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July 26, 2012
Providence Regional Medical Center Everett is celebrating its first year of patient service in the new Marshall and Katherine Cymbaluk Medical Tower.
The 12-story, 680,000-square-foot tower is the largest expansion project in Providence’s 150-plus year history. It has capacity for 328 intensive-care and acute-care unit beds, 60,000 square feet of diagnostic imaging and treatment, a new 60,000-square-foot emergency department, 28 surgery suites, an underground loading dock and support services.
Providence opened the tower in June last year, several months before the originally anticipated completion date. The early opening equated to a cost savings of $6 million.
A shared trailer
The early completion and cost savings can be attributed to the integrated design and construction process. Mortenson Construction and Zimmer Gunsul Frasca Architects were co-located in the job site trailer, which greatly expedited the inspection, submittal and decision processes, and encouraged collaboration amongst the team.
Critical subcontractors were engaged early in the process to help develop the aggressive schedule goals. They included Hermanson (mechanical), Veca Electric, Diamond B Constructors (plumbing), Walters & Wolf (curtain wall), Goldfinch Brothers (glass and glazing), and Expert Drywall.
Mortenson coordinated with the design team to issue construction document packages, which allowed early procurement and fast-track phasing. An aggressive project procurement process was put in place to enable the team to preempt any early schedule impacts as a result of material procurement.
The team presented design options to the owner by using building-information modeling, or BIM, to create virtual mock-ups.
The use of BIM began with basic designs and continued until the final design was solidified and agreed upon by all the stakeholders. The virtual mock-up process was used in many different areas of the project, including patient rooms, surgery suites and the building enclosure.
Once all of the stakeholders had come to a design conclusion, the team built full-scale mock-ups and sought further input from Providence staff to ensure each space was usable.
Through the use of BIM, the team was able to coordinate the design to provide recessed slabs on a room-by-room basis in rooms that were to receive major medical equipment. This provided in-slab routing space for mechanical and electrical services once the equipment was selected and vendor shop drawings were finalized. Using BIM also allowed Providence to select medical equipment later in the construction process so the hospital could take advantage of pricing and improved technology.
The team, including the medical equipment vendors, worked together using the model to decide upon the final placement of each piece of equipment based on existing building systems. This allowed all the other components around the room to be completed and fully functional before the major equipment room design was complete.
Technology on site
In order to make the job site a continuous source of up-to-date information, wireless access points were installed in the field as soon as the building structure far enough along that it could protect the equipment.
Mobile computer stations were made available to all trades as a tool for referencing the models and electronic documents, which saved countless hours by eliminating the need to go back and forth from the job site to the trailer. For example, lift drawings could be printed at a mobile computer station right in the field.
Utilizing the model also helped the team to determine sequencing of the trades and ensure systems were installed correctly to eliminate the need for re-work. Project engineers were also able to use the model on tablet computers for in-wall and overhead mechanical, electrical and plumbing inspections. They could reference both the model and construction documents to ensure everything was installed correctly before covering the walls and ceilings.
The team used modeling to assist with the placement of two tower cranes, minimizing their interference with the hospital’s helicopter traffic.
“4-D” modeling was used to coordinate structural steel erection and concrete placement, integrating the critical path method schedule with the more commonly used 3-D model. This allowed the team to resequence the erection and deck placing efforts, shaving two months from the project schedule.
By “prebuilding” the entire project virtually in the 3-D model, subcontractors were able to prefabricate assemblies in a controlled environment, such as a remote shop. This resulted in extremely accurate and detailed field installation drawings. It also reduced the on-site office overhead required to manage extensive installation and design/coordination issues that traditionally arise in the field.
By prefabricating 256 headwalls, the project team saved 53 minutes per unit, totaling 220 man hours, which translated to labor costs savings in excess of $20,000 and material cost savings of $4,500.
Through the lean practice of value stream mapping, the team was able to analyze the flow of materials or information for any part of the design, document control or construction process.
A value stream mapping study of the request-for-information process helped identify areas of waste and opportunities for improved efficiencies. The results led to the use of an electronic method that saved more than 3,000 professional staff hours in review time and thousands of dollars of paper.
At the peak of construction, 500 to 600 craft workers were on site, along with 100 people in management. From start to finish, approximately 6,000 craft workers came and went, and at least 30 local unions contributed to the tower’s construction. Many of the subcontractors on the project were based in Everett.
This project delivered a greatly improved health care facility for the Snohomish County community and provided jobs to thousands of construction workers during a severe economic downturn and weak construction market.
Michael Harder is the general manager of health care with Mortenson Construction, a national general contractor with a local office in Kirkland.