FKP Architects of Houston served as the design architect and architect of record on the 425,000-square-foot tower. Wood Bughard & Swain Architecs of Irvine, Calif., was the construction administration and associate architect, and McCarthy Building Companies of Newport Beach, Calif., served as the general contractor.

The seven-story tower holds the region’s only dedicated pediatric operating rooms, emergency department, imaging department and laboratory. The building also features updated amenities including an in-house multimedia center, pre-teen and teen rooms, patient outdoor play area, café and outdoor garden, family resource center, and meditation and prayer center.

From the onset of the project, architects aimed to create an iconic building that would reflect the vision of providing the best facility and patient outcomes for the children of California, according to Gary Owens, AIA, LEED AP, senior principal with FKP.
“A prime deliverable was for the building exterior to express the strength of care available at the hospital and to serve as a beacon for arriving families, patients and the community. Furthermore, the building’s layered forms, interlaced into the interior design of the building, mirrored the layering of the surrounding communities and the various geographic regions in Southern California,” he said.
Another goal of the design was to create an environment that would be a source of inspiration to visiting families and to also create a place of discovery for child patients, Owens added.

“The architecture of the building, both exterior and interior, projects a playful and delightful feeling,” Owens said. “From the initial arrival and throughout the child’s visit, the composition of forms, shapes, color, light and encountered experiences achieves the original goal: for the building to support the patient, the families, the staff and the vision of providing quality pediatric care.”

Located in an urban setting, the tower was constructed on a tight 2.4-acre site that was formerly a two-level parking structure adjacent to the existing hospital. The site required critical planning in order to minimize disruption and keep the project on schedule.

“Utilizing the industry’s most advanced software and field hardware along with design-assist delivery greatly aided in an early completion by allowing all key team members to seamlessly collaborate from the beginning of the design phase through to the grand opening,” said Max Burchman, project director with McCarthy.

A major challenge in the project was coordinating deliveries of large structural members, mechanical equipment and miscellaneous bulk deliveries, according to Burchman. The team attained a lane closure permit in order to safely unload trucks without halting traffic. Just-in-time delivery was also used for construction materials and the export of construction debris and dirt.

McCarthy implemented an Electronic Plan Room to streamline planning, free up office space and enable the team to view documents simultaneously. Additionally, the contractor created an Electronic Facilities Manual for Project Closeout to provide organized electronic copies of construction documents, as-builts, O&Ms, training videos and warranties, Burchman said.

In order to minimize construction issues and develop resolutions, BIM technology was used in the preconstruction phase and construction phases to create high building confidence and extreme accuracy.

“BIM clash detection and resolution identified thousands of clashes of varying magnitudes over the course of the project. With each adjustment made to the different trades, the 3-D model was updated automatically, thereby giving the team the latest coordinated BIM content,” Burchman said.

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Q: Can you describe lean principles as they apply to health care organizations?
Kumar: Lean refers to a management philosophy originating in the automobile industry that considers any work or use of resources not adding value for the end customer as wasteful. Although different from the assembly-line style of auto manufacturing, the delivery of care to the patient is also a complex process with multiple inefficiencies. By aiming to remove or minimize these non-value-added steps, health care organizations can greatly improve process efficiency.
Q: How do lean principles benefit health care staff?
Kumar: By targeting non-value added steps, lean principles attempt to maximize the efficiency of health care staff. It cuts down on duplicate or unnecessary work, such as the creation of reports that are not even read. Another large focus of lean is to streamline processes that are deemed necessary. Evaluating factors such as the flow of patients in a hospital or the distance between supply locations and point of use, it recognizes the value of time and allows health care staff to use their time more effectively.
Q: How do lean principles benefit patients?
Kumar: Unlike some initiatives often undertaken by health care organizations, lean principles have a visible, direct effect on patients. Minimizing wasted time and redundant information gathering while streamlining other processes will have clear benefits from a service point of view. More importantly, the ultimate result of many principles is better quality of care. The lean concept of “defects” is represented by untoward outcomes such as preventable readmissions, hospital acquired infections and surgical errors. By reducing these defective “products,” patients ultimately see better results.
Q: Do lean principles reduce operational costs?
Kumar: Lean aims to reduce resources that are being used unnecessarily. Whether targeting work performed, time used or money spent, lean principles provide a tool for organizations to evaluate individual steps in the complex delivery of health care. By becoming more efficient with often-scarce resources, the end result will be a reduction in costs without a sacrifice in quality.
Q: What kinds of practices or resources are becoming obsolete in health care facilities?
Kumar: Recent policies encouraging electronic records have led to facilities naturally adopting lean practices. The widely adopted conversion away from paper-based records has helped tackle many challenges previously faced. Information is redundantly gathered less, as both patients and hospital staff have benefited from having to fill out fewer forms. Accuracy is being maintained during the coordination of care across departments, facilities and entities. This is evident in the reduction of medical errors during provider handoffs and less duplication of lab tests and exams that patients are subjected to, not to mention the fewer phone calls asking for clarification of physician handwriting.
Q: What are some of the simplest actions or changes a health care facility can make to become leaner?
Kumar: It has been proven that lean can be successful in health care but it is not something that can be done overnight and is not something to be done because it’s trendy. It can earn quick wins on a departmental level, but to be truly successful, it must be embraced as part of the organizational culture. With the support of leadership, it is necessary to learn the concepts first and then tailor-make potential improvements to your organization – you cannot simply copy what’s been done elsewhere. Additionally, adopting lean is just one potential part of the solution. Initiatives such as IT modernization and maturity of business analytics capabilities will also help reduce health care costs. It is up to organizations to evaluate themselves in an honest manner and decide what combination will yield the highest returns.

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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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