All resources will be moved in phases to the new facility before full operations begin. “Our entire operation will begin seeing patients on Nov. 16 after a phased move of equipment and resources. This move will not impact patients directly, and we expect no disruption of services from Friday to Monday morning,” said Casey Cooper, chief executive officer of the Cherokee Indian Hospital, in a statement.

The project began almost two years ago and used an Integrated Project Delivery (IPD) agreement. Through the IPD approach, the Cherokee hospital was able to realize $7 million worth of added value and gain an additional two months from the original schedule, according to Tim McCurley, director of project management for CBRE Healthcare. This approach also allowed the project team to beat the local participation goals that were set by the hospital. Greenville, S.C.-based Design Strategies served as the architect on the project, while Raleigh-Durham, N.C.-based Robins and Morton served as construction manager.

The Cherokee Indian Hospital Authority, which formed in 2002, has worked to receive funding for the project and improve services for the care of tribal members. “We believe that we can serve our community better than anyone else and we are committed to that goal,” said Cooper in a statement. “We believe that the new building will help us foster an environment of wellness so our patients don’t just come to us when they are sick, they come to us as friends and partners in wellness.”

Patient care has become a large focus for the Cherokee Indian Hospital Authority. Linda Sadler, principal and senior technology consultant with Nashville, Tenn.-based Smith Seckman Reid, Inc., engineering design and facility consultant firm, said that the technology systems were specifically selected and implemented to support the Cherokee’s commitment to patient care.

Daily project implementation meetings were held after the IPD process advocated for the meetings. The meetings included the architect, engineer, contractor, subcontractor and a representative from CBRE Healthcare. The daily gatherings allowed for integrated design and management which made reaching the budget and schedule milestones possible, according to a press statement from CBRE Healthcare. The health care network believes that meeting these milestones is a testament to the efficiency that the IPD approach offers.
 

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The original objective was to relocate Coler-Goldwater Specialty Hospital and Nursing Facility (later renamed to Henry J. Carter Specialty Hospital and Nursing Facility) from Manhattan’s Roosevelt Island to the Harlem neighborhood of New York City. The $285 million project would be divided into two projects: renovating 270,000 square feet of the former North General Hospital in Harlem and building 185,000 square feet of space next door to accommodate a new, 164-bed nursing facility.

Had the original timeline been maintained, the hospital and separate nursing facility would still be under construction with a completion date set for March 2015. These plans were overhauled, however, when New York City’s mayor made a special announcement.

“We started schematic design and realized quickly that Mayor Bloomberg had announced that Cornell University and its partner, the Techion-Israel Institute of Technology, were going to be awarded an applied sciences technology school,” said Marsha Whitt, principal at Array Architects, based in King of Prussia, Pa., and project manager for the Henry J. Carter facility.

The technology school was set to build on the same Roosevelt Island site where the Coler-Goldwater hospital was located. The only problem was that the hospital needed to be demolished — quickly. The expedited demolition date moved the completion and patient-move date for Henry J. Carter up to November 2013 and shrank the schedule by 16 months.

“That’s when we had to back up and relook at the project and look at how we were going to approach it. How long was design going take? How long was construction going to take? How were the design team and the construction managers going to work together to meet these accelerated deadlines?” Whitt said.

A new time frame wiped out the design-development process. The solution was to regroup and implement integrated project delivery (IPD) strategies and a collocation system. Array went straight from schematic design to construction documents. This forced the project’s construction manager, Gilbane McKissack (a joint venture between Providence, R.I.-based Gilbane and Nashville, Tenn.-based McKissack & McKissack) to start looking at how they could quickly get resources on-site.

All stakeholders involved in the development process came together in full-team meetings. The strategy united the design team, construction manager and hospital owner in one location, and the collaboration accelerated the decision-making. Additionally, performance incentives that included shared cost and schedule metrics for both the contractor and design team helped to maintain the team effort.

“You’re joined at the hip by money, but since we were collocated, we put that piece aside and started to work as a cohesive team; we were all working toward the same goal,” Whitt said.

