Originally posted on Monday, 19 May 2014
Written by Chris Towery
DeSoto County, Mississippi, has experienced tremendous growth over the past two decades. To ensure the county’s burgeoning population has access to high-quality healthcare services, Methodist Le Bonheur Healthcare (MLH) built a 100-bed, full-service, faith-based hospital in the city of Olive Branch. The 208,000 square-foot facility includes four operating rooms, 18 emergency department exam rooms, an intensive care unit, as well as labor and delivery facilities.
DeSoto County, Mississippi, has experienced tremendous growth over the past two decades. To ensure the county’s burgeoning population has access to high-quality healthcare services, Methodist Le Bonheur Healthcare (MLH) built a 100-bed, full-service, faith-based hospital in the city of Olive Branch. The 208,000 square-foot facility includes four operating rooms, 18 emergency department exam rooms, an intensive care unit, as well as labor and delivery facilities. The total budget for the new hospital was set at $100 million (including medical equipment, land cost, furniture, etc.), and the goal of the project was to deliver an energy efficient, LEEDcertified, modern healthcare facility without exceeding the budget. To help achieve this goal, the project team employed Integrated Project Delivery (IPD), Building Information Modeling (BIM), and LEAN Construction principals, all of which ultimately allowed the team to deliver a successful project ahead of schedule and below budget.
Overall Project Management
MLH Project Manager Richard Kelley headed up the project team, with support from the company’s internal director of facility management, Vice President David Rosenbaum. In 2011, MLH adopted IPD to more effectively deliver complex construction projects, and the Methodist Olive Branch Hospital—MLH’s first IPD project—demonstrates just how successful such a collaborative approach can be. After issuing an RFP for an IPD team to deliver the Methodist Olive Branch Hospital, MLH brought on board contractor Turner Construction, architect Gresham, Smith and Partners, and consulting engineer Smith Seckman Reid.
To further enhance collaboration, MLH developed clear protocols for communication on the project by establishing ground rules for interaction between all stakeholders and setting project-specific goals. A Core Team was formed consisting of representatives from the Owner, architect, consulting engineer, and contractor to manage the critical coordination of the project. The main function of the Core Team was to develop a consensus when decisions dramatically affected the scope, schedule, and budget of the project. Regularly scheduled meetings were held to ensure all parties were well-versed in the progress and direction of the project. An Executive Team was established as well, and its purpose was to provide oversight at the individual firm level should the need arise. The Core Team held bi-annual meetings with the Executive Team to inform them of project schedule, budgets, successes, and obstacles. This extensive coordination, led by Kelley, established clear channels of communication for each aspect of the project and helped the team meet project goals while remaining on schedule and under budget.
Project Scheduling: The project schedule was extremely aggressive for a greenfield hospital of this size and complexity. The project team was tasked with moving from the inception of design to substantial completion in just 23 months, so all stakeholders had to buy into the process and allocate the resources necessary to complete the project within this limited time frame. Extensive time was devoted in the planning phase to outline design and construction schedules and determine early-release packages to accelerate the start of construction.
Work packages were coordinated so that once Turner was mobilized, a logical sequence of construction activities could occur with seamless information issued by the design team. For this schedule to be successful, MLH had to contribute many of their own resources to the project. With leadership from Kelley and Rosenbaum, the team was given unlimited access to MLH’s internal medical equipment planners, interior designers for standards, information technology specialists, and clinical operational leaders, among other assets.
Timely decision making was vital to meeting the schedule’s strict deadlines. Critical decisions had to be made early and aggressively. Under the leadership of MLH and the Core Team, pull schedules and one- to three-month look-ahead schedules were developed to ensure the overall schedule was followed from day one. LEAN construction methods and IPD were also used as tools to monitor the schedule.
Cost Management: In order to monitor and control costs, MLH held weekly meetings with the project team to review the project’s status and budget through each of the design phases. This effort utilized component team pricing, a method in which the project is divided to smaller cost centers similar to CSI format.
Each cost center is assigned an agreed budget and monitored weekly to ensure compliance. Using this method, any variance from the projected cost can be dealt with immediately. From there, the area in question can be evaluated and brought back into budget, or other areas of the project can have their budgets adjusted to compensate for overtures. The goal of this pricing exercise is to keep the entire team informed of budget issues in real-time, as opposed to using milestone pricing. With this method, issues were addressed weekly, without wasted effort or lost time by the team.
