Dose of Teamwork Mixed with 4-D CAD, an Executive Project Board and Early Subcontractor Involvement Provides Preventative Cure for Construction

With multiple phases of the $90 million expansion currently underway for Banner Health System’s Good Samaritan project in Phoenix, the construction hotline to field patient complaints is unusually quiet for a job of this size and scope, according to David Cheney, Senior Administrator for Good Samaritan Regional Medical Center, who added that Good Samaritan’s “extremely pleased with the level of participation and cooperation by all parties.”

Every quarter since the project was kicked off in February 2000, the project’s Executive Board, which is comprised of 15 people from Good Samaritan, DPR and architect OWP/P, has met to review performance, discuss challenges and issues, and ensure that the project stays on course with the team’s vision to “create the visionary place to heal and be healed.”

“We’re running the project like a $90 million business,” said Ron Rendina, project manager for DPR. “The team created an Executive Board, which includes Good Samaritan’s CEO Steve Seiler, to help manage the project from a big picture perspective, and we’ve included most of the major subcontractors, both their management teams and field representatives, so that they can hear first hand the vision from Good Samaritan’s CEO and be active participants in the process.”

Increasing the facility’s bed capacity from 508 to 625 beds once completed in 2004, the multi-phased expansion project includes a 195,000-sq.-ft., three-story building, which will house a new diagnostics and medical imaging center, an ambulatory care center, cardiology and cardiac rehabilitation department, and a new maternity center. As part of the project, which also includes a new five-story parking structure, DPR recently completed a 10,000-sq.-ft. chiller plant, featuring new chillers, an additional cooling tower and two stand-by back-up generators, and a new surface parking lot with 234 covered spaces. In addition, in January of this year, DPR wrapped up the demolition and build out of eight Intensive Care Unit (ICU) rooms on the 11th floor of an existing tower in eight weeks without disrupting hospital operations.

“I feel like we’ve got an ‘A-team’ on this project, from the contractor’s and architect’s side,” said David Cheney, Good Samaritan Senior Administrator. “Banner has also been impressed with DPR’s unique vision as to how a contracting company can work with a hospital to build something special, while being sensitive to the staff, physicians and patients — mothers having babies on the floor below or the kidney transplants occurring above. We have become true partners, which is the ideal relationship to successfully realize our goals.”

4-D CAD: Communication Through Visualization

To minimize the impact construction may have on the operating hospital, as well as to serve as an ongoing communication tool, DPR, in coordination with OWP/P, utilized Four-Dimensional Computer Aided Design (4-D CAD) technology during preconstruction. Using 4-D CAD, the team incorporated floor plans and building elevations linked to the construction schedule to animate the process, allowing hospital administration to visualize the building under construction even before project start.

“We built the project virtually first, which provided hospital administrators and staff with a clear picture of all that’s involved with a multi-phased project of this magnitude,” said Hamilton Espinosa, preconstruction manager for DPR. “The 4-D CAD model includes any phasing issues, temporary routing, site logistics, construction sequencing and phasing, and constructibility matters.”

Rendina added that the 4-D CAD model continues to be used during monthly coordination team meetings to illustrate exactly where the project is in the process and also during pre-bid meetings with subcontractors to give them a quick picture of what they will be building and the effect their work will have on the functioning hospital.

Good Samaritan is also producing a monthly, two-page newsletter called the “Expansion Express” that provides an update on construction, answers to Frequently Asked Questions (FAQs), lists comments and concerns, and features short stories and photos of various stages of the project. In addition, a project Website has been developed that includes a project directory, reports, budgets, and schedules all written in an executive format to relay quick overviews on the job.

“Usually, it is the owner that tries to get everyone on board. In our case, DPR is leading the team, including the subcontractors, to make sure that we’re all on the same page and following the vision we have created for the project,” said Cheney.

Along with the vision, the team identifies specific project goals from construction budget and schedule to safety and permits. “Each month, we meet and discuss in narrative form what the upcoming construction activities are for each phase and then list all of the goals associated with those activities to track our progress,” said Rendina. For example, the goal for Construction Budget is “The First Construction Estimate = Contract Price.” DPR is tracking estimates of all phases against the actual amounts, and, to date, the 11th floor ICU renovation, South Parking Lot and Chiller Plant have come in under budget.

Reducing Noise Levels

“Good Samaritan measures patient satisfaction on a monthly basis, getting feedback from patients and their families on how we are meeting their needs and asking about their stay,” said Cheney. “Our goal is to maintain our patient satisfaction scores during the construction process. Nobody likes the inconvenience of construction but you can try to do your best to make sure it has the least amount of impact.”

With roughly four months to demolish and renovate 40 rooms on the fourth floor of an existing tower, DPR is working as quickly and quietly as possible, including selecting one room as a “mock-up” that will be completed before all of the others to proactively address any potential issues.

To help reduce noise and vibration, DPR will be using gravity connections and a common-shared unistrut system to decrease the number of attachments for the build out of a new 50,000-sq.-ft. medical imaging center. The center is located on an existing floor sandwiched between occupied administrative offices and surgical post operation and emergency departments.

The new imaging area, including some RAD Frequency rooms, will be located within an existing concrete structure, and to further assist in minimizing noise and vibration, all attachments will be core-drilled where possible into the concrete.

“Conventional methods will only be used where core drilling is not practical and after extensive scheduling with the departments that will be affected,” said Jim Herzog, superintendent for DPR. “Also, by changing several structural steel shear connections to what we call gravity connections, we can drill from the top and attach using chemical anchors rather than drilling through concrete beams, eliminating the need to drill into hypersensitive suites adjacent to surgery for through-bolting. This not only addresses vibration and excessive noise issues but also potential physical disruption to those departments that are in 24-hour operation.”

In addition, utilizing a unistrut support system for overhead services could decrease the number of attachments throughout the structure by anywhere from 20 to perhaps as much as 40 percent.

Infection Control: Managing Risk

As part of the project, DPR will be adding 14,000 sq. ft. of new floor space on top of the existing 54,000-sq.-ft. surgery center, which will require the removal of 14,000 sq. ft. of inverted and ballasted roofing, along with mechanical units during this portion of the project. Planning well in advance, the team is currently holding monthly infection control meetings with individuals in the hospital risk assessment and infection control group, “using everyone’s great minds to come up with the best plan of action as we head into different areas of the hospital,” said Herzog.

“DPR’s proactive approach is a tremendous project asset,” said Cheney. “Some areas of the hospital have zero tolerance for anything that resembles dust. We meet on a regular basis to talk about all the steps that need to be taken to provide the highest level of safety for our patients and workers. It’s a critical metric of the entire project. We always emphasize it, and it is nice to see an architect and contractor that also believe safety is the number one issue too.”