The DPR-led project team for one of the largest new hospitals built in California, Palomar Medical Center, in Escondido, scored a major success this April. California’s Office of Statewide Health and Planning Development (OSHPD) granted permission to “staff and stock” the facility four days earlier than originally planned, following an arduous four-year construction process.

Achieving this milestone was all the more notable in light of the highly challenging and intensive journey the team faced when it took over the construction management (CM) of the $660-million (construction cost) project in 2008, after construction had already begun in 2007. DPR Project Executive Brian Gracz said that an “unbelievable amount of effort, long hours and perseverance” paid off as the team demonstrated its ability to clear countless hurdles, reshape the construction process midstream and still meet the critical target date for delivering this landmark healthcare facility, which opened to the public in August.

Designed by CO Architects, and dubbed the “hospital of the future” for its many cutting-edge features, the 740,000-sq.-ft., 11-story Palomar Medical Center accommodates up to 360 patient beds, 12 operating rooms, a 50-room trauma center, a 60,000-sq.-ft. undulating green roof and a 40,000-sq.-ft. central plant, among other features. The hospital incorporates many sustainable design principles and reflects the owner’s commitment to creating not only a healing environment for patients, but one that also supports the well-being of the staff through features such as skylights and light wells that deliver natural lighting into employee-only spaces.

Developing the High-Performance Team

When DPR joined the project in 2008, the team knew it would be critical to establish an integrated, collaborative approach to the project to improve on the current progress of construction.

“We initially focused on two things: first, trying to figure out what was happening in the field so we did not impede, but rather improve, the current progress of construction, and second to quickly form a core leadership team for the project,” said Gracz. “We didn’t have the luxury of the preconstruction period—where we could really get to know each other and build trust—so we had to find a way to accelerate that process.”

DPR kicked off that process with a series of meetings with the owner, Palomar Health, the architect and engineering team, an outside facilitator, Lou Bainbridge, and key trade contractors to align goals and expectations and establish a high-performance team to focus on continuous improvement and project/team success. The high-performance team process was anchored by a virtual board of directors for the project consisting of Palomar Health, CO Architects, DPR, KPFF and Lou Bainbridge, who met regularly to develop strategies and make major project decisions.

While the project already had a multiple-prime contracting delivery method in place, the new team also incorporated a hybrid integrated project delivery (IPD) model using numerous lean processes. Several of the contracts with key trades were modified to better capture risks and rewards tied to project goals to ensure the focus was always on what was best for the project, rather than for individual companies. In addition to its CM contract, DPR also held prime construction contracts for interior framing/drywall and miscellaneous specialties work.

“One of the things that we effectively did was create one virtual company with a clear mission and values,” said Wendy Cohen, district director of construction for Palomar Health. “The other key was the concept of identifying the ‘right person’ to resolve an issue regardless of their contractual responsibilities, job title or role on the project.”

The cohesive, solution-oriented approach resonates with Frances Moore, associate principal with CO Architects, who calls the project a “career highlight” and one of the larger projects her firm has undertaken to date, as well as one of the most satisfying. “This has been the most collaborative, integrated process we’ve ever had on a project, in terms of the designers, the engineer, the owner and the builders all working really closely together to find solutions,” she said.

Overcoming Obstacles

That collaborative mindset was critical to overcoming challenges along the way. One of the more significant hurdles arose when the manufacturer of the huge, custom air-handling units (AHU) went bankrupt just as the units were delivered to the site—and it was discovered that their fans did not perform as specified.

“Our team had to dive in pretty deep to figure out how to make these units work,” Gracz noted. “People really put their heads together to come up with the best solution, and despite this pushing the start of the AHUs back a good six months, we were able to mitigate that impact through a lot of hard work, re-sequencing a portion of the installation of interiors and other measures.”

The collaborative focus was also central to overcoming the many small field coordination issues, which threatened to slow production. “With more than 1,000 people on site at our peak, it became difficult to address these issues in a timely and coordinated fashion,” Cohen said. The solution, which she calls a “turning point” in the project, was to deploy “SWAT” teams—integrated design and project management teams—into the field to work directly with the craftspeople to resolve issues much more quickly.

The SWAT team approach is another example of the ongoing commitment to continuous improvement to meet the aggressive schedule and budget objectives set early in the project. “Despite the challenges, as we wind down, people are actually finding it a bittersweet moment to leave this job,” Gracz said. “They have genuinely enjoyed being a part of it, which isn’t something you can always say for such a large, complex project.”

Cohen added, “One of the things that I am personally and professionally most proud of on this project is the level of pride and commitment from the project team. I have never seen anything like that, and I think this carried us through to the end.”