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D4COST Software

Successful Teamwork Critical to Building ‘Hospital of the Future’
Modified IPD Saves Major Project $35 Million
By Scott Berman

Today’s healthcare construction projects are highly specialized, complex, expensive, lengthy, and regulated along stringent parameters. It’s a complicated formula that can exert great pressure on the relationship and communication among stakeholders. Major projects can suffer from common consequences of such pressure: delayed completion, blown budgets, and lawsuits over flaws caused by misunderstandings among segregated architects, contractors, and owners.

A very different scenario played out at Palomar Medical Center (PMC) in San Diego County, California. This advanced healthcare facility, noted worldwide as the “Hospital of the Future,” opened for patients in August 2012. There, owner Palomar Health, architecture firm CO Architects, and construction manager DPR Construction came together to assemble an integrated team united by a set of core values.

Tom Chessum, FAIA, principal at Los Angeles-based CO Architects, describes those core values as “emphasizing innovation, integrity, trust, excellence in craft, passion for the work, and unity.” Those values were made tangible and operational by the contract, daily performance across trades, and use of Building Information Modeling (BIM) technology. Each element combined to deliver an innovative, quality project with notable efficiency.

The approach, explains Wendy Cohen, district director of construction for San Diego-based Palomar Health, was inspired by the concept of Integrated Project Delivery (IPD). The process was a crucial step in expediting the delivery of PMC, which, at 760,000 square feet with an almost $1-billion budget, was the largest project in California during its construction. Even so, the project was finished ahead of the construction schedule established by the team, and about $35 million under budget.

Those are significant achievements that Brian Gracz, project executive at the San Diego office of DPR Construction, attributes in large part to effective team dynamics, which he believes “are really about understanding what each company brings to the table, and looking at what’s best for the project.”

A Collaborative Approach
The owner faced the challenge of building a medical center that would be constructed efficiently, designed and equipped with the highest levels of innovation, and watchful of the budget. Indeed, “at one point, our hourly labor output was more than $50,000, so any unproductive day, hour, or minute was worth a lot of money,” Cohen points out.

Given such challenges, the owner wanted to fully participate throughout the process of construction, and decided that a thoroughly integrated approach was the best strategy.

IPD can take various contractual forms, but the main concept is that owner, architect, and builder are equally responsible for the on-time on-budget completion of the project. As Chessum explains, “in ‘official’ IPD agreements, the owner, designer, and builder sign one contract that binds them to each other. For PMC, there was a two-party method, which followed the tradition of separate owner-designer and owner-builder agreements.” Even with the separate contracts, Chessum points out that “provisions enabling extensive interaction between the designer and builder made the process function in an IPD fashion regarding relationship, risk, and incentives.”

The approach “can really be described as a hybrid method in the spirit of the more formal IPD approach,” says Cohen, and hammering it out was itself a key step. As Chessum says, “the process of developing a specialized IPD approach is an essential trust-building exercise. It sets the tone for successful relationships throughout the project.”

Contracts set, the owner formed and was part of a board of directors with executive representatives from the architecture firm, project manager, contractor, and key engineering firms. Cohen explains that the board essentially functioned as a business from the ground up—from formulating the project’s mission and core values to stipulating relationships to hammering out incentive-based contracts. The process set in motion, as Cohen says, a fundamental and “specific way of conducting business during the course of the project.” At the core of the board’s purview: carrying the culture and core values of the project through to its completion.

Building Information Modeling
The integrated team made the core values a daily reality at PMC in myriad ways, and extensive use of BIM was one of the more important. BIM, the program of digital building design renderings and technical documents, was an effective tool in eliminating risk and waste during design and construction, thereby helping stakeholders validate concepts, share expertise, and identify and resolve conflicts.

Put another way, BIM provided a shared platform or parametric design tool that reflected and implemented the spirit and contractual letter of collaboration. The technology provided a means for each team member to easily see specifications, share concerns, and, essentially, eliminate any frictions before they were poured into concrete. The use of BIM on this project was awarded by the American Institute of Architects for its pioneering applications and early adoption of the technology.

The D&T wing’s green roof, a striking feature, is a signature example of how the team employed BIM to great advantage. Sensing an opportunity for important savings and efficiencies, the steel subcontractor used BIM to analyze the design of the roof, which was initially envisioned as a two-way truss system. The analysis resulted in a collaborative decision to change it a one-way system, which saved $8-million worth of steel and staff hours, while maintaining the integrity of the structure, function, and design.

Tangible Results
According to Cohen, the hybrid approach also “made the team more nimble in order to address critical issues at hand. It allowed for creativity in our problem solving and made it easier to identify the best person to resolve an issue, rather than who was contractually obligated.”

That was important because a project of such size and scope will have its share of surprises. Indeed, as Chessum notes, “the larger the project, the greater the potential for stumbling blocks to arise and potentially create peripheral consequences that affect the quality, cost, and schedule of the work.” The difference at PMC was that no matter what stumbling block arose, it was “addressed with the same committed focus and process,” says Chessum. Essentially, the core values guided responses that were consistent and creative.

Gracz explains that at one point, state inspectors unexpectedly added two stipulations for a series of solar tubes already ordered for the project. The tubes—devices inserted through a roof to enable daylight to permeate interiors—needed to be seismically braced and fire rated. However, the tubes were not designed for those standards, and the situation could have been an expensive obstacle. The high-performance team concept at PMC quickly came into play. The mechanical contractor proposed a solution—inserting the tubes into braced and fire-rated ductwork—and worked with CO Architects and DPR to implement it, says Gracz. It took some ad-hoc activism, but all state standards were met and the desirable daylighting feature did not have to be abandoned. It was a telling example of what made the process work.

In fact, the process streamlined the entire project, generating its greatest savings from increases in productivity in mechanical engineering, plumbing, dry wall, and structural steel, according to Gracz.

In Chessum’s view, “IPD is best when it responds to the project’s circumstances and the particular character and goals of all of the participants.” Each situation is different. As Chessum warns, “formulaic IPD agreements, imposed by any party, prevent foundational dialogue and the establishment of common goals and values.” Thus, investing in the effort it takes to collaboratively forge and implement the right approach is worth it. Chessum argues, “while potentially seeming to be a time-consuming process at the outset of a new project, assembling the owner, designer, and builder team to determine the IPD formula for the project is essential to longer-term success.”

Gracz agrees, pointing out that the approach devised for PMC allowed professionals to go the extra mile to achieve the common goal. He adds, “end-users of buildings ultimately benefit when professionals are willing to step outside of their comfort zones for the good of the project.”

Construction collaboration, hybrid BIM-enabled IPD, call it what you will—the process produced a complex, high-design medical facility with $35 million in savings. PMC is a promising example. As Cohen adds, their IPD process created “a collaborative and creative environment where the end goal was success for all parties, and not the individual success that has been so traditional in the building industry.”

Scott Berman has written about architecture, construction, design, entrepreneurship, business, history, and other topics in the United States and Scandinavia. A former newspaper reporter and public relations executive, Berman’s doctoral dissertation examined how public architecture communicates.

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