One critical component of adjusting to the tighter schedule involved dividing the two projects into multiple bid packages, which helped speed up information delivery, contract award and start of construction.

“Traditionally you may have a site package, an exterior package and a fit-out package. On this, we ended up with 20 packages because we broke it out by what could be purchased and when to get it on-site and get it installed,” Whitt said.

The client, contractor and design team worked side-by-side to review and approve packages. That process helped with getting parts of construction completed earlier — things such as elevators, major medical equipment and the mechanical, electrical and plumbing (MEP).

Just when the process was starting to go smoothly, the development process for the hospital and new nursing facility hit a new obstacle — Hurricane Sandy. Luckily, the Harlem site was not flooded, but it prompted a review of storm and flood elevations for the facilities. The project team included additional equipment protection and elevated electrical equipment on higher pads.

The Henry J. Carter Specialty Hospital and Nursing Facility opened on time, and Array is now involved in “Day 2” revisions, assessing what else is needed — or needs to be adjusted — after occupant move-in.

The post A Case Study in Construction Cost and Schedule Challenges appeared first on HCO News.

Atlanta-based Heery International, program manager for the new project, broke ground in mid-July. Dennis LaGatta, Heery’s project executive overseeing the work, said there would be three components to the construction process. First, the facility’s central plant is set to be replaced, then a new addition will replace the emergency and operating departments, and at the same time, the hospital’s nine-story patient tower will be revamped to give the 1950s exterior a more modern look.

“We anticipate that the central plant will be operational in November 2015, and that has to be done first so that we can connect to the new OR-emergency department expansion in December of 2015 to allow the completion and opening of the OR/ED in the winter of 2015,” LaGatta said.

The new central plant will serve as the hospital’s connection point for vital building services, so it’s important for it to be operational first. It also houses the hospital’s back-up generator system.

“The next phase would be, once we have the operating room and ED up and running, that we’ll go back and reconnect the rest of the existing hospital to the new central plant for the purposes of upgrading their emergency power system. Running concurrently will be the re-cladding of the [patient tower],” LaGatta added.

The transformed patient tower will be the most visible element of the process with a glass curtain wall and metal panel system. The prominent tower can be seen from Broward County’s Interstate 95, and it overlooks the hospital’s 35-acre campus.

Inside the hospital, the newly expanded 53,000-square-foot operating suite and emergency department will allow the hospital to continue as the only Level II trauma center in the north end of the county. The ER has 53 treatment spaces, and each treatment space is identical in room orientation and available medical equipment. A decentralized nursing station model allows for flexible treatment space utilization during peak and non-peak event time frames. The operating department will feature six new class-C operating rooms.

When Broward Health hired Heery, the hospital system asked the program manager to use an integrated project delivery-lite (IPD-lite) approach. The traditional IPD delivery method creates a single team of project participants that are uniformly responsible for completion. IPD-lite uses some elements of traditional IPD, but there are still incentives to collaborate.

Heery then reached out to Dallas-based HKS Architects and Chicago-based Perkins + Will as well as Skanska USA Building in Parsippany, N.J., as the construction manager at-risk, to create a four-company team throughout the planning, design and construction phases.

“Our IPD-lite approach allowed our team to focus on meeting Broward Health’s needs in the most cost-effective and time-efficient way possible,” LaGatta said in a press statement. “The creative thought process yielded innovations in our approach to the program as a whole and substantially reduced the construction schedule timeline, which means these new facilities will be operational and supporting the hospital conservatively 12 months earlier than initially projected.”

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Tom Hudak, AIA has been with Array Architects since 2006. He can be reached at thudak@array-architects.com

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The tower project is currently under way, with an opening slated for November. The design team includes St. Jude Medical Center, Petra-Integrated Construction Strategies (Petra-ICS), McCarthy Building Companies and Taylor Design.

