Discussion. SYMPOSIUM 101 PART II An Overview of the Essential Information You Need to Serve the Healthcare Market

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1 Discussion Strategic and Functional Planning Incorporating Process Improvement Health Information Technology Health Environments Interior Design Deb D Agostino Ann McGauran Annette L. Valenta Rolando Conesa Orest Burdiak SYMPOSIUM 101 PART II An Overview of the Essential Information You Need to Serve the Healthcare Market

2 Presentations The Architect as Team Leader Equipment The Owners Perspective Project Delivery Method Integrated Project Delivery Susan Black Tony Frietas Stephen Brigham Jim Rossmeissl Doug Mangers The Architect as Team Leader Susan Black

3 Learning Objectives Who are the team players? How are teams managed? What influences and constrains design outcomes? Master Builder Era of patronage Non-contractual relationships with trades Passion and vision uncompromised Antonio Gaudi - Sagrada Familia, Barcelona

4 Maestro! Orchestrating towards successful delivery Managing complex processes Instilling passion and innovation Seattle Symphony Orchestra Master Builder Maestro Architect as Lead

5 Stip Sum Client Architect as Lead DIV 01 DIV 02 DIV 03 DIV 04 DIV 05 DIV 06 DIV 07 DIV 08 DIV 09 DIV 10 DIV 11 DIV 12 DIV 13 DIV 14 DIV 15 DIV 16 Field Review all consultants DBFM Client Developer Constructor Architect as Lead DIV 01 DIV 02 DIV 03 DIV 04 DIV 05 DIV 06 DIV 07 DIV 08 DIV 09 DIV 10 DIV 11 DIV 12 DIV 13 DIV 14 DIV 15 DIV 16 Field Review all consultants

6 Client Compliance Team Developer Finance + Legal User Groups Constructor Facilities Management Architect as Lead Consultants Structural Building Science Medical Planning Equipment Planning Civil Landscape Interior Design Elevator LEED QA/QC Contract Administration Field Review Building Codes Municipal Process Site Plan Application Life Safety Accessibility Infection Control MEP

7 Organization Trends Medical City Medical Tourism Specialized diagnostic Facilities

8 Trends Trends

9 Trends Trends

10 Constraints Public vs. Private Funding Constraints Public vs. Private Funding

11 Innovation Innovation

12 Architect as lead Architect as lead PEB In JV with IBI Group

13 Equipment Tony Frietas Learning Objectives What are the current trends? What are the future trends? How do these trends impact design? How do you evaluate investments?

14 Not so Long Ago Paper and More Paper

15 Drafting Machines Planners Wear Many Hats

16 Hat # 1 Administration Initial Budgeting Best Guess Budget Validation Equipment Alternatives to Meet Budget Goals Ongoing Budget Management Hat # 2 User Input / Emerging Trends Evolution from Macro to Specific Equipment Trends Hybrid OR Rooms AV Integration Automation Pharmacy and Lab Equipment Reuse

17 Hat # 3 Procurement Balance Value and Price Compliance with Budget Constraints Standards Development GPO Agreements Local and National Contracts Hat # 4 Architect User Meetings Functionality and Fit Utility Requirements Backing and Anchorage Drawings 2D and 3D

18 Hat # 5 Engineers Structural, Mechanical, Plumbing, Electrical Details and More Details Coordination Meetings Amps BTU s Engineer Humor

19 Hat # 6 Specialty Areas Lighting, Low-Voltage, IT, ADA, Food Service and Others Common Questions Network Remote Monitoring EMR Bridging the Gap : What is an Equipment Planner

20 Equipment Planning Integration Programming Size and Trends Initial List and Budget Validate Budget - Budgetary Pricing Department Meetings Desire vs. Need; Function vs. Flex Equipment Planning Integration Specification Development Design vs. Performance Specs Architectural Coordination Collaboration with Architect/MEPS Code Issues

21 Lack of Coordination Equipment Planning Integration Final Submittal and Sign-Off Owner Authorization to Procure Government Submittal Code Compliance OSHPD Construction RFIs Connection Anchorage Punch

22 Successful Completion The Owner s Perspective Stephen Brigham

23 Learning Objectives What defines a successful project? What do owners look for when selecting a team? What are owner s expectations from a team? Tucson, Arizona Arizona s academic medical center Sole trauma center for Southern Arizona

24 Tucson, Arizona Arizona s academic medical center Sole trauma center for Southern Arizona 2 hospitals 68 properties 31 clinics 8 guest lodging units 2 million square feet of buildings 1,000 projects / work requests per year $27 M per year in projects What do owners look for when selecting a team? Who will I work with? Who is on the real team? Qualifications - can they do the job? Will this be a difficult relationship? What added value will this team bring? Does the team have special knowledge to bring to the project? Is the team local?

