Hospital achieves success through IPD
Sutter Health is the first large building owner to embrace Lean construction and require design and contracting companies to implement it. The early results were positive enough to attract the attention of many other health care owners, who adopted it as well. Project delivery teams who learned to follow Sutter’s admonition to “optimize the whole, not the pieces” have been achieving significantly better outcomes.
The clinical program for the replacement of the Sutter Health Eden Medical Center (SHEMC) in Castro Valley, Calif., launched in July 2007 and finished in November 2012, had to be delivered on time and within the approved budget using Lean project delivery methods. Otherwise, there was no project. Starting with a high-level program, the team spent 2 months developing a concept, estimating the cost, and planning how to construct it within the budget and schedule constraints. They presented a “validation report” to Sutter Health and waited for approval. Once the board of directors accepted the report and authorized the project, the team decided to wait until the detailed clinical program was complete before starting design. During this time, Sutter Health developed and published a set of clearly defined owner’s goals to be used as guiding principles on the project. These goals served as the starting point for the metrics the team used to measure how effective they were, and to determine what the final outcome would be at the end.
Soon after design commenced, the team saw that the market cost to deliver the detailed program, along with operational and sustainability goals, exceeded the target cost that the team had agreed to with Sutter Health. From that point, the leadership team asked the cluster teams to develop alternatives to deliver equivalent value for lower cost. They made a rule that no concept or detail could be proposed without first considering its cost and schedule impact. This work had to be done within the design review schedule Sutter Health had negotiated with California’s Office of Statewide Health Planning and Development (OSHPD), the state agency responsible for safe design and construction of all hospitals in California.
Big decisions had to be made quickly so that the structural system could be designed and modeled for submission and review before a new building code was adopted. The project team was able to meet that and all subsequent design package delivery dates because they continued to map and refine work processes and pull work backward from the milestones. (The more common method is to work toward arbitrary deadlines without detailed discussion with all affected parties on the time needed and the information exchange required). Using cost as a constraint on design decisions allowed the team to maintain the project target costs through the completion of fabrication level design documents.
SHEMC was delivered for the target cost 1 week ahead of the milestone for the authority having jurisdiction (OSHPD) to sign off for “staff and stock.” It opened for business 6 weeks ahead of the “first patient” milestone. There were almost no compromises to the space program (i.e., owner’s needs requirements), which is very rare in hospital construction in California. All of the owner’s goals were achieved. The building achieved U.S. Green Building Council LEED Silver certification, with 97% of inspections passed the first time. The injury and lost-time incident rates were very low. The time on task for the major trades was 74%, which was far above an average 30% to 50% range found in previous studies.