Held on May 22, 2014 at the Newport Beach Marriott, the annual awards program recognizes the most outstanding design-build projects in the Western Region, and the St. Jude recipients won for the Projects in Progress category. The team was recognized for exceeding owner’s expectations through successful application of design-build best practices as defined by the DBIA Design-Build Manual of Practice. Those practices include early integration of key team members during the proposal process via a proposal charrette or other collaborative outreach effort and close coordination between design and construction team members from design development through field construction.

When completed, the healthcare facility will consist of a four-story, 200,000-square-foot hospital wing that is connected to an existing tower on the first and fourth floors. A 20,000-square-foot central utility plant will also be constructed, as well as a 215-car parking structure expansion and re-routing of major site utilities on an active medical campus. The Northwest Tower is designed to meet California’s strict seismic requirements for structure and contents, and it will replace a seismically noncompliant tower.

The project also incorporates a design-build collaboration closely resembling the structure of an Integrated Project Delivery (IPD) process. According to a press statement, the design-build form of delivery on the St. Jude Medical Center project includes IPD “lite” terms and conditions with unique contractual incentives for the design team, contractors and subcontractors while still providing the owner with the certainty of a Guaranteed Maximum Price. To receive these incentives, the team members must meet specific goals for safety, budget, design, facility satisfaction, quality and schedule.

“We chose a design-build project delivery method in an effort to lower the overall design and construction cost as well as to bring a heightened level of accountability to the design phase of the project,” said Jim Bostic, V.P., Construction for Petra ICS. “It is a known fact, that as an owner representative, our best opportunity to control the cost of a project is during the design phase.”

The project also utilized advanced construction technology. For example, BIM 3D, 4D and 5D were used to tie the model to constructability, cost and schedule.

“The design-build team developed the design of this project using 100 percent 3D modeling for all disciplines, not just the MEP systems,” Bostic said. “The entire design team, even at the subcontractor level, worked together from the very beginning of the design process, which is not the current practice on many projects. This delivery system facilitated coordination of every element of the design within the same 3D model.”

One challenge the team faced, according to McCarthy Project Director Holly Cindell, was the onsite logistics and managing the sequencing for multiple phases of construction on an active and operating healthcare facility. Because the campus is almost completely built out, space is limited for materials staging and access to construction activities.

“Close coordination with each major specialty contractor and the hospital departments was required to ensure a seamless workflow and to minimize disruptions to the hospital,” Cindell said. “Our team also utilized Syncro software to develop the site logistics plan. This effort successfully resulted in zero operational disruptions and unplanned shutdowns.”

An additional challenge was the original proposed location. “Due to operational disruptions and the cost of phased construction, the design required a fresh approach,” Cindell explained. “This was achieved with a new site location and revised scope that met all program needs, provided the opportunity for expanded services and advanced technology, and met the established budget.”

Despite the setbacks, the project team ultimately decreased the total project cost by 10 percent.

“Our team has worked together on other projects, but this has been the most collaborative design and construction effort that Petra-ICS/St. Joseph Health System has achieved over the duration of our existence,” Bostic said. “It is a model project for ‘Best Practices’ in the use of BIM tools and the implementation of the design to construction process.”

The post St. Jude Medical Center Team Honored in Western Region appeared first on HCO News.

The tower project is currently under way, with an opening slated for November. The design team includes St. Jude Medical Center, Petra-Integrated Construction Strategies (Petra-ICS), McCarthy Building Companies and Taylor Design.

Held on May 22, 2014 at the Newport Beach Marriott, the annual awards program recognizes the most outstanding design-build projects in the Western Region, and the St. Jude recipients won for the Projects in Progress category. The team was recognized for exceeding owner’s expectations through successful application of design-build best practices as defined by the DBIA Design-Build Manual of Practice. Those practices include early integration of key team members during the proposal process via a proposal charrette or other collaborative outreach effort and close coordination between design and construction team members from design development through field construction.

When completed, the healthcare facility will consist of a four-story, 200,000-square-foot hospital wing that is connected to an existing tower on the first and fourth floors. A 20,000-square-foot central utility plant will also be constructed, as well as a 215-car parking structure expansion and re-routing of major site utilities on an active medical campus. The Northwest Tower is designed to meet California’s strict seismic requirements for structure and contents, and it will replace a seismically noncompliant tower.

