Capital Project Solutions – February 2012
Are You Ready To Sail Your Ship: Top Budget and Schedule Considerations When Undertaking an Existing Campus Revitalization
David Vollmer, Senior Consultant “I'm not afraid of storms, for I am learning to sail my ship.” Aeschylus A large healthcare capital construction project can be challenging and create a storm of information. Once an Owner commits to undertaking a major Campus Revitalization Project, there are many issues that must be balanced in order to successfully deliver the new facility on time and within budget. This month’s issue of Capital Project Solutions will analyze the causal relationship that major issues may have on the Owner’s ability to effectively manage the project. Regulatory Approval Process Once a Launch Gap Analysis has been conducted and the Master Facility Plan, Project Vision and Guiding Principles have been developed, the Owner can move forward with the Regulatory Approval Process. After setting the basic structure for the project, the Owner must then determine the necessary jurisdictional approvals. In addition to the local approvals, many states also require a Certificate of Need (CON). Once the necessary approvals have been identified, they must be worked into both the project schedule and budget. Timing is a critical factor and if not managed properly can play havoc on the schedule. Clearly identify which approvals are prerequisites to others as well as what aspects of the project must be completed in advance. It is likely that some aspects of the project can completed in parallel. In addition, it is extremely important to have a fully evaluated budget that quantifies exposures. Take the time to conduct a thorough review of the existing infrastructure services. Capacity upgrades and coordination with the local service providers may be necessary which will take considerable time and can be costly. In the event that a project moves forward to quickly, an Owner will likely find further delays and increased costs due to change orders and resubmission for new designs. Community Involvement When coordinating the overall approval process, do not underestimate the impact of community involvement. A hospital is an integral part of its 1
Capital Project Solutions – February 2012
community and the surrounding areas. As a hospital grows, it can often become larger than intended and impact the surrounding areas. This impact can come in many forms: Building Size Light Pollution Noise Pollution Traffic Due to these factors, it is imperative for hospitals to maintain good community relations, even in cases where no large projects are planned. A great way to begin the communication process is to have a Community Advocate. Once a hospital project is planned, the Advocate should meet with residents to solicit their input and share information such as: Project Intent Size Location Services Offered Amenities Process Updates Traffic Patterns and Delays Noise Issues Community Impact During and After Construction Parking The community can either aid or hinder Regulatory Approvals. A perfect example is parking. For a hospital struggling with a land locked site that has limited options for parking, residents need to be informed as to the potential impact. Develop a plan to address contractor, employee, patient and community parking. Be sure to factor this into your Master Program Budget. An offsite parking scenario, for employees or contractors, can become very expensive and should be appropriately evaluated. Proactively addressing potential issues and communicating a plan of action, will assist in gaining community support for the project. Construction Process and Scheduling In creating the overall Master Facilities Plan, there is more to consideration then just the building location, massing and connectivity to the existing facilities. The phasing of the project can have a domino effect on service lines, impact the cost and alter the timing of construction itself. Some of the questions that must be answered early on are as follows: Are there limitations to staging material on-site? How does construction traffic impact patient and visitor access along with daily hospital deliveries? Is there any interference with emergency services? 2
Capital Project Solutions – February 2012
In addition, time must be allocated to investigate the subsurface area that is to be disturbed. This includes environmental testing, utility location and geotechnical reviews. Existing soil may contain hazardous materials, abandoned utility lines, construction debris or undocumented fill that could have negative impacts on the construction process. Identify all unknowns and proactively manage issues well ahead of design completion as they may dramatically influence the location and foundation costs as well as the permitting process. The exterior impact is only half the battle when connecting to an existing facility. When establishing construction phasing, evaluate the need to shutdown active corridors and the impact it may have on adjacent departments and services. This would include Code Blue teams, Trauma teams, ICU transports, dietary deliveries, etc. The development of the contractor schedule should be fully reviewed with the clinical departments. Noise and vibration tends to travel and can impact sensitive instruments, effect on-going procedures and disrupt patients. Set realistic expectations on the construction process and work hours. Open and clear communication will ensure that the highest level of staff and patient satisfaction is maintained. The effectiveness of the construction process inside / adjacent to an existing facility is directly correlated to the understanding of the existing conditions by the Design Team and that these are properly translated to the Construction Documents. It is important to identify and show on the drawings how much of the existing conditions will be corrected as well as where finishes and upgrades will stop. Updated building codes may require correction to deficiencies in fire rating of existing walls and doors, replacement of existing mechanical systems that are not part of the project, replacement of ceiling tiles adjacent to the work areas and flooring tie-ins. The boundary lines need to be strictly outlined, properly coordinated, and considered during the budgeting process. Beyond aesthetics infrastructure work and tie-ins to existing services must be reviewed. This would include emergency and normal power; steam, medical gas, sanitary, domestic water (hot & cold loops), heating hot water, nurse call systems, network infrastructure. Review of the existing MEP and telecom utilities is very critical during the construction means and method planning. If at all possible, the design team and the contractor should locate all isolation 3
Capital Project Solutions – February 2012
valves, zone valves and identify what risers serve which areas of the hospital, including low voltage systems. For example, the loss of domestic water to a unit can have a tremendous impact on potable water for ingestion, hand washing and toilet/ shower operations. The inability to phase or isolate areas for work may require temporary provisions and can result in extended shutdowns in clinical operations, increased operational costs, lost revenue. Infection control is a huge aspect of a renovation / expansion project and can greatly impact the schedule. It is critical that all team members are fully aware of the risk level to areas adjacent to the construction site. It is also extremely important to understand the infection control department’s interpretation of the hospital policy regarding construction adjacent to certain service lines. Delivery and removal routes through the occupied sections of the hospital as well as work above and below occupied areas must be taken into account. The ability to gain access to an occupied space below the construction site can be hindered by the time of year or patient census. Allocate appropriate time to account for service lines that may need to be temporarily relocated or displaced. The construction schedule should indicate ideal building times and account for afterhours work that may be necessary. Owner Directed Changes Once the design has been established and the User process completed, it is the Owner’s responsibility to make as few changes as possible. Any changes made at this point can be costly and delay the project. Ultimately, it would be ideal if hospital leadership would agree that no changes can be made during construction and for a short period after occupancy. The use of mockups and 3-D renderings during design can ensure that clinical staff is able to visualize the end product and determine if the design will function to meet their needs. Additional planning and contingency allocation for appropriate changes can be accommodated and will more than likely reside in Medical or Technology Equipment modifications.
As the planning and associated construction for
facility upgrades can take place three to five years in advance, the rapidly changing technologies should be planned in as flexible a fashion as possible to allow the Owner to open a new facility that is competitive and timely. Conclusion Time spent evaluating exposures and uncertainty in the project scope, will allow the Owner to accommodate most issues that may be encountered during a Campus Revitalization project. This investment will pay dividends and help to ensure that the project achieves its vision on time and within budget. 4