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Cass Lake Clinic Expansion: Managing Scope Changes in Healthcare Construction

Healthcare construction in Minnesota presents unique challenges. Working on an active campus, coordinating with ownership, and sequencing multiple phases means that change is not an exception, it is part of the process.

The Cass Lake Clinic Expansion was a 57,525-square-foot healthcare facility expansion in Minnesota, serving the City of Cass Lake and the Leech Lake Band of Ojibwe. As a native construction project serving a Native community, the work required not only technical excellence but cultural awareness, collaboration, and respect for the people it serves. The project added imaging, dental, optometry, physical therapy, central sterile, administrative spaces, a maintenance garage with rooftop helipad, and expanded geothermal well fields — all while the facility remained operational.

“Managing change is a challenge,” said Eric Lien, Project Manager. “[For each change] the architect would draft up a document … a proposal request with a change to the project scope and update their drawings with new details.”

Serving as Construction Manager, Nor-Son held contracts, analyzed cost and schedule impacts, and maintained transparency with the owner throughout the process. That transparency was especially critical on a native construction project where trust, accountability, and long-term community impact matter deeply. Changes were reviewed, summarized, and discussed regularly to ensure alignment on both budget and timeline.

Over the life of the project, Nor-Son managed more than 200 documented scope changes, making it a clear example of effectively managing scope change in healthcare construction.

“The amount of change was unusual,” Lien said. “But staying organized, communicating clearly, and owning the process made it manageable. Getting recognition of the [Nor-Son] team, the Eagle Award, was a good feeling.”

Nature Link Cabins: Design-Build Construction in Minnesota

The Nature Link Cabins project demonstrates that construction change management isn’t limited to large healthcare projects. Sometimes, innovation and site conditions require just as much adaptability.

Located in Nisswa, Minnesota, the project included twelve micro-cabins (six duplexes) built for a growing resort in the Brainerd Lakes area — a strong example of Minnesota commercial construction with a creative vision.

From the beginning, the steep hillside near the lake presented one of the project’s biggest challenges. Traditional foundations were not feasible.
“The first challenge we noticed was the grade, or slope, that we had to deal with,” said Austin Torma, who managed the project. “They wanted to build the cabins right inside of a hill, right [near] a lake.”

Using a design-build construction approach, Nor-Son’s in-house design team worked closely with the field crew to adapt quickly. The team partnered with a local specialty contractor to engineer a foundation system using helical piers — large steel screws drilled deep into the ground.

“The challenge wasn’t just installing the piers,” Torma explained. “It was figuring out how to build off them. How do we create a structure on 22 toothpicks sticking out of the ground?”

Movement, alignment, and structural integrity required constant coordination. When curveballs arose, like a significant wobble after the first two floor systems were installed, the team evaluated multiple solutions by thinking outside the box. They added steel angles in an X brace pattern to some of the piers. The result? The system was stabilized and sound.

With nearly half of the labor self-performed, Nor-Son crews were able to remain nimble as conditions evolved. Construction began in spring 2024 and by November, all the units and a sauna building were open to guests.

The project was completed safely, efficiently, and without lost-time injuries, earning ABC’s Pyramid Award.

“For me, it was especially meaningful,” Torma said. “This was one of the first large projects I ran with Nor-Son. It felt good, an award in my professional career that the [Nor-Son] team got … it was more sentiment for me in that aspect.”