Add a Lesson Learned

Month: January 2020

Equipment Vendor Communication

Facility name: Los Robles Hospital And Medical Center

Project name: LOSROB-042017P2-Imaging Relocation
Location: THOUSAND OAKS, CA
Project classification: Hospital – Horizontal Expansion
Project type: Acute Care
Project number: 3055500036
Lesson Learned number: 66
Impact: Cost


Lesson Learned/Best Practice

Lesson learned here is to create a monthly dialogue with HCA’s Medical Equipment vendors who deliver equipment to the project toward completion.

We found a best practice to be creating somewhat of a “monthly newsletter” that goes out to the vendors with site updates, schedule updates, and progress of the project. This helps create a better dialogue with vendors so they know who they are dealing with and who to ask questions and follow up with. This also creates a streamline service so no delivery is showing up late or early. This will be applied to our projects moving forward.


Suggested Actions for Future Projects

Create a monthly newsletter to equipment vendors with site updates, schedule updates, and progress of the project to improve dialogue with vendors and ensure no delivery shows up too late or early.


Actions Taken / Current Status

A monthly vendor newsletter may be useful on some projects and should be considered when appropriate.  Additionally, for all projects, there should be Medical Equipment vendor coordination calls (separate from OAC meetings) starting 120 days prior to the occupancy date.

Up to date cut sheets from equipment vendors

Facility name: Regional Medical Center Of San Jose

Project name: RMCSAJ-052017M-ASC(OP Surgery)
Location: SAN JOSE, CA
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 0838500026
Lesson Learned number: 65
Impact: Cost, Schedule, Scope


Lesson Learned/Best Practice

OFE data is sometimes out of date, especially in states with lengthy AHJ approval processes (e.g., OSHPD) .  Reach out early to the equipment vendors to make sure that the cut sheets we’re given are still current and correct.


Suggested Actions for Future Projects

Reach out early to the equipment vendors to make sure that the cut sheets we’re given are still current and correct.

Tie-ins to existing hydronic loops

Facility name: Regional Medical Center Of San Jose

Project name: RMCSAJ-052017P1-IP Surgery Dept. Reno
Location: SAN JOSE, CA
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 0838500028
Lesson Learned number: 64
Impact: Cost


Lesson Learned/Best Practice

Subcontractor asked for a change order to bring in a freezing vendor rather than drain the system.  When planning a renovation where we’re tying into existing hydronic loops, mandate freezing the lines at tie-in’s instead of depending on there being isolation valves, in order to avoid draining the loop and losing the glycol and treatment chemical.


Suggested Actions for Future Projects

When planning a renovation where we’re tying into existing hydronic loops, mandate freezing the lines at tie-in’s instead of depending on there being isolation valves, in order to avoid draining the loop and losing the glycol and treatment chemical.

Steel erection and soil conditions

Facility name: Aventura Hospital & Medical Center

Project name: AVENTU-New Tower
Location: AVENTURA, FL
Project classification: Hospital – Vertical Expansion
Project type: Acute Care
Project number: 3092000015
Lesson Learned number: 63
Impact: Schedule, Scope


Lesson Learned/Best Practice

Building in south Florida due to the soil type, the structural columns are set below grade two foot or greater. Due to the weather (mostly rain) we constantly fought to keep the sand from washing down around the columns after they have been cleaned out.


Suggested Actions for Future Projects

Review steel erection plan then get phasing plan set for all columns prior to steel erection beginning. Once work commences set columns, plum column, tighten all bolts, weld washer (as required). Then form up three of four sides, grout all base plates and then finish forming the fourth side. Let steel erection complete so if any pulling is required to connect beams there is play but the columns are formed up so no dirt can wash around prior to concrete pedestals poured.

Set up a coordination meeting with structural steel and concrete subs to layout a phasing plan to dig around, grout base plate, and form up the columns as to avoid have the earth wash back down around the column prior to pouring the column wraps below grade.

Analysis of complete vs. selective demolition

Facility name: Memorial Health UMC Savannah

Project name: MEMSAV-032018M-Children’s Hospital
Location: SAVANNAH, GA
Project classification: Hospital – New & Renovation (Blend)
Project type: Acute Care
Project number: 2696000002
Lesson Learned number: 62
Impact: Cost, Scope


Lesson Learned/Best Practice

During the pre-construction and bidding process, selective demolition and pour back of an existing 4″ slab on grade was priced to account for plumbing and electrical underground systems. The process of selective demolition, as well as trenching for underground MEP systems, resulted in areas of cracked or unusable slab, which required additional demolition and pour back on a T&M basis. This additional work had minimal to no schedule impact, but did have a cost impact as described below.

5,000 SF of selective demolition and pour back was captured in the original scope of work at $17,242. The additional selective demolition and pour back totaled $23,752 for a cumulative scope cost of $41,476. Conversely, complete demolition and pour back of the entire slab (23,453 SF @ $3.55/SF) would total $83,258. While this cost analysis indicates that selective demolition and pour back is the most cost efficient process, we propose that an allowance be captured in the bidding phase to account for cracked and unusable slab following demolition and installation of MEP underground systems. Factoring such an allowance at the bidding phase will allow for competitive pricing to work in the Owner/GC favor, as T&M work may exceed competitive bidding costs.


