Controlling construction costs
Calif. hospital uses integrated project delivery team
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.”