Embracing the Integrated Project Delivery (IPD) approach, KPFF and its trade partners contractually bound themselves together to expand the Fairfax Hospital in Kirkland, Washington, adding 68 new beds for this private behavioral health facility. The team’s “conditions of satisfaction” set the stage for how they would measure and deliver success.
From the first meeting in the project Big Room, to the last vestiges of construction in the field, team members relied upon each other to predictably meet commitments, bring forward innovative ideas, and challenge the status quo. KPFF and our trade partners delivered success through:
Sharing the risk –“Pure” IPD
In what might be the first of its kind in Washington State, trade partners contractually agreed to share the project risk and reward. The owner, builder, architect, structural engineer, civil engineer, and several other key team members all signed the multi-party Consensus Document contract, committing to a successful delivery, and sharing the risk and reward. Other projects in Washington have used an ‘umbrella’ agreement which overlays the traditional contracting relationships. But for this hospital expansion, the team collectively defined success, set the target construction cost, quantified the financial risk and reward for each company, and signed up to deliver.
Setting the Program – the early planning process
One interesting aspect about the ownership is there were two ownership organizations that were represented throughout the project. Fairfax, founded in the 1930’s, has served Western Washington for more than 80 years. Fairfax Behavioral Health, is a medium stay facility that operates a 157-bed, standalone psychiatric hospital, in Kirkland, Washington. It is composed of six units providing specialized treatment for mental health and co-occurring disorders. It is the largest private behavioral health hospital in Washington State.
Fairfax, however, operates within the family of Universal Health Services (UHS), one of the largest hospital management companies in the nation. At times, the two ownership groups had differing goals and program pro forma. The intensified early planning process defined the overall program and collective owner’s goals for both this immediate expansion as well as longer term needs.
At the start of the project, KPFF and its trade partners worked through the priorities identified by both ownership groups. Cluster groups were established to explore costs associated with future vertical expansion, on site structured parking, and space for an onsite school. The cluster groups used the A3 decision analysis process (choosing by advantages) to align the goals of Fairfax and UHS.
The hospital needed to stay open throughout construction. Maintain existing operations 24/7 – patient and emergency vehicle access, deliveries, and onsite parking - was crucial for the success of this project. Construction staging and design worked hand in hand to accomplish the short term and long term goals. The stormwater detention used shallow prefabricated chambers to shorten drive lane closure. Alpine rockeries were used to protect site aesthetics while dealing with complex topography.
Transparency – fiscal and process
In the Big Room, the team embraced process transparency, starting each meeting with a ‘dashboard’ review, and closing with a ‘plus/delta’ session. The dashboard review brought forward updates on specific metrics and included a status of each team member’s commitment from the previous meeting. Every team member took a turn running the Big Room meetings, creating the culture of transparency and accountability. Each meeting included cost trending by the builder, so that cost was transparent, and part of the collaborative decision making. When a challenge was daylighted, the team applied the “5 why” root cause analysis process to work through the issue and identify the forward path.
LEAN techniques and Building Information Management (BIM)
Eliminating waste is a core tenant of IPD, and part of the Fairfax team’s decision making process. Major and minor elements were designed for fabrication concepts, minimizing material and time waste. The exterior wall assembly aligned window sizes with siding unit sizes, minimizing material waste and joints. The seismic force resisting system - buckling-restrained-braced-frames (BRBF) - were oriented and laid out in conjunction with the supplier, so that design incorporated the requirements of final assembly and delivery to the site. And, a comprehensive Revit model was shared between designers and builder for an integrated BIM approach.
Pull planning the work
In the project Big Room, the team created and continually refined the schedule, using pull planning. Each team member participated in identifying the milestone, working back to establish the workflow and dependent activities, and to take out any hidden time contingencies. The schedule was organized in ‘swim lanes’ and each trade partner had its own color, so that information could be ascertained easily. Active discussion by trade partners led to buy-in.
In the last 10 years, KPFF has engineered more than 200 hospital, research, laboratory, ambulatory and emergency operation facilities for over 75 healthcare institutions. With an impressive portfolio worth over $5 billion in healthcare facilities in the United States, we understand that a knowledgeable and committed design team provides a competitive edge for healthcare organizations in meeting present and future facilities’ needs.
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