Not many construction markets can claim to remain at historically high levels despite several years of dismal broader economic performance. But after a 2 percent gain last year, FMI
forecasts health care construction will grow another 3 percent in 2012. It’s slow growth—partially due to declining revenues from underinsured patients and fewer elective surgeries—but growth nonetheless.
According to the American Society for Healthcare Engineering
, about 73 percent of medical construction projects entail renovations and modernizations geared toward updating IT infrastructure, improving patient services and greening operations. For medical centers that can spend the capital to build from scratch, efficient project delivery plays a major role in their ability to be successful. IPD: MaineGeneral Regional Hospital
With three inefficient and aging facilities to maintain, MaineGeneral Medical Center
set out to consolidate services with a new state-of-the-art regional hospital
in North Augusta, Maine. In addition to directing administrators to research evidence-based design for the latest improvements in hospital quality and safety, MaineGeneral President and CEO Chuck Hays made examining potential project delivery processes a priority. After commissioning research on integrated project delivery (IPD) and analyzing impressive results in California and Washington, Hays’ team decided the collaborative approach was a perfect fit for the largest health care construction project in Maine’s history.
The project broke ground last August; currently, several sequences of steel are in the process of being erected and sealed. When complete, the hospital will include 192 private inpatient rooms, 10 operating rooms, diagnostic facilities, laboratories and doctor’s offices, as well as an emergency department, helipad, pharmacy, cafeteria, medical library and community education center. Designed to achieve LEED Silver certification, the facility is expected to save $900,000 in annual operating costs and 12 million gallons of water per year through the use of efficient heating and cooling systems and local building materials.
Assembling an IPD team of likeminded designers and contractors has been a crucial step in bringing MaineGeneral’s vision to life. On the architectural side, Maine-based SMRT
is partnering with Boston-based TRO Jung|Brannen
. For construction management, HP Cummings
, Winthrop, Maine, is teaming up with Robins & Morton
, Birmingham, Ala. More than a dozen subcontractors are already on board, all of which have ties to the state.
Hays reports $149 million of the $152 million contracts ordered as of mid-March have gone to Maine-based companies working independently or as part of a joint venture with regional or national contractors. Ninety-two percent of the roughly 250 workers currently onsite live in Maine.
The architects and construction managers signed an IPD contract with MaineGeneral that contains attachments for major subcontractors involved throughout the life of the project. Though the agreement was drafted and approved fairly quickly, it took a while for the umbrella insurance policies to fall into place. So as not to lose time, MaineGeneral issued letters of intent that allowed subcontractors to contribute to the design before the contract was finalized.
More than half of the project’s $312 million construction price tag is tied to the IPD contract. As designated project milestones are met, a percentage of the profit is distributed based on the team’s performance. At the end of the job, contract signatories will receive the rest of the profit for hitting the final milestones, as well as meeting overall budget, schedule and quality goals.
“In bidding everything out, we focused on selecting companies that would be a good cultural fit, could work as a team and were progressive thinkers,” Hays says. “IPD is a totally different mindset. Major contractors have to make comments on all stages of design, which is a different perspective than they’re used to. We wanted to make sure they could look at the project as a whole, and not just from their individual silos.”
Interviews with potential team members centered on contractors’ proven performance on complex projects, as well as their ability to respond to questions in the context of an overall team rather than only their specific trade. Adaptability also has turned out to be a key trait, as evidenced by the project’s concrete contractor. Since the 640,00-square-foot project began, the IPD team has asked Newman Concrete Services, Richmond, Maine, to change its approach several times to get ahead of schedule.
“They have been incredibly adaptable and willing to make adjustments for the benefit of the project,” Hays says.
With IPD, contractors are better able to accommodate owner- and architect-driven requests because they are involved in the design meetings, so they know why something is changing. They know the functional reason for something being done a certain way; if contractors have an alternate method, they can bring it up during a planning meeting rather than onsite when the work is supposed to be getting done.
Input in team meetings and during subcontractor and vendor selection has been a major plus for Johnson & Jordan, Inc.
, Scarborough, Maine, which is handling the hospital’s plumbing and medical gasses in partnership with MMC Contractors
, Kansas City, Mo. In addition to having a solid relationship with the owner, architect and engineers, Johnson & Jordan’s ability to provide local manpower was a major reason it was selected for the IPD team. About 25 of the firm’s 200 employees are currently onsite, and another 50 will be there before the project wraps up.
“All of our work is based on partnerships and relationships. The theory of collaboration is really part of our core, but this true IPD contract is a first for us,” says Chris Jordan, vice president of Johnson & Jordan.
On IPD projects, team members often achieve collaboration through co-location. For Johnson & Jordan, this means working side by side with MMC Contractors and project engineers to review one-line diagrams that eventually are input into 3-D building information modeling (BIM) software specifically geared toward pipe fabrication. This process has taken the mechanical contractor’s BIM capabilities to the next level. Work the company used to subcontract out can now be completed internally due to experience gained on MaineGeneral’s new regional hospital, Jordan says.
“Materials handling on a project of this size also has been a good learning experience,” he adds, noting that IPD is all about the chemistry of the team. “If you have one bad apple, it’s going to cause a problem.”
Thus far, Hays only has positive results to report. Most notably, the project’s initial completion date of June 2014 has been revised to December 2013. Six weeks of that gain can be attributed to unexpectedly good weather, but the remainder ties back to efficiencies from IPD.
