Originally posted Wednesday, 16 January 2013
Written by Scott Saier
In 2005, Texas Children’s Hospital (TCH) located in Houston launched a comprehensive strategic planning process to forecast the hospital’s future evolution and growth. A master plan was envisioned that encompassed four major new building initiatives, one of which was the new Pavilion for Women, a 15-story, 770,000 SF building with a four-level, 500,000 SF subterranean parking garage. This new hospital facility is dedicated to caring for women and their infants throughout their lives, beginning before conception and continuing after delivery.
A commercially developed land site was purchased across the street from the TCH main campus as the home for the new Pavilion. The Pavilion includes assessment, antepartum, labor and delivery, postpartum, and mental health facilities, along with outpatient clinics, private practices, imaging, a conference center, patient and public food services, and office spaces built over a four-level, 1,000-car subgrade parking garage. The Pavilion is connected to the main TCH campus with a two-story, twin-span oval pedestrian skybridge located above a major thoroughfare (Fannin) and a METRO light rail transit infrastructure. The initial phase of the project serves approximately 5,000 births per year, and future vertical expansion could accommodate up to 7,000 births per year. The building is designed for expansion to 1.7 million SF, with two 23-story towers serving both maternity and pediatric patients.
TCH’s in-house project management team, Facilities Planning & Development (FP&D), has a staff of skilled project managers that oversee the TCH capital construction and renovation program. But to keep6 Patientroom the highly complex Pavilion for Women project on schedule and under budget, FP&D enlisted the aid of outside project management consultants Broaddus & Associates. Broaddus & Associates served as the “boots on the ground” management team that maintained the day-to-day design and construction activities and reported progress to FP&D, who retained overall control of the project’s scope, schedule, and budget.
FP&D incorporated a fast-track, integrated project delivery model with a single team focus. TCH selected an A/E/C team based on their demonstrated ability to perform in a collaborative, integrated project delivery setting. In order to effectively check performance to budget and finish on schedule, a construction manager/contractor was selected concurrent with the design consultants to participate as a cost, scheduling, and constructability advisor during the design phase.
To facilitate project communications, expectations, and timely decisions, TCH established a project organization structure to define roles and responsibilities. This consisted of a seven-member core team of TCH Board of Trustees’ Building and Grounds Committee, a project steering committee, and 27 user groups comprised of key stakeholders. The core team monitored and validated the project management processes and priorities, and regularly met with the project management team for key decisions and to verify project design solution was consistent with the TCH “image.” The steering committee represented the numerous user groups and was the guiding force for operational and functional discussions.
Regular meetings at two-week intervals with all stakeholders kept the critical decisions needed in focus. In any given month, up to 60 meetings were scheduled to keep this pace. The team created a decision timeline schedule to determine when decisions needed to be made. This schedule was consistently reviewed and continuously updated to ensure the proper information was developed ahead of time so that timely decisions could be made. During the fast-track process, the team also developed back-to-back design and construction meetings in order to allow decisions for critical areas of design/ construction overlap to happen immediately with all key team members present, instead of waiting until the next scheduled meeting.
One of the biggest scheduling challenges during the project was the construction of the skybridge. Construction required closing Fannin Street and the METRO light rail over six weekends. Due to the disruptions this caused, this challenge involved coordination with multiple parties, including the City of Houston, Metropolitan Transit Authority of Harris County, Texas Medical Center, private businesses, and Reliant Park activities, including the Houston Livestock Show & Rodeo and the Houston Texans football schedules. There were times when the completion of the bridge looked impossible because of the challenges of working with so many groups. This challenge was anticipated and planned for early over two years with substantial communication. The skybridge was finished later than originally planned, but was completed when the building opened.
Ultimately, the Pavilion for Women took five years, five months to complete (Oct. 2006-March 2012). The project was completed on schedule and under budget.
TCH entered into this project understanding that any project, no matter how well planned and documented, is going to encounter change. With this in mind, TCH established a formal change-management process employing internally developed budget-management tools that allocate and monitor commitments of project costs. Three tools were used: Risk/Opportunity Summary, Pending Considerations List, and Outstanding Issues List. The Risk/Opportunity Summary tool was used to predicatively measure budget performance relative to progress, potential risks, and available budget funds. The Pending Considerations list was developed to facilitate prioritization and timely resolution of proposed scope changes. Finally, during occupancy, stakeholder-requested changes can quickly get out of hand if not managed, so the TCHteam used the Outstanding Issues List to record and track all user-requested changes.
In the end, several factors were key to the successful completion of the Pavilion for Women:
The Owner’s project management experience: The project’s success owed much to the experience and leadership of FP&D, TCH’s in-house project management team, which clearly understood7-Construction the design and construction process and was able to navigate the complex internal workings and political structures within TCH. From the start, FP&D established a work plan that defined communication processes, major stakeholders, team roles and responsibilities, and levels of authority. They also developed budgets and timelines with realistic expectations based upon their experienced understanding of similar projects. This plan was approved by the hospital Board, and it empowered the FP&D project team to proceed with confidence throughout the project.
