Bringing Reimagined Care to San Diego's North County
Kaiser Permanente San Marcos Medical Center | San Marcos, California
The new San Marcos Medical Center is a state-of-the-art, 433,000-sq.-ft. hospital addition that includes a HCAI OSHPD-1 patient tower, central utility plant (CUP), and extensive sitework. Built adjacent to the existing multi-specialty San Marcos Medical Offices, the new medical center underscores Kaiser Permanente’s commitment to San Diego's North County.
About the
Project
The seven-story hospital includes 206 beds, eight operating rooms, a 39-bay emergency room, two C-section rooms, an ICU, neo-natal intensive care unit, maternity care, and 204 parking spaces. Infectious disease treatment, cardiology, general surgery, and orthopedics are among the services the new medical center brings to the San Diego region. Designed for expansion, the hospital includes 29,000 sq. ft. of shell space to meet future community needs.
Kaiser’s determination to provide high-quality, affordable care was met with the team’s persistence in working with key trade partners toward the most cost-effective and efficient options. The project finished below budget and two months ahead of schedule. Expedited owner decision-making, target-cost budgeting, detailed forecasting, and iterative feedback removed typical schedule roadblocks. Other strategies included an ambitious teaming process and VDC-led design-assist approach, early procurement of critical-path materials, targeted phasing and permitting, and prefabrication.
Certified
LEED Platinum
Green features include reclaimed water use for landscaping and cooling towers, EV charging stations, rideshare and vanpool parking, bike racks, showers for alternative commuters, and drought-tolerant indigenous landscaping. The hospital is also equipped with a first-of-its-kind DC-powered LED lighting system and active chilled beams. Building envelope and glass were selected based on thermal rating, and the glazing type, frit patterns, and sunshades were also optimized for direct sunlight, all to reduce HVAC demand and improve occupant comfort.
The
Challenges
Fast-Track Schedule
The project’s schedule was aggressive for a ground-up, OSHPD-1 hospital tower, spanning four years from start of design to Certificate of Occupancy. Pandemic-related challenges threatened on-time completion, as did existing campus operations, site constraints, and rigorous permitting and inspection processes. From day one, the project team worked closely with the City of San Marcos, HCAI, and Kaiser Permanente to find solutions.
Rigorous Quality Requirements
The process of closing up ceilings and walls was a major effort as trades made their way up the 7-story tower. OSHPD inspections involve finalizing complex MEP work and related support, insulation, and seismic requirements. Also, the team’s ability to hit milestones was affected by labor availability amid market- and pandemic-driven shortages of skilled craft.
Existing Site/Operational Constraints
Building next to four active medical office buildings, our limited site access, parking, and laydown became even more challenging as the pandemic progressed. One major disruption to campus was removing the existing loading dock and relocating the medical offices’ deliveries to the hospital’s new (shared) loading dock. The new loading dock, CUP, and basement required a total excavation of 134,000 cubic yards of dirt and blasting of 77,000 cubic yards of rock.
The
Challenges
Fast-Track Schedule
The project’s schedule was aggressive for a ground-up, OSHPD-1 hospital tower, spanning four years from start of design to Certificate of Occupancy. Pandemic-related challenges threatened on-time completion, as did existing campus operations, site constraints, and rigorous permitting and inspection processes. From day one, the project team worked closely with the City of San Marcos, HCAI, and Kaiser Permanente to find solutions.
Rigorous Quality Requirements
The process of closing up ceilings and walls was a major effort as trades made their way up the 7-story tower. OSHPD inspections involve finalizing complex MEP work and related support, insulation, and seismic requirements. Also, the team’s ability to hit milestones was affected by labor availability amid market- and pandemic-driven shortages of skilled craft.
