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Ryan Felton, Project DirectorVirgil Pope, Superintendent

NHA Conference October 2018

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Mercy Hospital Joplin: Before, During & After Construction• Nebraska Society of Healthcare Engineering• October 2018

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Presenters

• Ryan Felton, Project Director, McCarthy Building Companies, Inc.

• Virgil Pope, Superintendent, McCarthy Building Companies, Inc.

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Learning Objectives

1. Recognize the elements and conditions of the cohesive relationship among the team members that lead to a successful project. Implemented design/build principles, but contracted CM at Risk.

2. Identify the lean principles/strategies that were used to deliver the project on time and on budget.

3. Investigate how alternate delivery methods including design-assist and co-location can be successful.

4. Discuss the importance of disaster planning and how the new facility has been designed to withstand future storms.

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• Add video here

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St. John’s Pre-Tornado

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Mercy Joplin Pre-Tornado Status

• 114-acre campus

• 600,000 sf, 370-bed hospital

• 160,000 sf of connected medical office buildings

• Daycare center

• Foundation building

• Ground shop

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The Disaster

• Time: Sunday, May 22, 2011, 5:41 pm

• Hospital Patients: 183 inpatients, including 25 ED patients

• Co-Workers: 117 working at the hospital

• Impact: EF5 tornado with 200 mph winds, 13 miles long, 1-mile wide band of complete destruction, 161 fatalities, approximately 8,000 homes damaged/destroyed

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Impact on St. John’s

• Direct hit

• Windows and walls blown out

• Portions of roof pulled off

• Building infrastructure severely damaged

• Generators destroyed

• All communication lost

• Water, sprinkler, gas and sewer pipes disrupted

• Liquid O2 tanks damaged

• Massive debris throughout building

• 86 medical staff member offices destroyed

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Mercy’s Promise to Rebuild

• Maintain healthcare services to the Joplin community

• Maintain employment

• Enhance healthcare services in the area

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Three Steps for Hospital Services

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Mercy Joplin Replacement Hospital

• $465 million project; $345 million construction

• 890,000 sf; 260+ beds

• CM at Risk Agreement

• Design/Assist Subcontractors• Mechanical: US Engineering• Electrical: Guarantee/ Hunt JV

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Mercy’s Partnership Selection

• A proven team that had previously worked together!

• A common purpose

• Complete trust in each other

• All members checked egos/agenda at the door

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Project Challenges

• Design Schedule

• Cost control

• Labor availability

• Schedule

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How to Meet this Fast-Tracked Schedule

Program: 5 monthsDesign: 12 monthsConstruction: 36 monthsMove-in: 3 months

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Empowered Core Team

• Defined and clearly understood expectations

• Developed weekly work flow

• Developed schedules

• Ensured decision makers present

• Created a strong/working/trusting culture

• Enabled team members to do their job

• Red/green light decision tracker

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Team Communication

• Transparent communication

• Weekly face-to-face meetings

• Weekly project leadership coordination

• Weekly design/user meetings

• No silos

PROJECT

Architect

Contractor

Design Assist / Sub-

ContractorsOwner

Architect’s Consultants

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Program, Pre-Design and Planning

Pre-Design

• Vision set by system leadership

• Design infrastructure

• Established system guidelines

• Established departmental adjacencies

• Early contractor pricing

Schematic Design and Design Development

• Multiple integrated design teams, on-site frequently

• Frequent local leadership meetings with system involvement

• System templates: departmental flow diagrams

• In-place mock-ups: tours of existing facilities within system

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Work Plan/Bid Packaging Plan

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Design: Hardening Components

Site

• Underground utilities / utility tunnel

• Bunkered CEP

• Infrastructure protected below grade in Lower Level

• Partial below grade protection at Level 01

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Design: Hardening Components

Central Energy Plant

• Bunkered CEP

• Harden CEP Exterior

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Design: Hardening Components

Windows

• Laminated glazing is the minimum strength glazing provided throughout the exterior

• 140 mph impact resistant glazing at tower connecting bridge

• Precast embeds fastened to curtain wall system

250 mph window tag for fire dept

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Design: Hardening Components

Stairwells

• Heavy gauge steel studs and layered impact resistive gypsum board with increased fastening and offset seams at primary egress stairs

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Design: Hardening Components

Compartments

• Upgraded cross-corridor doors & hardware

• Disaster supply storage cabinets are located at each nursing unit for slide boards, flashlights and shovels

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Design: Hardening Components

Entrances

• Impact hurricane doors at all external doors including sliding auto doors

• 140 mph impact resistant glazing at ED

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Design: Hardening Components

Penthouses

• Composite concrete metal deck roof with hot mop insulation on deck

• AHU penthouse units anchors are structurally designed to withstand high uplift conditions

• Exterior penthouse enclosure designed to meet Miami-Dade building code

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Design/Assist MEP Subcontractors

• Selection process

• Truly integrated design team

• Benefits

• Challenges

• Making a connection

• Team building is just as important as the dollars

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Co-Location

• Dedicated resources – decision to meet the need

• Everyone understood the job going in

• Felt ownership of the design

Use technology to create a virtual

environment for project team members to share

Create a physical space in which all team members are based, as their sole place of work for the duration of a project

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Co-Location Tools

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Why Integrate Technology?

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BIM/Coordination/Technology• Cloud-based software

• Secure central exchange for project information

• Enhances team collaboration

• Shop drawing process

• Supports BIM workflows

• BIM 360 usage

• Kiosk stations

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Real Time Estimating / Target Value Design

Updated Estimate Weekly

• Everyone on the team was aware

• Reporting on actual costs as well as estimated costs

• Past procured, being procured and going to be procured

• Lock in as much as possible while still having so many unknowns

• Trend analysis log

Model based estimating helps generate quantity take-offs and assist in the

creation of cost estimates

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Estimate Trends

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Prefabrication

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Mechanical Prefabrication

• Procured off-site warehouse• Multi Trade Headwall

prefabrication

• In-wall plumbing and med-gas assemblies

• Electrical

• Mechanical

• Plumbing

• Piping

• Sheet Metal

• Metrics:• Critical fab in Kansas City

• 1.2 million lbs of ductwork

• 7,000 grilles

• 476,244 linear feet of system piping

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Electrical Fabrication

• Conduit Bends

• Box Assemblies

• Voice/Data Drops

PreFab items are quantified from the model, made in the most efficient manner possible and then ready to install once space is ready

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Mock-ups

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Best Practices

• Fostered an integrated culture –challenged each team member to “improve the process”

• Transparent communication

• Strong trustworthy partners/teamwork

• Developed and bought into weekly work flow schedule

• Early involvement with local city/state officials – expedited approvals, involvement in the project

• Real time estimating

• Quarterly partnering meetings/constructive criticism

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Lessons Learned

• AFA – Always Flexible and Adaptable

• Dynamic value analysis process (don’t wait until its on paper)

• Medical equipment selection

• BIM expectations

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Promise Fulfilled

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Exterior

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Lobby

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Patient and Family Areas

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Amenities

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Caregiver Stations

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Patient Care

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QUESTIONS?