Seattle Daily Journal of Commerce

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August 22, 2013

A Special Section of


Contractors can help with health care transition
Skanska USA

Pregnancy center offers one-stop care for new moms

Not all healing gardens deliver as advertised
By MARK EPSTEIN Hafs Epstein Landscape Architecture

Outpatient clinics multiply as big projects dry up

Workplace health clinics are making a comeback
McGranahan Architects

Integrated delivery pays off for Kirkland hospital

How buildings help with patient care

Children's addition built to be safe after an earthquake
Coughlin Porter Lundeen

August 22, 2013

Integrated delivery pays off for Kirkland hospital

  • Fairfax expansion shows how hospitals save time and money when project team members work together more closely. Fairfax Hospital expansion</span>
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    Fairfax Hospital expansion
    Owner: Fairfax Management and Facilities
    Developer: Universal Health Services
    Architect: Boulder Associates
    General contractor: BNBuilders
    Civil engineer: KPFF Consulting Engineers
    Mechanical/electrical engineer: McKinstry Co.
    Earthwork: Hos Brothers
    Steel contractor: B&B Fabricators
    Drywall contractor: Expert Drywall
    Geotech consultant: GeoPier
    Landscape architect: Berger Partnership
    Soil engineer: AESI
    Health care construction continues in Washington, despite the slowdown in hospital construction projects.

    There are fewer landmark projects for large hospitals and a rise in specialty care clinics, medical office buildings and hospital renovations, primarily outside of the metropolitan core. This shift has created emerging markets for many and the opportunity to pioneer new delivery methods and smart technology.

    An expansion of Fairfax Hospital in Kirkland will add 68 beds and create the largest private behavioral health hospital in Washington state.

    When completed Fairfax will be a marquee accomplishment in integrated project delivery, or IPD. Utilizing the IPD methodology for the ground-up hospital project enabled the project team to deliver a high-quality facility at a lower cost.

    As health care providers seek to reduce costs, maximize efficiency and remain competitive, they are relying on the design and construction industry for innovations to traditional project delivery methods. Fairfax Hospital benefited from the successful implementation of IPD with time and cost advantages and greater efficiency.

    The unique aspect of IPD is the consensus document (contract), which places a lot of risk on the project team to overcome the normal obstacles of construction. It also provides an incentive to work together and find better ways to complete a project. The contract is designed to break down the typical silos that a construction team tends to form. The entire project team is motivated to work in unison to find efficiencies and innovations that ultimately benefit all parties.

    Image courtesy of BNBuilders [enlarge]
    BNBuilders is using integrated project delivery to build a $20 million expansion to Fairfax Hospital in Kirkland.


    Communication and collaboration are at the heart of the IPD process. With12 firms part of the IPD system on the Fairfax Hospital project, communication was an early challenge that forced the team to quickly find ways to improve the process.

    Significant value and quality were gained with a fully collaborative process and a focus on enhanced communication. The collaborative design approach allowed Expert Drywall and the architect, Boulder Associates, to work closely together in developing the framing and envelope details to minimize material waste and labor cost in assembly. By sizing the windows to suit the unit size of the siding, the team was able to minimize material waste and joints on the exterior.

    'Pull planning' has been very effective in getting the trades to participate in the planning process and take ownership of their commitments. Re-sequencing the building pad was one example of this, but it has also helped to flush out many details in the work sequence that may not otherwise have been uncovered until later in the process.

    This was very apparent in planning the utility installations across the site in conjunction with final grading. Due to the size and complexity of the underground water-treatment systems, the site has been severely restricted through the civil work. Sequencing of the utilities has been critical to completing this work, and those details were worked out in the pull-planning sessions.

    Full collaboration promotes an environment of trust and ties the entire team to the common goals established at the start of the project. Establishing the 'conditions of satisfaction' early provides the road map for future decision-making.

    Image courtesy of BNBuilders [enlarge]
    The project team for this hospital in Fremont, Calif., found it could make better budget decisions after getting input from subcontractors.

    Better solutions

    Budget was a challenge for the project early in pre-construction. Rather than go through multiple rounds of value engineering, the team was able to discuss and select materials and finishes based on value as the design developed to help mitigate challenges.

    Another example of creative construction, the project team achieved savings in the stormwater detention and filtering system. The civil engineer recognized that the system lacked sufficient void space volume due to the type of fill material being used.

    In a typical contracting method, this might be an opportunity for the civil contractor to create a change order for over-excavation and backfill of additional drain rock. In this case, the civil engineer worked collaboratively to create a better solution and proposed using the lay-back area of the excavation as additional void space, thus eliminating the need for over-excavation.

    IPD provides a set of tools that enable decision-making based on choosing by advantages rather than cost, which favors the long-term benefit of the facility.

    Other tools such as pull-planning, productivity observation and resource sharing allow for detailed planning, continuous improvement and elimination of waste, saving time and money while improving quality.

    Uses for BIM

    The integrated approach to this project has enabled the team to make use of building-information modeling (BIM) to communicate with the project team and perform design and trade coordination.

    Using BIM is key in eliminating conflicts in the field and allowing trade subcontractors to pre-fabricate certain elements, greatly reducing wasted time and material on the job site. A byproduct of this tight coordination is a resulting dataset of as-built information that is highly accurate and reliable for future use by the building owner.

    Additionally, project progress is communicated to the project team through regular 'dashboard' reports. The dashboard presents timely updates on metrics including schedule, budget and upcoming tasks in graphical form.

    BIM utilization allows these metrics to be fine-tuned and for information on future work to be accurately communicated to the owner.

    Wisdom of 'cluster groups'

    BNBuilders has adopted IPD for health care construction along the West Coast. Partnering with Universal Health Services to expand their Fremont Hospital in the San Francisco Bay Area, the team found success through the formation of IPD 'cluster groups.'

    The budget cluster group includes the drywall/framing and HVAC trade partners in addition to UHS, the architect and BNBuilders. Integrating the trade partners and making budget decisions together gained tremendous efficiencies.

    Having input from subcontractors developed a greater awareness of how decisions often have a ripple effect that impacts subcontractor performance. This has led to a great sense of ownership of the budget by the entire team.

    IPD in the health care industry is particularly beneficial to the end users due to the level of collaboration with the facility during design and construction. The ability to incorporate input from the users of the space through design and construction will greatly benefit Fairfax Hospital and Fremont Hospital as they strive to provide excellent patient care in a competitive market.

    Erik Westover, a project executive at BNBuilders, has spent his career delivering technical health care projects in the Seattle area. Jim Charpentier has over 15 years of experience in the health care industry in Washington.


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