The project also incorporates a design-build collaboration closely resembling the structure of an Integrated Project Delivery (IPD) process. According to a press statement, the design-build form of delivery on the St. Jude Medical Center project includes IPD “lite” terms and conditions with unique contractual incentives for the design team, contractors and subcontractors while still providing the owner with the certainty of a Guaranteed Maximum Price. To receive these incentives, the team members must meet specific goals for safety, budget, design, facility satisfaction, quality and schedule.

“We chose a design-build project delivery method in an effort to lower the overall design and construction cost as well as to bring a heightened level of accountability to the design phase of the project,” said Jim Bostic, V.P., Construction for Petra ICS. “It is a known fact, that as an owner representative, our best opportunity to control the cost of a project is during the design phase.”

The project also utilized advanced construction technology. For example, BIM 3D, 4D and 5D were used to tie the model to constructability, cost and schedule.

“The design-build team developed the design of this project using 100 percent 3D modeling for all disciplines, not just the MEP systems,” Bostic said. “The entire design team, even at the subcontractor level, worked together from the very beginning of the design process, which is not the current practice on many projects. This delivery system facilitated coordination of every element of the design within the same 3D model.”

One challenge the team faced, according to McCarthy Project Director Holly Cindell, was the onsite logistics and managing the sequencing for multiple phases of construction on an active and operating healthcare facility. Because the campus is almost completely built out, space is limited for materials staging and access to construction activities.

“Close coordination with each major specialty contractor and the hospital departments was required to ensure a seamless workflow and to minimize disruptions to the hospital,” Cindell said. “Our team also utilized Syncro software to develop the site logistics plan. This effort successfully resulted in zero operational disruptions and unplanned shutdowns.”

An additional challenge was the original proposed location. “Due to operational disruptions and the cost of phased construction, the design required a fresh approach,” Cindell explained. “This was achieved with a new site location and revised scope that met all program needs, provided the opportunity for expanded services and advanced technology, and met the established budget.”

Despite the setbacks, the project team ultimately decreased the total project cost by 10 percent.

“Our team has worked together on other projects, but this has been the most collaborative design and construction effort that Petra-ICS/St. Joseph Health System has achieved over the duration of our existence,” Bostic said. “It is a model project for ‘Best Practices’ in the use of BIM tools and the implementation of the design to construction process.”

The post St. Jude Medical Center Team Honored in Western Region appeared first on HCO News.

Located on the Tradition Center for Innovation Campus in Port St. Lucie, the new $110 million building includes emergency services, an intensive care unit, labor and delivery, neonatal intensive care unit, general and specialized surgery, inpatient oncology, diagnostic imaging, clinical research and gastrointestinal endoscopy. The facility was designed and built at a time when many health care systems were waiting out the recession and the uncertainty over the impact of national health care reform on medical reimbursement.

HKS Architects designed the approximately 200,000-sqaure-foot health care facility and Balfour Beatty Construction served as construction manager. Both firms hold regional offices in Orlando, Fla.

The center, which is expected to see 30,000 emergency department visits, 6,000 patient admissions and 1,500 births in its first year of operation, was designed with flexibility in mind. Traditional Medical Center has the ability to expand to 300 beds in order to meet future growth.

Strong Collaboration

The project team worked closely, using the Integrated Project Delivery (IPD) method to maximize efficiency. According to Roy Gunsolus, AIA, LEED AP BD+C, director of sustainable health care with HKS, the IPD method allowed for strong collaboration from the outset of the project.

Six “component teams” were established with a diverse set of players, Gunsolus said. The teams included site; exterior envelope/structural; interiors; MEP/sustainability; technology; and schedule/general conditions. Each team had members representing the owner, design team and construction team on the project, which brought about more informed decisions as well as unique perspectives.

“It intentionally varied in who was involved,” Gunsolus said. “Regardless of whether somebody was the stereotypical leader of that group or just loosely allied, everyone had an equal voice.”

