Con­trol­ling con­struc­tion costs

Calif. hospi­tal uses in­te­grated project de­liv­ery team

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Rules of thumb, ap­par­ently, are made to be bro­ken. As health­care con­struc­tion costs con­tinue to es­ca­late, it’s be­come gen­er­ally ac­cepted that typ­i­cal gen­eral acute­care hos­pi­tals will cost about $1 mil­lion a bed—ex­cept in Cal­i­for­nia, where you can ex­pect ev­ery­thing to be twice as ex­pen­sive. That’s why 134-hospi­tal Univer­sal Health Ser­vices’ new 140-bed Te­mec­ula (Calif.) Val­ley Hospi­tal and its $148.6 mil­lion price tag are get­ting at­ten­tion.

“The av­er­age cost of hospi­tal con­struc­tion in Cal­i­for­nia is now $2 mil­lion per bed,” Jan Emer­son-shea, the Cal­i­for­nia Hospi­tal As­so­ci­a­tion spokes­woman, says in an e- mail. Although “that varies some­what de­pend­ing on a num­ber of fac­tors in­clud­ing land costs, lo­cal reg­u­la­tory re­quire­ments and what’s needed in terms of seis­mic com­pli­ance.”

Set to be com­pleted in Au­gust 2013 and ad­mit its first pa­tients that Oc­to­ber, Te­mec­ula Val­ley will have the ca­pac­ity to ex­pand to 320 beds. It’s about 55 miles north of San Diego and has the same is­sues to deal with as other hos­pi­tals in the state.

What’s prob­a­bly dif­fer­ent from con­struc­tion work at many other hos­pi­tals is the use of an in­te­grated project de­liv­ery team, this one headed by Re­becca Hath­away, a se­nior op­er­a­tions ex­ec­u­tive with Te­mec­ula Val­ley.

Us­ing lean con­struc­tion tech­niques, Hath­away over­sees a team led by a joint ven­ture be­tween DPR Con­struc­tion and Turner Con­struc­tion Co., along with HMC Ar­chi­tects, who work, as she de­scribes it, “side-by-side, el­bow-to-el­bow” with “sheetrock guys work­ing along­side ar­chi­tects” in a plan­ning room that fea­tures a floor-to-ceil­ing grid with sticky notes at­tached to dif­fer­ent squares.

“They know their kids’ names,” she says. “We’re hav­ing fun, and now I wouldn’t do it any other way.”

Hath­away is a nurse who is ac­tive in pro­mot­ing the Plan­e­tree Vi­sion­ary De­sign Net­work, which ad­vo­cates for pa­tient-cen­tered care and, ac­cord­ing to its web­site, “a more per­son­al­ized, hu­man­ized and de­mys­ti­fied health­care ex­pe­ri­ence.” She says there’s an em­pha­sis on putting “square footage in rev­enue.”

As an ex­am­ple of this, she de­scribes how reg­is­tra­tion desks were taken out of the de­sign, and plans call for hav­ing a clerk reg­is­ter pa­tients at their bed­side. Hath­away says the aim is to re­duce pa­tient move­ment, fa­cil­i­tated by bed­side (not por­ta­ble) com­put­ers in the pa­tient rooms.

“Ev­ery time you move a pa­tient around a hospi­tal, it costs $500,” she says. “We have ev­ery­thing at the point of care when­ever pos­si­ble.”

Pa­tient data from two nearby UHS Cal­i­for­nia hos­pi­tals, 218-bed In­land Val­ley Med­i­cal Cen­ter in Wil­do­mar and 51-bed Ran­cho Springs Med­i­cal Cen­ter in Mur­ri­eta, were used to make pa­tient-traf­fic pro­jec­tions that aided in Te­mec­ula Val­ley’s designs.

A man­i­fes­ta­tion of this is a 28-room sec­tion that won’t have li­censed beds but will be used for di­ag­nos­tic pro­ce­dures, pre- and post-op hold­ing ar­eas and as swing space for the emer­gency depart­ment. Ac­cord­ing to pro­jec­tions, it’s ex­pected that two or three beds will be used for emer­gency pa­tients three hours a day, three to five days a week.

An­other ex­am­ple of strate­gi­cally lo­cat­ing fa­cil­i­ties in­cludes plac­ing the phar­macy near the emer­gency depart­ment, op­er­at­ing rooms and out­pa­tient cen­ter on the first floor. The se­cu­rity of­fice also is next to the ED. Hath­away says se­cu­rity will be strict but un­ob­tru­sive even as the build­ing re­mains open to vis­i­tors 24 hours a day.

