Case study: IPD at work in health care
In 2013, Advocate Health Care (now known as Advocate Aurora Health) embarked on a building program to modernize and expand its Advocate Medical Group (AMG) outpatient health care reach throughout the greater Chicagoland area. To best achieve its goals, Advocate put together a design and construction team that would work in a highly integrated, team-oriented fashion to deliver high-quality projects that result in project cost savings. This approach has enabled Advocate to take advantage of innovations and improvements in both clinical and construction processes that are traditionally lost when projects are one-off, design-bid-build (DBB) endeavors. To date, the team has delivered more than 21 projects ranging from small, 5,000-sq-ft clinics to new, greenfield, 75,000-sq-ft buildings, with more projects on the way.
From the start of the building program, the team operated with an IPD approach to all aspects. Multiparty contracts between the owner and designers and the owner and contractors were used to take an open-book approach to costs, risks, and opportunities. As the team built trust and true integration, larger projects within the program were transitioned to poly-party or integrated form of agreement (IFoA) contracts, which enabled further innovation by eliminating barriers to team integration.
By creating an integrated team, lessons learned from past projects can be applied to the next. This refinement continues with every subsequent project as the traditional attitude of “It’s good enough, just get it done” is replaced with “How can we make this better to make future projects better?” By knowing that innovation and fresh ideas are encouraged, appreciated, impactful, and not lost on the next project, the team is constantly looking to improve.
One such project is the AMG clinic in Des Plaines, Ill. This project is a greenfield, 30,000-sq-ft new clinic opened in 2017 and providing family health, obstetrics, radiology, and immediate care (see Figure 4). Within the context of continuous improvement and eliminating waste, one of the areas the design and construction team approached differently was the mechanical and plumbing system documentation. Instead of the traditional method of the consulting engineer developing a design model and 2-D permit/procurement drawings that would then just be redrawn and re-coordinated by the mechanical and plumbing trade partner, both parties combined their efforts to create a single model that could be used for all needed applications-permit, procurement, coordination, fabrication, and installation.
IMEG Corp. (the design engineer) and Martin Peterson Co. (MPC, the mechanical/plumbing trade partner) worked closely together throughout the entire design and construction process to deliver a single model. IMEG Corp. maintained all engineer-of-record responsibilities and full authority on all aspects of the design of the project. IMEG provided design and direction to MPC’s BIM modelers to create the model from the beginning. By working collaboratively, waste was eliminated and outcomes were improved. Other benefits of this approach included:
- Greater understanding by all parties on all actions, be it a design decision that a contractor wouldn’t traditionally be a part of, such as a future renovation consideration, or the layout of a section of ductwork that makes installation easier, which an engineer might not see on his or her first pass of design.
- Elimination of miscommunication that typically occurs between the creation of separate design documents and shop-drawing layouts. By having a single model, all information is known and exposed. Information can be trusted. Rereviews and redrawings are not needed.
- With design and construction part of the process from the beginning, a layout was developed that enabled MPC to create prefabricated, multitrade overhead mechanical-electrical-plumbing (MEP) racks that could be delivered to the site. These multitrade racks result in safer, higher-quality construction with reduced time on site.
Of course, project approaches and expectations that sound good in theory often prove to be more challenging than expected. This project was no exception, even with a team that was highly integrated, had the utmost trust in each other, and was working toward the best interest of the project. Challenges that the team encountered and ultimately overcame included:
- Miscommunication between firms. Shorthand notation and assumptions that an engineer can make with his or her own staff can cause confusion with team members from another company. It was learned that it was necessary to use language that was clear to the other firms to reduce confusion and limit rework that was due to misunderstanding.
- Iterating and redesign. While natural to the consulting engineer, the design process of progress, iteration, and options was unfamiliar to BIM professionals, who are used to taking a set of clear parameters (contract documents) and converting them to a model for fabrication and installation. The continual engagement with this staff throughout the design process helped them become more comfortable with this approach.
- Timing of architectural/owner changes during construction. With IMEG Corp. providing mechanical and plumbing design direction but having to rely on MPC’s BIM staff to update the model, more thorough communication had to occur. This is a staffing stress that isn’t typical to a TDM project where construction updates are communicated via a design-model change. This was addressed by MPC by resetting expectations and sharing scheduling constraints with the team at large.
By working together collaboratively, IMEG Corp. and MPC streamlined the mechanical and plumbing systems’ documentation process and eliminated waste. This improvement, in conjunction with an entire team working together in the best interests of the project along many different fronts, allowed the team to deliver the project ahead of schedule and under budget.