The IPD method also allowed the team to design the project to budget rather than design and price later only to be over budget and require redesign, Gunsolus said.

BIM Technology

The project used BIM modeling and Constructware software to further foster collaboration across the project team. By using BIM technology, Gunsolus said, the contractor was able to view models and make comments or identify potential construction issues before decisions were made.

The team also took on a sort of lean methodology to the BIM process. Architects and engineers can end up drawing the same thing twice, Gunsolus explained.

“We tried to have people take ownership and do everything once,” he said. “We discussed as a group who would be the logical person to implement whatever feature it was into the model.”

For example, lighting fixtures would be a responsibility dedicated to the electrical engineer with guidelines given by the project team.

Sustainable Goals

The project team, which is seeking LEED Gold certification for Tradition Medical Center, made sustainability goals clear from the outset. The team began with a sustainability workshop.

“We talked about the advantages of being sustainable and why it made sense to do this not only from a cost savings standpoint, but also from more of an intangibles perspective, such as patients healing quicker when they have connections to nature,” Gunsolus said.

The acute care hospital, which overlooks a large retention pond, used connections to nature and natural light as an overarching design driver. In addition to typical public spaces such as the main lobby, dining and waiting areas, daylighting was also used via high windows in uncommon areas such as the receiving area, pharmacy, lab and the kitchen.

Approximately 83 percent of construction waste was diverted from the landfill. Additional green features included a heat recovery chiller, LED lighting and a reflective roof. The siting of the building, which also provides connectivity to a medical office building developed in collaboration with Mann Research, also created energy-efficiency opportunities.

“The natural inclination might have been to site the building in the middle of the site to maximize proximate parking,” Gunsolus said. “The project team considered a variety of factors and ultimately located the building more proximate to the retention pond to maximize patient views while minimizing eastern and western exposures to maximize energy efficiency. This location reinforced the overall master plan, which was developed to allow for future ambulatory services and structured parking while separating public and service traffic.”

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The firm, which is serving as contractor, has worked closely with project subcontractors and architect of record HKS to collaborate on the $297 million project. Both Brasfield & Gorrie and HKS hold local offices in Orlando, Fla.

“Collaboration is an element of IPD in which the contractor and the subcontractors work together with the designers through the design phase so the end result is a product that is achievable, is buildable and all the while we’re providing real-time estimates and budget updates to ensure the owner that we’re staying consistent with our financial responsibilities,” said Jerry Whitfield, senior project manager with Brasfield & Gorrie, in a statement.

The project consists of the 10-story, 300,000-sqaure-foot North Tower, the five-story, 100,000-square-foot south expansion and 100,000 square feet of renovation. The project team recently celebrated the topping out of the North Tower.

According to Brasfield & Gorrie, the IPD delivery method improves construction efficiency, risk management, and the predictability of cost and schedule. The construction project has implemented detailed phasing due to the sites urban setting and close proximity to the existing hospital, which continues to operate daily.

“This approach invited everyone to the table early on to map out the construction strategy, thereby increasing transparency and enabling us to provide Orlando Health with realistic cost projections at the start of the project,” said Ren Tilden, operations manager at Brasfield & Gorrie, in a statement.

Currently, all project subcontractors on the project are working in a warehouse near the jobsite in order to work alongside the project team to increase collaboration and maintain strong communication.

“The best outcome of this process is that it is enabling us to deliver a building that satisfies the expectations of our client while deepening trust and support between contractors and subcontractors,” Tilden said.

This is the third IPD health care project for Brasfield & Gorrie. The firm has also implemented IPD in past projects including the Texoma Medical Center in Denison, Texas, and the Spring Valley Hospital in Las Vegas.

Construction on the Orlando Regional Medical Center is expected to complete in late 2014.

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The 192-bed community hospital consolidated the inpatient services of MaineGeneral Medical Center’s Thayer campus and the hospital on the medical center’s Augusta campus. To complete the 640,000-square-foot center for health in 24 months of construction, which included 18 months of deign and construction overlap, the design team used an Integrated Project Delivery (IPD) method.