The Owner’s senior leadership and decision making: The TCH Board of Trustees Building and Grounds Committee also played a crucial role in the project’s success. The Committee is long tenured and has extensive knowledge of the TCH facilities and the role that those facilities play in serving the mission and image of the hospital. The Buildings and Grounds Committee designated core team, comprised of seven board trustees, offered oversight of the project management process with guidance from FP&D. This provided clarity and focus, allowing decisions to be made at the appropriate time without being revisited later.
Early selection and involvement of a construction manager: Early in the design process, TCH hired a trusted construction management firm, W. S. Bellows Construction, as a cost and 7-curvewindowsconstructability advisor to keep the design within budget. Bellows’ early involvement provided guidance at a point in the design process when the greatest influence over cost and value could be achieved, rather than later, when the ability to effectively make cost management changes is greatly diminished. Bellows was also able to provide advice on constructability issues, allowing the design team to maximize value, while providing practical solutions that could be physically put into place.
Selection of the right team: The design team, construction manager, architect, and engineers were all selected with the intentional view toward shared goals and collaborative teamwork, rather than seeking the cheapest solution. Although cost effectiveness is always a critical consideration, TCH understands that cost effectiveness is the result of careful, intentional, and deliberate management of the project and the process, rather than simply seeking a low bidder.
Selection of outside project managers to support inhouse project-management: During the design phase, FP&D brought in Broaddus & Associates to supplement their own in-house project management staff. FP&D staff managed the design consultants, internal stakeholders, and institutional communications, while Broaddus & Associates staff managed field coordination and communication. To ensure success, the two groups remained true to their pre-determined processes, responsibilities, and authorities.
Effective change management: Project scope changes were managed according to a pre-determined change-management process laid out in the project management plan. Cost impact was reviewed and schedule implications were addressed and managed. TCH approached all changes with the realistic understanding that on any project, some change is inevitable, especially on a project done in a fast-track method over several years.
Communication to key stakeholders: Throughout design and construction, the Board’s Building and Grounds Committee core team and the end users were kept involved with all relevant scope and design decisions, down to interior materials and color selections. The continuity of involvement from conceptualization to completion resulted in a high level of ownership among the stakeholders and pride in the project’s successful outcome.
The TCH Pavilion for Women project was particularly complex for a number of reasons, including:
• Preparing the site for construction came with several major challenges: relocation of occupants located in buildings on-site to be demolished; clearing the site with implosion of a 12-story building containing two levels below grade; demolition of a four-story bank building with an underground vault; and asbestos abatement of both buildings. Additionally, excavation and dewatering of the site four levels below grade took over a year. This was because a natural underground water source, which wasn’t encountered during prior neighboring construction and not detected by soil borings during design, was discovered during construction preparation.
• Difficulty of construction in the Texas Medical Center (TMC), which is similar to major urban areas in terms of density, population, and traffic congestion.
• The bridge steel fabricator went out of business during construction, making it necessary to arrange for another company to deliver and fabricate the remaining steel.
• Upgrade of an existing bulk hospital oxygen tank to a much larger tank. This required months of planning because the switch-over required the hospital to use a temporary oxygen supply over a weekend. The removal of the old tank and installation of the new one required closing Fannin Street and the METRO light rail for a day.
• Minimal laydown area due to a restricted site.
• Significant regulatory approvals from various authorities.
• Strain of TCH resources due to the three other concurrent construction initiatives.
The TCH Pavilion for Women incorporated several initiatives to maximize sustainability:
• The use of high-performance materials and systems using “best value” design priorities to optimize efficient and economical long-term facility performance.
• The building design followed U.S. Green Building Council guidelines and LEED® criteria, but in lieu of committing project capital funds to the administrative costs of seeking LEED® certification, TCH opted to invest in the facility. However, the guidelines were still reviewed, and if the payback for investment was less than five years, the respective guideline was incorporated.
• During design, the City of Houston implemented local amendments to the International Building Code with more stringent requirements associated with energy savings, and these new codes were incorporated into the design.
In a project of this magnitude, it’s inevitable that conflicts will arise among designers, builders, the Owner, and the stakeholders. FP&D managed those conflicts through a carefully developed approach:
• Prior to design, FP&D developed a project plan that detailed the organizational structure for the design and construction of the Pavilion. This plan focused on a collaborative team approach that clearly defined the project goals and priorities, along with everyone’s roles, decision-making responsibilities, and levels of authority. Whenever a potential conflict arose, the team referred to the plan.
• A/E consultants, construction managers, and contractors were painstakingly selected with a strong emphasis on their collaborative ability.
• The project team was empowered by TCH administration and the Board of Trustees to make the critical decisions in accordance with the project plan. Therefore, not only could decisions be easily made, but the authority and accountability for those decisions was clearly delineated.
• From the start of the project until completion, the entire TCH organization was actively involved in the project to ensure the alignment of goals and priorities. The constant involvement of all parties meant constant buy-in.
• Complete mock-ups of four different patient room types (defined by size, millwork, locations, equipment placement, communication, electrical and medical device locations, and quantities of furniture) were built early in the project in order to resolve any conflicts prior to repetitive construction of these highly expensive rooms.
• When decisions became debatable, even at the highest levels within the organization, information and statistics were collected, so the decision-making was guided by analytical data, not just opinions.
For such exemplary project planning and management, the Texas Children’s Hospital was presented COAA’s 2012 Project Leadership Gold Award for its Pavilion for Women project.