IMPROVEMENTS IN THE PLANNING, DESIGN AND CONSTRUCTION PROCESS THROUGH INTEGRATED PROJECT DELIVERY

KSHE Healthcare Coalition ConferenceSeptember 18, 2019

An Engineer’s Perspective:Integrated Project Delivery

Speed, Quality, Price

Pressure on the Healthcare Industry

Low Cost & High Quality?

Fast & High Quality?

Low Cost & Want it Now?

SPEED

Pressure on the Healthcare Industry

QUALITY

Pressure on the Healthcare Industry

PRICE

Pressure on the Healthcare Industry

Pressure on the Healthcare Industry

SPEED

Pressure on the PDC Process

QUALITY• Remove Risk• Attractive, Maintainable & Safe• Total Cost of Operation• Resilient, Flexible• Patient & Staff Safe• Success Metrics

Pressure on the PDC Process

PRICE

Pressure on the PDC Process

Shortcomings of Traditional Project Delivery:• The disconnect between “Design” and “Construction”

§ Communication§ Collaboration§ Education§ General lack of trust

• Standard Results§ Misunderstood intent§ Lack of evolution/continuous improvement§ Animosity§ Increased costs, compromised quality, lower value

Traditional Project Delivery

Traditional Project Delivery

CHANGE

Traditional Project Delivery

CHANGE IS EASYYOU GO FIRST

“We cannot solve our problems with the same thinking we used when we created them” – Albert Einstein

Silo Mentality to Teamwork

Evolution in Delivery

Need image of inside a central plant crowded/piping/equiment

Opportunity to Improve

Tools• Integrated Project Delivery Methodology• 3-D software/Building Information Modeling• Lean Construction Processes• Contracting Vehicles

Results• Coordination• Prefabrication

Learning• Design Process• Coordination• Model Management• Project Dynamics

Integrated Project Delivery

Traditional Delivery

Builder Involvement

Designer Involvement

Designer Involvement

Bui lder Involvement

Integrated Delivery

Collaborative Process:• The builder knows what is being designed (and why) and how he’s

going to build it.• The designer knows how it will be built and how his design supports

that process.• The Owner knows what he’s getting and what it costs.

Integrated Project Delivery

Goal: The Elimination of Value Engineering

BIM / 3-D Modeling

BIM / 3-D Modeling

• Plan it before we build it

• Coordinated – it all fits

• Minimize rework

• Consolidating efforts and resources

• Prefabrication

Lean Construction: Pull Planning

IPD Methodology•Collaboration•Communication

BIM / 3-D Modeling•See the fit•Avoid the clash

Lean Construction•Faster•Better•Cheaper

Value

Recipe for Success: Mutual Dependancy

Success via Various Contract Structures:• 3-way/4-way IPD/IFOA agreements

– Shared Savings

– Cost Incentives

• Traditional CM at risk and design team contracts with bridging

agreements

• Design–Build

Contract Structure

Design Assist• Enhanced Coordination• Real Time Pricing

Integrated Project Delivery

Target Value Component Teams• Early Equipment Procurement• System Selection Process

Prefabrication• Strategy• Facilitation

Design Assist – Mission Health

Narrative / Pricing RFP (end of SD)

Prequalification Interview

Project Delivery: Design Assist Process

Design Assist Prequalification

• History• Team• Capabilities• Capacity• Backlog• Quality

Project Delivery: Design Assist Process

Narrative, Pricing RFP (end of SD)

Project Delivery: Design Assist Process

Project Delivery Design Assist Process

Preconstruction

Project Delivery: Design Assist Process

Narrative, Pricing RFP (end of SD)

Project Delivery: Design Assist Process

Partner Selection

• Pre-Construction Presentation– Your Design Assist Role– Your Approach To Complete GMP– No Project Specifications, How Did You Handle– Your Role In Controlling The Budget– Interpretation of Budget Accountability

Project Delivery: Design Assist Process

• Target GMP Budget Presentation– Line Item Review with Backup Support– Quality Take-Off Examples

• Ability & Experience• Pricing Accuracy & Transparency• BIM Capability• Accountability – Ownership of Scope & Cost

Interview

Selection Criteria

Kickoff – Set Expectations & Ground Rules

Project Delivery: Design Assist Process

Total Team:• Design Reviews• Constructability Reviews• Pricing Updates• Trust• Challenge #1 – Align SD

Estimate to Budget• Trade Contractor Design Basis

Model Development (New Approach)

Design Integration: Mechanical

Design Integration: Mechanical

Design Integration: Electrical

Design AssistSt. Thomas Rutherford Medical CenterMurfreesboro, Tennessee

Results: Coordination

• Several Images coming from Sarasota

Project Delivery Design Assist Process

Major Equipment Buyout

Project Delivery: Design Assist Process

• DD Drawings/Specs• Equipment RFPs – Transparent, Competitive Process• Equipment Vendor Interviews• Best & Final Pricing• Owner Selection (Not MEP Subs)• $750k Savings to Budget• Enabled / Initiated Prefabrication• Selection Made During CDs

Atwhatpointdowerealizethateverycomponentinthefacilityhastangibleandpossiblymajorimpactsononeormoreothercomponents?Adecisionmadeononecomponentinasilointroducesariskofimposinganegativeimpactonanothercomponent.

Target Value / Component Team Approach

HVAC

HVAC System

First CostSpace

Requirements

Patient Satisfaction/

Comfort

HAI’s

Maintenance Cost & Access

Energy Cost

Exterior Skin

Glazing

Impact to Electrical Systems

Staff Retention

HVAC

HVAC System

First Cost

Space Requirements

Patient Satisfaction/

Comfort

HAI’s

Maintenance Cost & Access

Energy Cost

Exterior Skin

Glazing

Impact to Electrical Systems

Staff Retention

Glazing

HVAC

HVAC System

First Cost

Space Requirements

Patient Satisfaction/

Comfort

HAI’s

Maintenance Cost & Access

Energy Cost

Exterior Skin

Glazing

Impact to Electrical Systems

Staff Retention

Space Requirements

HVAC

HVAC System

First Cost

Space Requirements

Patient Satisfaction/

Comfort

HAI’s

Maintenance Cost & Access

Energy Cost

Exterior Skin

Glazing

Impact to Electrical Systems

Staff Retention

Maintenance Cost & Access

The Historical Way . . . .

§ First Cost§ Space Requirement§ Patient Satisfaction /

Comfort§ Patient Safety / HAIs

§ HCAHPS / Noise§ Long-Term Maintenance

Goals§ Energy Cost

The Innovative Way

Optimized Decision Making

Conceptualize the Options

Ground Source Heat Pump Water Source Heat PumpVariable Refrigerant Flow

Chiller/VAVActive Chilled Beam

Create & Study Models

Energy Model

First Cost Model

Space Utilization Model

O/M Cost Model

Develop through

SD

Utilize A3

A3

• Full Impact of Prefabrication§ Plan it§ Build it§ Install it

• Early Identification§ What opportunities exist?§ How can design facilitate?§ Impact to design sequences.

• Paradigm§ It’s not about building, it is about

making decisions.

Prefabrication

• Integrated view of “costs”§ Material§ Labor§ Schedule§ Quality

St. Thomas Rutherford Medical CenterMurfreesboro, TN

• Timing of design decisions• Impact to sequencing• Cost offsets

Lessons Learned

Lessons Learned

RevitConstruction

Models

RecordsDrawings As BuiltsOwner

DISCUSSION

KSHE Healthcare Coalition ConferenceSeptember 19, 2019