Suggested Actions for Future Projects

Perform a cost analysis of complete versus selective demolition on existing slab on grades during the design/bidding process, and if selective demolition is found to be most cost efficient (as is the case here), include an allowance for additional selective demolition in the competitive bidding process.

Work around sprinkler systems and other live systems

Facility name: Los Robles Hospital And Medical Center

Project name: LOSROB-042017P2-Imaging Relocation
Location: THOUSAND OAKS, CA
Project classification: Hospital – Horizontal Expansion
Project type: Acute Care
Project number: 3055500036
Lesson Learned number: 61
Impact: Schedule, Quality


Lesson Learned/Best Practice

Working in extremely tight spaces next to live systems, hit Fire Sprinkler head and set system off. This was 100% avoidable.

When contractor is knowingly working in congested spaces around many live systems such as fire sprinkler systems for a period of time, it’s better to request the facility to shutdown the fire sprinkler system to account for the human error and risk of hitting a sprinkler head.


Suggested Actions for Future Projects

Coordinate with facilities to isolate and shutdown fire sprinkler system and go under fire watch.  When contractor is knowingly working in congested spaces around many live systems such as fire sprinkler systems for a period of time, it’s better to request the facility to shutdown the fire sprinkler system to account for the human error and risk of hitting a sprinkler head.


Actions Taken / Current Status

Per Process Improvement Memorandum #1 (see attached), follow best practices for prevention of jobsite incidents.


Related files. Click to view/download.

File 1:
48660ProcessImprovementMemoNo1_JobsiteIncidentsPrevention_5_7_19.pdf

Disruptive construction impact on facilities

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: 60
Impact: Scope


Lesson Learned/Best Practice

There should be effective communication with facility personnel through a consistent process.  The use of a Disruption Notice Permit ensures full understanding and coordination between the construction team and hospital.  The permit acts as an agenda guide to ensure all questions are asked and answered prior to commencement of work.


Suggested Actions for Future Projects

Implement the use of a Disruption Notice Permit or similar process.  Use this or similar method to implement a formal standard process of conveying the extent of disruptive construction activities.  In order to reduce impact to hospital operations, effective communication and joint understanding ensures collaborative success.

BLOX Units – Electrical Issues

Facility name: East Florida Division Office

Project name: DAVHOS-102018M-New Hospital (NOVAMC)
Location: Davie, FL
Project classification: Hospital – New
Project type: Acute Care
Project number: 3597900001
Lesson Learned number: 59
Impact: Cost, Schedule, Quality


Lesson Learned/Best Practice

Make sure BLOX tightens all EMT conduit screws and couplers. Failed electrical inspections because conduit screws and couplers were loose on many units. BLOX is having to bring in multiple electricians to repair onsite.  Need to do a root cause analysis with BLOX and HCA on why their QA/QC process missed this.


Suggested Actions for Future Projects

Improve offsite QA/QC.  Bring in local inspectors early once BLOX units are onsite.


Actions Taken / Current Status

Issue has been addressed by HCA Healthcare with BLOX.  Actions have been taken by BLOX to correct the problem.

Existing Conditions – Sprinkler System

Facility name: St Mark’s Hospital

Project name: STMRKH-032018P1-5th Floor Ortho Renovation
Location: SALT LAKE CITY, UT
Project classification: Hospital – Renovation
Project type: Acute Care
Project number: 3440700014
Lesson Learned number: 58
Impact: Cost


Lesson Learned/Best Practice

Investigate existing conditions as soon as possible.

Where the penthouse sits on the roof of the 5th floor the ceiling steps down roughly 8′ for all of the existing mechanical equipment in the penthouse. This large step in the roof/structure means that when we demo the entire 5th floor and have to turn our sprinkler heads up we will have several location where the ceiling will be nearly 15′ tall which will require additional sprinkler pipe and bracing. This will also need to be coordinated with the other MEP trades.


Suggested Actions for Future Projects

Investigate existing conditions as soon as possible.

Mechanical and civil work coordination

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: 57
Impact: Cost, Schedule


Lesson Learned/Best Practice

It was discovered after (2) 1750 gallon grease interceptors were set and piped in the loading dock drive area that the tops of the precast box structures would be protruding significantly above the designed civil paving grade elevation as a result of the pipe invert elevation specified on the plumbing drawings forcing the grease interceptor structures to be set high.

Coordination between underground plumbing design and civil grading & drainage should be exercised to ensure any specified pipe invert elevation per a plumbing design drawing coordinates with civil grades to ensure structure and pipe coverage is adequate.


Suggested Actions for Future Projects

During a plan review or plan check opportunity with the Early Design Involvement (EDI) contractor team, the plumbing design scope which engages with the civil design scope should be reviewed to confirm the take over point is properly coordinated and specified plumbing or civil structures which must interact or connect between the two design disciplines do not foul or conflict.