By Kimberly Bonvissuto / Special to Healthcare Facilities Today

In 2008, St. Jude Medical Center Hospital in Fullerton, Calif., assembled a team to build an energy efficient patient care tower.

The project came with a wish list that included an energy efficient facility that met all state and local requirements, including the state’s seismic laws and strict air quality requirements.

The design-build team spent about eight months working on a plan to replace the existing tower. But it became apparent that the planned site had significant logistical and cost issues. So the project was shifted to another site on campus.

And then the challenges really began.

An aggressive plan

The St. Jude’s project called for a four-story, 197,000-square-foot, state-of-the-art patient care tower and a 14,000-square-foot central utility plant. And they wanted it completed within the original deadlines.

“Although there was an election to change the site, we still had to conform to original deadlines,” said Neal Rinella, principal with Taylor Design. “That created a need to really create a very aggressive approach to how to deliver the project.”

While the revised location was a better fit, it was a tight construction site with an existing hospital on two sides of the project, and a loading dock in the center of the project that could never shut down. Andrew Carpenter, Southland Industries’ project manager, said deliveries had to go right through the heart of the construction site all day, meaning there was no lay down area.

The design team, general contractor, key sub-contractors, inspectors and the construction management team shared a common office space that allowed for challenges and issues to be addressed expediently, according to Robert Noonan, St. Jude director of engineering, and Glen Wakabayashi, director of construction at Petra ICS.

Carpenter said equipment, materials and trades were scheduled meticulously. Crews had a 30-minute window to get everything from tuck to floor, which required the trucks to be on time, and prefabricated pieces had to be installed as they were delivered. Carpenter said almost everything was prefab – medical zone valve boxes, mechanical, ductwork, plumbing – so it could go from the shop to installation.

“We staggered everything so we were not bogging down the loading area,” Carpenter said. “It took a lot of planning.

 “The inspector for the medical gas systems came to the shop and inspected everything in the shop so we could directly ship it to the project. We tried to prefab everything we could. As soon as you wait on materials, you’ve got an empty hand.”

Teamwork

The St. Jude Medical Center Northwest Tower project – completed in 2014 – incorporated a combination of Integrated Project Delivery (IPD) and Building Information Management (BIM) 3D, 4D and 5D, as well as pre-fabrication, to lower the overall design and construction costs and comply with safety, budget, design, facility satisfaction, quality and schedule requirements.

Rinella said the teams, protocols, values and emissions were set up to simulate the best attributes of an IPD project. That meant bringing all the right people together at the right time and establishing protocols that led to an incredibly successful project.

“We established a value system modeled on trust, respect, team building and flexibility,” Rinella said. “That went hand-in-hand with promoting an environment of innovation.”

Working with an aggressive schedule, the challenge was having to fast track structural design before the team had a program designed into the floor plans and uses. A structural grid was established to start working out floor plans that Southland and systems experts worked toward to size equipment at the central plant.

“What we had to do was create room templates using several vehicles to put definition to what was going inside the building,” Rinella said.

Integrated cloud-based collaboration tools through Bluebeam Software brought the entire design team together from the very beginning of the project to best address onsite logistics and manage the sequencing for different phases of construction.

An electronic plan room was used early in the process and included information on coordinated models, schedules, interactive virtual mock-ups, live quality control punch lists, exterior and in-wall coordination, and interior build-out and interference wall plans. Because the information was available in the cloud, it was shared with sub-contractors and designers, giving the entire project team immediate access to live information.

“We tied the virtual wok through visualization to the development of construction documents,” Rinella said. “It was hand-in-hand development. The users always had something they were able to refer to to know and understand what their experiences would be before it was built.”

Glen Wakabayashi, Petra, said these tools had a positive benefit to the overall project, its schedule and cost success.

“With the level of planning and coordination that occurred, starting during design and in conjunction with the use of this delivery method and technology, we were able to avoid many of the conflicts that traditionally occur during the course of construction,” Wakabayashi said. “This was especially true during the construction of the building infrastructure and systems.”

Energy efficiency

The new tower incorporates environmentally friendly features, including an energy-efficient building envelope with high performance window glazing, sunshading, and insulated walls and roof.

Two years later, the mechanical, plumbing and control systems are performing as designed.  As with any system, there are adjustments that need to be made to the system due to factors such as weather or temperature change, but facilities staff are well educated on how to manage the overall system and its function and capabilities. Overall we have received very few complaints regarding the Northwest Tower from our patients or staff assigned to this building. 

A key feature of the mechanical systems is an HVAC system with heat recovery designed to utilize 100 percent outside air for improved indoor air quality and infection control. The recovery loop allows the tower to be served by only four air handling units.

Matt Volgyi, principal engineer at Southland, said the system eliminates the possibility of infectious agents circulating in the area to be brought back into the hospital. The design will make future remodels significantly easier.

“It really provided a lot of flexibility on the design that was very important,” Volgyi said. “A lot of it had to do with the design aspect and advances that hadn’t been done in the past.”

Cost savings

Carpenter said a significant portion of the cost savings on the project -- $1 million – came in labor costs.

“The real schedule savings came down to the advancements we made in delivery and prefabrication so no one was ever waiting around for anything,” Carpenter said.

Wakabayashi added relocating all inpatient care and key clinical and support services form the two oldest buildings on caput reduced use and dependence on the older central plant equipment.

The result of this collaboration and energy efficient was a $225 million project completed ahead of schedule and $2 million under budget.

The 120-bed Northwest Tower has 14 leading-edge surgical suites, including a neurological suite that was the first in the state to bring together digital intraoperative magnetic resonance imaging (iMRI) with sophisticated new surgical navigation, visualization and information capabilities. Other features include a hybrid cardiovascular suite; a pre-op/post-op anesthesia care unit; dining; pharmacy, including robotics; sterile processing; physician and staff lounges; and healing gardens.

Carpenter said the fact that Southland was involved as an integral part of the design team from the start enabled them to design what the end users wanted and provide realistic costs.

“The fact that we were brought on so early, we were able to develop with key individuals of St. Judge and ultimately deliver the project early and under budget,” Carpenter said. “That doesn’t happen all the time.”