Quality Management: Maintaining overall project quality was a primary goal throughout the entire design and construction processes. With IPD, silos of Owners, designers, and contractors are torn down, and quality management becomes the responsibility of the entire team. MLH understood that quality management is similar to safety management, in that neither can be delegated. Rather, they must be an integral part of the project’s culture. One aspect of implementing a culture of quality was to have fullteam, “big room” reviews of the documents during various stages of design. The team also empowered the mechanical, electrical, and plumbing subcontractors to engage in design assist with the engineers and to work jointly in a single BIM model. This provided for a reduction in overall scheduling by allowing the subcontractors to commence with fabrication drawings while the design was being completed. Since the completion of the BIM model was a joint effort, clashes and constructability issues were openly discussed between team members, and resolutions were developed in the world of virtual reality, instead of losing time and money by waiting until the actual construction.
Overall Project Success
Complex projects such as hospitals can achieve success on many different levels. For the Methodist Olive Branch Hospital, the management team engaged in a retreat, where MLH established clear direction on the project’s mission, vision, and guiding principles. This direction formed the foundation for the final product. Project directives established at the retreat include:
Mission: To build an affordable community hospital that provides safe, high-quality care that will meet the healthcare needs of the community. Olive Branch Hospital will be the spiritually-based, premiere healthcare destination for clinical excellence, as seen through the eyes of our patients, staff, and community.
Vision: Our vision at Methodist for Olive Branch is to become a regional center of excellence by actively listening and partnering to meet the individual healthcare needs of those we serve. We are following this vision as we design and construct the new hospital, to ensure it meets the needs of our patients, employees, physicians, volunteers, and visitors.
Safety and Care Excellence
Recruitment & Retention
Efficiency and Waste Reduction
Mission & Ministry
Intelligent Design that Promotes Growth & Flexibility
This was the first IPD project for MLH, and they researched the process thoroughly. The project team’s selection was due in large part to their success with previous IPD projects. From there, MLH combined the team’s practical experience with their own expectations, which relied on the principles of Reliance, Trust, Optimize, Improve, Collaborate, and Innovate to shape how members of the project team related to one another. The project team worked closely to develop a partnering agreement and incentive plan, which was signed by MLH, Turner Construction, Gresham, Smith and Partners, and Smith Seckman Reid. The agreement laid a clear expectation for how the different firms would communicate with one another, and it created rules for the team to follow. Below are several important declarations pulled from the agreement:
“Fundamental to the success of Integrated Project Delivery is the willingness and ability of all IPD team members to make and secure reliable promises as the basis for planning and executing the Project.”
“The Project Team will be expected to openly share information and cooperatively collaborate for the benefit of the Methodist Olive Branch Hospital”
“By forming an Integrated Team, the parties intend to gain the benefit of an open and creative learning environment, where team members are encouraged to share ideas freely in an atmosphere of mutual respect and tolerance. Team Members shall work together and individually to achieve transparent and cooperative exchange of information in all matters relating to the Project, and to share ideas for improving Project Delivery as contemplated in the Construction Documents. Team members shall actively promote harmony, collaboration and cooperation among all entities performing on the Project.”
“None of the parties can proceed in isolation from the others; there must be deep collaboration and ongoing flow of information. When a question or issue is uncovered, it is very important that both sides be able to state their point of view before a solution is made. ‘No’ should never be the first response to a question.”
“The parties accept the relationship of mutual trust and confidence established with each other by this Agreement, and promise to furnish their best skills and judgment and to collaborate and cooperate with each other and with other project participants in actively pursuing an integrated project and furthering the interests of the Project.”
“IPD Team shall provide ongoing review and recommendations on construction feasibility throughout the construction phase; actions designed to minimize adverse effects of labor or material shortages; time requirements for procurement, installation and construction completion; and factors related to construction cost including estimates of alternative designs or materials, preliminary budgets and possible economies.”
The members of the project team were deeply committed to treating one another with mutual respect. For example, when challenges arose, discussions were conducted in an atmosphere of respect, not conflict, and as a result, all players worked diligently to find the optimum resolution for the good of the project, rather than their own narrow selfinterest. The clear direction and environment of trust and respect that Kelley, Rosenbaum, and the rest of MLH established and fostered were among the most significant contributors to the overall success of the Methodist Olive Branch Hospital.
