiful new building to Bayhealth on time without sacrificing quality or cost.

LEAN Construction Techniques: Big Rooms

The LEAN construction technique of “Big Rooms” was utilized throughout the preconstruction and construction phases of the Bayhealth Total Care project. Multiple Big Rooms were held either in-person or virtually throughout the project duration, fostering a culture of collaboration among all project participants. During these sessions, the team worked through pull-planning exercises to establish project goals, identify tasks, create schedules, and coordinate efforts. They worked together in real-time to problem-solve and make decisions that would help speed up the delivery of the project. On a complex and large-scale construction project such as this one, where multiple stakeholders and disciplines were involved, the “Big Room” technique greatly fostered collaboration and teamwork between all project team members.

Key Partners

Environments for Health (E4H), LLC
Barton Associates
Anchor Health Properties
TBS Services
Intuitive Health
Chesapeake Healthcare Planning
Marvin F. Hartsfield
O'Donnell & Naccarato, Inc.
Becker Morgan Group, Inc.

Project Features

Emergency Department
Urgent Care
Outpatient Services Center
Diagnostic Imaging
Specimen Collections
Primary/Specialty Care
Shell Space


Award of Excellence - Delaware Chapter of Associated Builders and Contractors

Construction Excellence Award - Delaware Contractors Association

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