Existing Site/Operational Constraints
Building next to four active medical office buildings, our limited site access, parking, and laydown became even more challenging as the pandemic progressed. One major disruption to campus was removing the existing loading dock and relocating the medical offices’ deliveries to the hospital’s new (shared) loading dock. The new loading dock, CUP, and basement required a total excavation of 134,000 cubic yards of dirt and blasting of 77,000 cubic yards of rock.
The
Solutions
Design-Assist and “One Model” Approach
The team took an ambitious design-assist and “One Model” approach, bringing on 24 trades as design-assist partners in strategic waves. Designers and detailers shared the same BIM model, and subcontractors created both permit and field drawings simultaneously. When crews showed up on site to begin work, their materials were ready, the budgets were set, and permits were approved.
Divide & Conquer Work/Inspection Zones
Instead of a traditional floor-by-floor approach, the team designated four crews per subcontractor and four respective zones that functioned as “projects within the project.” Scripted work planning within and between these zones reduced downtime and rework. This also helped “dissect” the building on more complicated floors featuring diagnostic and treatment areas or kitchen space. In addition, the team worked closely with key trade partners to prioritize strategic overtime for critical-path trades and provide early access to critical and larger areas leading up to turnover.
Creative Sequencing and Prefabrication
To maintain loading dock access for the occupied campus, the new hospital loading dock and CUP were turned over nine months before the completion of the hospital. The early turnover required detailed coordination and sequencing for deliveries, crane movements, and installation of seven new underground tanks in a constrained space.
The team also elected to prefabricate risk-prone and trade-intensive building components, including medical gas headwalls for patient rooms. These were built on a shared jig by trade partners at the project’s off-site warehouse, hauled two miles to the site, and craned into place. This approach also saved time by increasing quality and consistency, and proved critical to keeping the fast-track schedule.
The
Solutions
Design-Assist and “One Model” Approach
The team took an ambitious design-assist and “One Model” approach, bringing on 24 trades as design-assist partners in strategic waves. Designers and detailers shared the same BIM model, and subcontractors created both permit and field drawings simultaneously. When crews showed up on site to begin work, their materials were ready, the budgets were set, and permits were approved.
Divide & Conquer Work/Inspection Zones
Instead of a traditional floor-by-floor approach, the team designated four crews per subcontractor and four respective zones that functioned as “projects within the project.” Scripted work planning within and between these zones reduced downtime and rework. This also helped “dissect” the building on more complicated floors featuring diagnostic and treatment areas or kitchen space. In addition, the team worked closely with key trade partners to prioritize strategic overtime for critical-path trades and provide early access to critical and larger areas leading up to turnover.
Creative Sequencing and Prefabrication
To maintain loading dock access for the occupied campus, the new hospital loading dock and CUP were turned over nine months before the completion of the hospital. The early turnover required detailed coordination and sequencing for deliveries, crane movements, and installation of seven new underground tanks in a constrained space.
The team also elected to prefabricate risk-prone and trade-intensive building components, including medical gas headwalls for patient rooms. These were built on a shared jig by trade partners at the project’s off-site warehouse, hauled two miles to the site, and craned into place. This approach also saved time by increasing quality and consistency, and proved critical to keeping the fast-track schedule.
Shared Ownership of
Quality
DPR Quality and VDC professionals, trade partners, and inspectors of record (IORs) owned the project’s QA/QC program together, meeting daily on site to review inspections for the day and week ahead, and prioritizing certain trades in the event of a time crunch. Also, with full-time QC representatives on both sides, DPR and subcontractors performed in-house inspections and made corrections prior to calling for formal inspections.
VDC involvement factored heavily into successful quality outcomes. In addition to using the BIM model as a single source of truth, DPR also used laser scanning and daily 360° photos to record progress, assess clashes, and document as-built conditions. These strategies reduced rework at every stage, from catching out-of-place embeds ahead of deck pours to fixing punch-list items before turnover.
San Diego Business
Journal
Kaiser opens San Marcos Medical Center, adding 206 new beds and bringing 1,100 jobs to the area.
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