December 2019 – HCA Healthcare

BLOX components delivery and installation scope

Leave a Comment / Construction, Prefabrication

Facility name: Lake Nona Hospital

Project name: Lake Nona-102018M- New Hospital
Location: TALLAHASSEE, FL
Project classification: Hospital – New
Project type: Acute Care
Project number: 2689500001
Lesson Learned number: 39
Impact: Cost, Schedule, Scope

Lesson Learned/Best Practice

A scope gap was identified where labor was not bought out to collect, palletize and load BLOX headwall racks, panelized bathroom racks, rigging gear and mover jacks onto long haul shipping trailers contracted directly with BLOX.

Ensure BLOX install foreman/subcontractor leadership responsible for loading BLOX hardware/equipment discussed project strategy at BLOX kickoff meeting on site to avoid confusion when BLOX install is complete in an area, phase, floor or project and hardware needs to be returned to BLOX facility in AL.

Ensure the specific phasing of BLOX delivery AND installation (if those two activities do not run finish-to-start) is reviewed in detail during the BLOX pre-mobilization meeting held on site.

Suggested Actions for Future Projects

Update BLOX install playbook to identify this scope responsibility and assign it to the GC to buyout with BLOX component installation.

On future projects, the BLOX install playbook should clearly identify that scope responsibility and the GC should ensure that labor responsibility is included with the installation of the BLOX components.

Communication with specific department leadership/staff regarding construction schedule

Leave a Comment / Construction, Facility Operations Impact

Facility name: Methodist Hospital

Project name: METHOS-102013P4-ED Renovation
Location: San Antonio, TX
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3938500016
Lesson Learned number: 38
Impact: Schedule

Lesson Learned/Best Practice

There was a 1 week delay to construction activities during the first week because the ED department was not ready to vacate some rooms. This will be avoided in the future by integrating specific department staff in schedule conversations further in advance.

Suggested Actions for Future Projects

Specific departments should be contacted directly to coordinate construction activities after coordinating with the DPO or construction manager of the facility. Ensure regular communication with department leadership as part of construction updates.

Wood-door manufacturer

Method of Procedures review with facility personnel

Leave a Comment / Construction, Constructability (means & methods)

Facility name: Memorial Health UMC Savannah

Project name: MEMSAV-092018M-3rd and 4th Floor Shell Buildout
Location: SAVANNAH, GA
Project classification: Hospital – Shell Buildout
Project type: Acute Care
Project number: 2696000011
Lesson Learned number: 36
Impact: Cost, Schedule, Quality, Scope

Lesson Learned/Best Practice

When working within active facilities which may have been altered from the original construction documents following construction completion or during construction without being properly as-built; implement and maintain a thorough Method of Procedures to be reviewed by contractors and facility partners alike prior to any work taking place. It is extremely important that seasoned facility workers be involved in planning, with a working knowledge of any changes that may have taken place within the building, to maintain operation throughout the years.

Submit Method of Procedures within a timely manner, giving adequate time to rehearse walk-through’s prior to activities taking place, and follow up with after action reviews discussing elements which can be improved upon or sustained.

Suggested Actions for Future Projects

Work closely with knowledgeable facility partners/subcontractors and rehearse activities in sequence or conduct “dry runs” prior to construction efforts taking placing utilizing reviewed and approved MOP’s. Adjust MOP’s following the “dry run” and implement changes which need to take place prior to performing the actual work effort.

Existing room dimensions verification

Leave a Comment / Construction, Constructability (means & methods)

Facility name: Doctors Hospital Of Augusta

Project name: DOCAUG-112017M-New Tower(Surgery Expansion)
Location: AUGUSTA, GA
Project classification: Hospital – Vertical Expansion
Project type: Acute Care
Project number: 3100300014
Lesson Learned number: 35
Impact: Cost, Schedule, Scope

Lesson Learned/Best Practice

1. Design team to field verify existing room dimensions at new building to existing building tie-in locations and GC to confirm dimensions on existing room as early as possible by conducting field measurements as soon as possible. The accuracy of as-built dimensions should not be assumed and all as-builts should be field verified.
2. During phasing discussions, portions of the facility which would be preferred to remain in operation should have plans in place in case unforeseen field conditions dictate the preferred portions need to be relocated/ taken out of operation.

Suggested Actions for Future Projects

Confirm dimensions of existing rooms at exterior walls focusing on locations of building tie-ins for future construction. Possibly develop plan early to relocate existing specialty rooms to other locations in the facility if feasible. Facility should maintain up-to-date as-built drawings and field verify for confirmation.

Target Value Delivery Log

Leave a Comment / Design, Construction, Other category

Facility name: Menorah Medical Center

Project name: MENORA-092018M-Bed Tower Expansion
Location: OVERLAND PARK, KS
Project classification: Hospital – Horizontal Expansion
Project type: Acute Care
Project number: 0972300007
Lesson Learned number: 34
Impact: Cost

Lesson Learned/Best Practice

The target value delivery (TVD) log was helpful to track decisions on an Early Design Involvement (EDI) project.

Suggested Actions for Future Projects

Continue TVD logs but stick with decisions once they’re made.

Continuous focus on cost and schedule impact of decisions in Early Design Involvement (EDI) project

Leave a Comment / Design, Other category

Facility name: Menorah Medical Center

Lesson Learned/Best Practice

Pricing throughout design process helped keep everyone on track. Considered cost & schedule impacts of each item or decision and developed a consensus about whether it made sense for the project

Suggested Actions for Future Projects

Include more stopping points to summarize each trades budget to evaluate the cost and look at reducing large cost items and allowing the design team to make sure all items are included

Early trade partner on-boarding in Early Design Involvement (EDI) project

Leave a Comment / Design, Other category

Facility name: Menorah Medical Center

Lesson Learned/Best Practice

Starting the project with A/E/GC on board and interviewing major trades as a team seemed to work very well in terms of entire team buy-in and creating collaborative culture on a Early Design Involvement (EDI) project.

Bring on Steel and Exterior Skin earlier; Elevators early was a big win; Ptube was unnecessary to bring on early; evaluate the p-tube system early to determine extent of EDI involvement needed

Suggested Actions for Future Projects

Mid-SD/end of SD seems like the optimal time to get trade partners on board to get maximum input and not waste time; Replicate this approach in the future

Big Room meetings on Early Design Involvement (EDI) projects

Leave a Comment / Design, Other category

Facility name: Menorah Medical Center

Lesson Learned/Best Practice

Hold monthly Big Rooms with conference call check-ins between; Cluster groups and Big Room meetings alternate every two weeks; The right people need to be in person at Big Room meetings; Big Room meeting monthly; WebEx every other week.

3-week cadence of big room meetings was too frequent and conflicted w/ user meetings; date and time of Big Room meetings did not align with other project meeting schedules causing meeting conflicts, wasted time, and all necessary participants to be present.

Breakout work session at end of big room conflicted with travel schedules and was a more difficult engagement at the end of the day. Moving to earlier in the day or before worked well.

Suggested Actions for Future Projects

Early Design Involvement (EDI) team transition from design to construction

Leave a Comment / Design, Other category

Facility name: Menorah Medical Center

Lesson Learned/Best Practice

Begin the transition earlier in the design process or incorporate more field personnel earlier in the design process if available; Beneficial for trade partner field staff (foremen) to be involved early in page turn/quality pauses; conduct quality pause/Big Room at location to allow field staff to attend more frequently when cluster groups start meeting (during DD).

Suggested Actions for Future Projects