“We don’t have a bazil­lion doors,” she says, and vis­i­tors will be clearly iden­ti­fied.

Hath­away says the new fa­cil­ity is de­signed to be 30% more op­er­a­tionally ef­fi­cient than other hos­pi­tals. Along with re­duced pa­tient move­ment, she says care was also taken to re­duce the steps doc­tors, nurses and other clin­i­cal staff will need to take dur­ing their work­day. To help fa­cil­i­tate these mat­ters, plans call for hir­ing a di­rec­tor of fa­cil­i­ties and op­er­a­tions a year in ad­vance of open­ing.

“If the di­rec­tor of fa­cil­i­ties can work sideby-side with the con­struc­tion team, they’ll know ev­ery inch of the build­ing be­fore it opens,” Hath­away says. “They will co-cre­ate it by be­ing on-site dur­ing the con­struc­tion.”

This is all part of the silo-break­ing, team struc­ture of in­te­grated project de­liv­ery, which could make some un­com­fort­able be­cause it

also calls for com­plete open­ness.

“Ev­ery­one knows what ev­ery­one makes,” Hath­away says.

She adds that there is still com­pe­ti­tion be­tween con­trac­tors, but “no one is gam­ing the sys­tem” so one can gain at an­other’s ex­pense.

“Com­pe­ti­tion drives value within the team,” Hath­away says. “It drives in­no­va­tion and that drives value to the cus­tomer.”

Tom Mc­cready, se­nior project su­per­in­ten­dent with the Dpr/turner joint ven­ture, says tra­di­tional con­struc­tion meth­ods have a lot of wasted time and ef­fort. He de­scribes how typ­i­cally an ar­chi­tect will draw a de­sign, its con­struc­tion will get priced, with the gen­eral contractor even­tu­ally say­ing the own­ers can’t af­ford it or the bud­get won’t al­low it, and the ar­chi­tect, lit­er­ally, is sent back to the draw­ing board—per­haps mul­ti­ple times.

So, in­stead of ask­ing peo­ple to re­peat­edly per­form the same tasks, Mc­cready says he asks, “How can we make this the most pro­duc­tive project you’ve ever worked on?”

“Af­ter 35 years of do­ing this, this is the most ex­cit­ing project I’ve ever worked on,” Mc­cready says.

Chris O’dwyer, a Dpr/turner joint ven­ture project en­gi­neer, agrees.

“Af­ter 3½ years, I can say the same,” O’dwyer notes, adding that, if the decision is made that in­te­grated project de­liv­ery was no longer the de­sired con­struc­tion method, “I will bang my head on my desk if I have to go back to the old way. It would be so frus­trat­ing at this point.”

O’dwyer is also en­joy­ing the ex­ten­sive use of in­for­ma­tion tech­nol­ogy on this project, in­clud­ing build­ing in­for­ma­tion mod­el­ing— or Bim—soft­ware (Oct. 26, 2009, p. 30). This in­cludes hav­ing three on-site BIM wire­less “kiosks” equipped with print­ers and 40-inch tele­vi­sion screens that help keep the crew up­dated on the lat­est plan and help en­sure there are no ar­gu­ments over whose draw­ings are the most cur­rent.

“Now you have elec­tronic doc­u­ments in­stead of marked-up plans, and there is no such thing as hav­ing the wrong draw­ing,” O’dwyer says. “That’s the in­no­va­tion I’m ex­cited about—that, and An­gry Birds.”

Mc­cready adds that the use of BIM will al­low for off-site pre­fab­ri­ca­tion of complicated plumb­ing and elec­tri­cal con­nec­tions that can then be de­liv­ered to the hospi­tal and as­sem­bled more safely and with less waste.

Un­like other projects where com­puter mod­el­ing may be used to try to cal­cu­late the best views a fa­cil­ity can pro­vide, this ap­par­ently wasn’t nec­es­sary for Te­mec­ula Val­ley, which is on a 37-acre site in the rolling hills of South­ern Cal­i­for­nia’s wine coun­try.

“There are views ev­ery­where,” Mc­cready says. “So we didn’t have that chal­lenge.”

Con­struc­tion work­ers and oth­ers in at­ten­dance signed the final beam as part of a top­ping-off cer­e­mony in March for the new Te­mec­ula Val­ley Hospi­tal. The hospi­tal, pic­tured in a ren­der­ing be­low, is set to be com­pleted in Au­gust 2013.

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