25 What do owners look for How will the project be done? Communication style and techniques? How will user input be managed? How does construction get managed (quality control / design intent review)? How do you assist the owner manage their process? How are projects closed out? Marketing tip #1 I can not eat that many lunches Consider an educational work session for the owner s staff Bring value to a meeting Time is valuable!

26 What are owner s expectations from a team? Architects / Engineers: Highly skilled and experienced project team who can talk with a sophisticated client. Current understanding of guidelines, codes, clinical practices, latest trends, and major equipment. Flawless documents NO EXTRA COSTS! What are owner s expectations from a team? Contractors / vendors: Highly skilled and experienced project team who can manage complex projects in a functioning facility. Current understanding of guidelines, codes, clinical practices, and major equipment. Quality control NO CHANGE ORDERS!

27 Marketing tip #2 the proposal Is it a book? The proposal or a tool to work with? $ x,yzx $ x,yzx $ x,yzx $ x,yzx or a tool to help make decisions?

28 What defines a successful project? An owner with lots of money, time, and quality!? Consider what healthcare organizations are trying to do the triple aim 1. Care for patients 2. Improve healthcare delivery 3. Cost containment What can YOU do to help the owners achieve this? Relationship of Trade-Offs Quality/ Scope Time Cost

29 Ideal Relationship Excellent quality Fast Cheap Normal Relationship I want the absolute BEST Is it done yet? Sorry I don t have $$

30 What defines a successful project? Failure = unmet expectations Success = expectations ARE met!! 1. Project scope completed to everyone s satisfaction 2. Project opened on time 3. Project was completed under budget TOTAL project budget! 4. Project was satisfactorily closed out with ALL parties. Marketing tip #3 What does a healthcare owner really need! Studies? Drawings? Tools to help make the best decisions! Projects that work!

31 Marketing tip #3 - EXAMPLE BIM? / Revit? Great for the project team, but Will they help solve owner problems? As-builts Space data Facilities management tools The Owner s Perspective I Questions?

32 Project Delivery Methods Jim Rossmeissl Learning Objectives What are the various construction delivery methods? What are the positives / negatives of these delivery methods?

33 Our Current Reality Construction productivity has declined since 1964! Our Current Reality Manufacturing Construction Wasted time is out of control! Waste Productive 12% Time Productive Time 88% Waste Productive Time Waste 43% 57% Waste 57% Productive Time 12% Source: Construction Industry Institute 2004

34 How Did We Get Here? Contractor Architect MASTER BUILDER Required Knowledge Engineer Owner Buildings Less Sophisticated Required Less Specialization Information Flow Was Efficient Conventional Project Delivery Design/Bid/Build Design/Build Variations Construction Management As Agent At Risk

35 Design/Bid/Build Delivery Method Pros Familiar delivery method Defined project scope then bid Single point of responsibility for construction Open, aggressive bidding Cons No design phase assistance Longer schedule duration sequential not concurrent Price not established until bidding is complete Adversarial relationship Lack of flexibility for change/change orders Best Suited New projects that are not schedule sensitive nor subject to potential change/not complex Least Suited Complex projects that are sequence or schedule sensitive; projects subject to potential change Design/Build Delivery Method Pros Single point of responsibility for design and construction Faster delivery Team concept Cons Loss of check and balance More difficult for owner to manage Best Suited New or renovation projects that are schedule sensitive Least Suited Projects that are difficult to define

36 Construction Management At-Risk Pros Selection flexibility Design phase assistance Single point of responsibility for construction Team concept Faster delivery schedule Change flexibility Cons Process is not well defined Difficult for owner to evaluate GMP (scope) Best Suited Larger new or renovation projects that are schedule sensitive, difficult to define, or subject to change Least Suited Smaller less complex projects More About Design/Bid/Build Construction Management