The design was headed by SMRT Inc., which holds offices in Portland, Maine, in partnership with Boston-based TRO JB. Contractors Robins & Morton of Birmingham, Ala., in a joint venture with H.P. Cummings of Winthrop, Maine, led construction.

“The common wisdom is that IPD is about collaboration, but it goes well beyond collaboration to a unity of purpose around a common goal. Collaboration implies parties agreeing to ‘play well in the sandbox,’ but for all practical purpose, the parties remain in their silos representing the interests of their individual organizations,” said Ellen Belknap, president of SMRT, in a statement. “Successful IPD requires unity, with all parties aligned to the goals and the good of the project, not to the organization and individual representatives. This requires a fundamental shift in approach attitude and behavior, creating a virtual single-purpose entity and integrated team with a common goal.”

According to the American Institute of Architects, leverages early contributions of knowledge and expertise through the use of new technologies, allowing all teams to better realize their highest potentials while expanding the value they provide throughout the project lifecycle. A multi-party contract, required by IPD, allowed the owner, designers and contractors to jointly manage the project.

This sharing of responsibilities and goals was a catalyst in achieving goals, including targeting LEED Gold certification rather than the initial LEED Silver goal. Utility costs in the new hospital are expected to be less than half of costs at the former health care facility.

“The IPD process drove the LEED certification from our goal of Silver to meeting the requirements for LEED Gold,” said Kate Everett, senior engineer at SMRT, in a statement. “With the design and contractor team working as a single entity throughout the design process and construction period, we were able to introduce and execute innovative strategies, like ice storage, very efficiently.”

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The long-awaited $150 million greenfield hospital was designed by Los Angeles-headquartered HMC Architects and constructed through a joint venture between DPR Construction, headquartered in Redwood City, Calif., and New York-headquartered Turner Construction Company. Working closely with the construction team and Universal Health Services (UHS), HMC used Lean principles to complete the project ahead of schedule and under budget.

“The most unique element of the project is the Lean process in which the project was delivered,” said Steven Wilson, principal with HMC Architects. “Numerous tools and processes exist to drive collaborative behavior down through multiple organizations in order to assure that everyone is sharing a common vision — and when used together, the tools form a system.”

Lean principles allow the owner, architect and contractor to participate in the design and decision-making process from the onset of the project, according to Wilson. The project also used an Integrated Project Delivery (IPD) for further collaboration and to optimize the project’s success.

“It has been documented that there is considerable waste in the construction industry,” said George Vangelatos, principal with HMC. “When Lean measures are coupled with IPD and applied to health care construction, the process can yield greater customer value while eliminating waste and it begins with the right team thinking about the project and not their own needs.”

An off-site “big room” was used as a meeting room for the project team to conduct problem-solving discussions. This open communication and dialogue throughout the design and construction process created a more efficient project with less rework, according to Wilson. The team also used the Last Planner System in order for all members of the team to make accurate commitments and not overproduce, which is seen as wasteful, Wilson said.

“The Temecula Valley Hospital project started with UHS, HMC Architects and a joint venture between DPR Construction and Turner Construction. We then evaluated other team members using the Choosing by Advantage technique to determine who would best fit in to the project’s Lean approach. This allowed the team to openly discuss the best method for getting something done and decisions were made to benefit the project rather than individual firms,” Wilson said. “Once the team was assembled, the focus was on establishing trust, learning, collaboration and innovation to deliver the best project possible. Ideas flowed from every team member and all were empowered to make decisions.”

The team’s ability to meet their responsibilities was reevaluated on a weekly basis for improvement or breakdown. This process, Wilson said, allowed the team to take out six months from the already aggressive schedule. Additionally, a 16-month acceleration was achieved though early collaboration with the Office of Statewide Planning and Development.

“The project team embraced Lean principles to break down the silos of traditional project delivery and required deep collaboration and teamwork. They all accepted the challenge to propel collaborative behavior down through the multiple organizations,” Wilson said. “The cooperation between team members drove down the project costs and fostered innovation, while meeting UHS’s efficiency and schedule goals.”

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