It wasn’t enough for the project to be completed ahead of schedule and under budget: the team was committed to delivering top-quality results for every phase of the project. The team placed individual performance measures as a basis for an overall incentive plan. The ability to meet project milestones, maintain budget without the need for end-of-phase value engineering, and adhere to their promises all factored into the individual firm successes. Further, to help determine the hospital’s ultimate success, a one-year post-occupancy evaluation will be conducted to evaluate patient satisfaction scores (HCAHPS), Energy Star ratings, staffing efficiencies, and other parameters.
The following are three issues that added to the complexity of the Methodist Olive Branch Hospital project:
Designing without end-user input: One major challenge was determining how to design a building as complex as a hospital without end-user input. At its inception, Methodist Olive Branch Hospital was a greenfield hospital with a staff of one. David Baytos was named the CEO of the hospital, and he relied on MLH’s internal facility-management group to manage the design and construction. MLH recognized that the schedule was dependent upon making service line directors and key personnel from their other hospitals available to the design team early in the planning and schematic plan phases. These individuals attended a series of comprehensive schematic design sessions and medical equipment planning charettes to provide critical input to the design team. This collaboration assured that the new hospital would meet the clinical needs of patients for years to come.
Infrastructure challenges: The new hospital is located in an area outside the Olive Branch central business district. Because of this, roads and utilities had to be upgraded to support such a development. The project received funding for infrastructure improvements from Mississippi Development Authority (MDA,) an agency tasked with promoting business development in the state. The utility and road work portions of the scope of work were broken out into different contracts, separate from the hospital’s contract with the city of Olive Branch. As a result, MLH was managing the work of several contractors working on the same site. Though challenging, this approach was key in bringing the hospital on line by the scheduled completion date.
Public Engagement: As with any major development, the local planning commissions have tremendous influence in the site planning and aesthetics of the campus. The opening of Olive Branch Hospital has been anticipated for more than a decade. MLH was rejected in its application for a Certificate of Need (CON) several times over the last 15 years, until a revision in the state health plan allowed for the new hospital. During the interim, Rosenbaum and his staff had been diligent in forming relationships with the authorities in Olive Branch. This gave the planning commission confidence in approving the facility at the schematic design level, knowing the integrity of the Owner would lead them to deliver on promises made.
MLH’s Dave Rosenbaum is a thought leader in the area of sustainability. His insight has helped MLH become one of the largest Owners to lead the way in conservation and sustainability. This project is measured under LEED’s 2009 Standard for Healthcare, and it is one of the only hospitals in world to receive LEED Gold in this category.
Central elements in the hospital’s sustainable design include:
• A water source heat pump HVAC system with a geothermal bore field for heat sink/source, along with dedicated outside air treatment units for optimal indoor air quality control. MLH was willing to engage a robust HVAC selection process that evaluated all aspects of cost and performance of the system, as well as impact on other disciplines and facility operation. The process evaluated cost of space utilized, impact of glass type and area, impact to electrical distribution, operation and maintenance costs, and other factors to arrive at a true life cycle cost. While the water source heat pump system proved to have the best life cycle cost, the Owner was willing to investigate further to determine if a geothermal heat sink/ source would be advantageous. After a detailed ROI analysis of the added cost for the geothermal field, the decision was made to adopt this feature. The final energy model indicates the facility will have an Energy Utility Index of about 150 kbtu/ sq.ft./year range, in an industry that averages closer to 260 kbtu/ ft/year.
• A specialized electrochromic window system was added to the hospital’s main entrance. The unique glass of this system reduces energy use and cost by limiting the amount of sunlight and heat that enter through windows. The glass automatically transitions between clear and variable tint, providing control over the amount of light and heat entering a building.
• The team employed enhanced commissioning, starting at overall system selections to final testing of the finished building.
• Upon investigation of the site, two wetlands were discovered. Additionally, a protected, blue-line stream bisects the site. Designers were challenged to design a hospital and site that would accommodate these two features. The site and its limitations had a tremendous impact on the design of the building, affecting its location, orientation, façade, and landscaping. The Owner charged the design team with providing a 100-bed chassis that was expandable to a 400-bed facility. The position of the stream and the need for future expansion were both determining factors in choosing the hospital’s site location, and the axis was skewed in order to take advantage of solar orientation and expanded views.
For their exemplary project management, Methodist Le Bonheur Healthcare was selected as the winner of COAA’s 2013 Project Leadership Gold Award for the Methodist Olive Branch Hospital. For more information on this project, visit www.methodisthealth.org.
Compiled by Chris Towery