37 Schedule Comparison Design/Bid/Build vs. Construction Management Design/Bid/Build Occupy Construction Management Time Saved Occupy Risk Comparison Design/Bid/Build vs. Construction Management Sub Sub Design/Bid/Build Owner Sub Sub General Contractor Overhead Profit Sub Sub Schematic Design Design Development Working Drawings Bid Construction Architect Construction Management CM Schematic Design Design Development Working Drawings Owner GMP CM Architect Construction Budget Monitor Cost & Schedule Sub Sub Sub Construction Time Saved

38 Value is dependent on A/E only (no professional construction input) Project Delivery Value Comparison D/B/B Competitive Bid Static No checks and balances No contractual cost input No VE or CA Process is is sequential Design Phase Construction Management With Competitive Bids Dynamic Accountable SPC to GMP Value enhancement Concurrent process Value added General contractor success is key driver Site work Concrete Steel Precast Mechanical Electrical Etc. Divisions of Work Construction Phase Site work Concrete Steel Precast Mechanical Electrical Etc. Divisions of Work Team orientation All bid to or by GC GC markup 1-3% fee All bid to CM CM fee 1-3% Competitively Bid No Value Added 1-3% Profit (average) for GC Competitively Bid Value Added 1-3% Fee (average) for CM Project Delivery Value Comparison The markup for a General Contractor is approximately equal to the Construction Manager fee. SUMMARY

39 Integrated Lean Project Delivery (ILPD) The ILPD approach leverages the talents of the entire project team. This process maximizes value and eliminates waste while aligning the team with a single set of project goals and promotes the open sharing of information and expertise. AE Owner CM/GC Delivery Method Evaluation Design/Bid/Build Design/Build Construction Management Integrated Project Delivery CM IPD D/B/B and D/B

40 Integrated Project Delivery Doug Mangers Learning Objectives What is Integrated Project Delivery? What are the positives / negatives of this technology?

41 Integrated Project Delivery Integrated Project Delivery (IPD) is a project delivery approach that integrates people, systems, business structures and practices into a process that collaboratively harnesses the talents and insights of all participants to reduce waste and optimize efficiency through all phases of design, fabrication and construction. Perceived Positives of IPD Increased collaboration Increased team efficiency/reduced waste Lean Cost and schedule certainty based on earlier decision making Shared risk and reward

42 Perceived Negatives of IPD Relational contracts new and untested Insurance concerns related to new contracts Earlier decision making Shared risk and reward Children s Hospital Colorado Case Study

43 Children s Hospital Colorado Original Hospital Designed & Built $412M Construction Cost 1.5M SF + 2 parking garages + sitework New hospital on 44 acre green field site H+L and ZGF AIA B141 Contract Phipps/McCarthy AIA 121 Contract East Tower Addition & Renovations Designed and Built $150M Construction Cost $235M Total Project Cost 350,000 SF new / 100,000 SF reno New 10 story East Tower plus renovations Consensus docs 300 Tri-Party Agreement Why a Tri-Party Agreement? Goals Complete the project on budget Complete the project on schedule Create a team atmosphere Ensure project success was tied to each other Create open communication Encourage transparent communication Encourage joint problem solving Share in the risk and reward

44 Contract Negotiations Timeline Terms and Conditions - Sticking Points ZGF relationship to Tri-Party members Contingency definition and closeout Clarification of design fees Professional liability insurance Design team specific scope of service Risk allocation provisions Contingency Insurance Shared losses provision Negligence?

45 Financial Negotiations Timeline (Amendment 1 - PTCE) Construction PTCE Program Estimate 03/05/10 $144,668,794 SD Estimate 06/03/2010 $145,179,039 $173,385,625 DD Estimate 11/30/2010 $135,616,377 $159,536,069 Final PTCE 06/27/2011 $137,733,104 $153,761,744 Value Analysis Contingency value adjustments Scope reconciliation and change order incorporation Alternate acceptance Progress of buyout Shared Risk and Reward A portion of the total contingency is set as the maximum risk/reward bucket funds left at the conclusion of the project are shared 50/50 between owner and design/construction team Total contingency spent is tracked monthly Two years in to a three year project status?

46 Other Results Technology - Use of Building Information Modeling (BIM) Schedule have we made quicker solutions Behaviors are they really changing? Discussion The Architect as Team Leader Equipment The Owners Perspective Project Delivery Method Integrated Project Delivery Susan Black Tony Frietas Stephen Brigham Jim Rossmeissl Doug Mangers