“Because the whole project is modeled in BIM, as well as interfaced to subcontractors’ 3-D modeling packages, subcontractors can prefabricate components and then drop them in place,” Hays says. “When they looked at the efficiencies gained through prefabrication, there was a large jump in how fast the work could get done.”
Going forward this year, the team is focused on ensuring the building is weather-tight before the snow and freezing temperatures return.
|IPD centers on owners, designers and contractors coming together early in a project and agreeing to make decisions, take on risks and earn rewards as a team, with project goals placed ahead of individual goals. This approach lowers costs, leads to faster delivery times and reduces the chance of litigation. |
— Joanna Masterson
- Owners, architects and contractors are bound by a single contract that specifies their roles, rights, obligations and liabilities.
- Core team members are selected based on their experience, technical expertise, and ability to communicate and work collaboratively.
- Major project-related decisions are made by consensus of the core team.
- The success of every team member is directly tied to the performance of all other team members; the goal is to work collaboratively to find solutions rather than shift blame.
Lean: Soin Medical Center
With the population growing outside Dayton, Ohio, spurred by nearby Wright State University and Wright-Patterson Air Force Base, Kettering Health Network
needed to get a new medical center up and running quickly. It settled on a location in Beavercreek, Ohio, to build the 80-bed, 276,000-square-foot Indu & Raj Soin Medical Center
. Work began in 2009 and wrapped up in November 2011—three months ahead of schedule.
Kettering Health Network relied on a solid team to keep the $120 million fast-track project on schedule. HOK
and Jain Malkin & Associates
handled design, which features natural colors and materials, a three-story water feature and an indoor bamboo garden. Danis Building Construction
, Miamisburg, Ohio, was tapped to manage overall building activities. As its eighth project for Kettering Health Network, Danis had a firm grasp on what the owner wanted: efficiency and quality. Lean construction techniques brought those objectives to fruition.
In addition to self-performing 22 percent of general construction and concrete work, Danis divided the hospital—and even individual patient rooms—into manageable zones so subcontractors could concentrate their efforts on a specific scope of work. Danis also hosted weekly meetings during which each subcontractor was brought up to date on key deadlines.
“By bringing field workers into weekly meetings, they commit to when something will be done. Every room got a date for when electrical, plumbing and framing would be complete,” says Danis Project Manager Nick Hoyng. “Lean construction is all about the steady flow of manpower.”
To streamline subcontractor assignments, the project team spent a lot of time perfecting the sample patient room so every headwall, gas connection and electrical hookup was identical (i.e., same-handed) and eligible for prefabrication. Construction of the patient rooms became repetitive, which reduced the amount of labor required and the number of mistakes that could be made.
Danis also utilized creative bid packaging to alleviate manpower issues and increase competition among subcontractors, which positively affected productivity.
“Bid packages were broken down so multiple subcontractors could be used during various phases of construction,” says Jim Albertson, Danis’ project director for the Soin Medical Center. “Breaking down bids into smaller jobs created more opportunities for minority-owned and disadvantaged businesses and reduced work stoppages.”
In an effort to further minimize field errors, the MEP subcontractors co-located for six months to go through BIM drawings and fix clashes. BIM was used to model about 90 percent of the mechanical work, with all pipe welding performed offsite.
The chiller and generator rooms are located underground to thwart noise pollution and service disruption during weather-related disasters. The two chillers have heat recovery capabilities to enhance energy efficiency, and the entire hospital is capable of running off two diesel-operated generators pumping out 3.5 megawatts of power.
Other green building components include efficient lighting systems and hot water boilers, high-performance windows and continuous insulation. Maintenance staff also has access to diagnostic software that can pinpoint where energy loads are greatest.
With so many details to keep track of, Danis relied on Vela Systems
field management software to prevent breakdowns in coordination among team members, especially during the punch list phase. Armed with iPads, field personnel could access documents, plans and punch lists anywhere on the jobsite. Updates were synched automatically with an online database and disseminated to all relevant parties.
“Vela’s impact on the punch list was invaluable,” Albertson says. “It both simplified and increased the productivity of the process because we were able to add or delete items as we went through each room.” Not only did this reduce confusion for subcontractors, but it also doubled the number of rooms the architect was able to review on its walk-throughs.
All in all, Danis expended 38,965 manhours on the project. Efficiencies from BIM and lean techniques led to the superstructure being completed in record time, which led to the team topping out four weeks early and finishing the interiors four weeks ahead of schedule.
Soin Medical Center opened in February and employs about 230 people, with more expected to come on board as the patient load grows. Construction already is under way on a 109,000-square-foot medical office building connected to the medical center, and the hospital is built to accommodate the addition of a future patient tower or expansions to the emergency room and intensive care unit.
|Lean construction centers on minimizing waste and maximizing value; in other words, giving customers what they need, when they need it. Lean construction is particularly useful on complex or quick projects. |
— Lean Construction Institute: www.leanconstruction.org
- Make the process transparent to all project team members to empower them to take action.
- Minimize the movement of materials and workers by sequencing and positioning workstations, as well as maintaining materials at workstations.
- Encourage specialists to help one another as needed to maintain a steady workflow (i.e., multi-skilling).
- Make everyone responsible for product quality.