Add a Lesson Learned

Fire Suppression (Div 21)

Evolving HCA standards

Facility name: Medical City McKinney

Project name: MCMKNY-102017M-BH & Rehab Relocation
Location: MCKINNEY, TX
Project classification: Hospital – Horizontal Expansion
Project type: Psych
Project number: 3833300011
Lesson Learned number: 148
Impact: Cost


Lesson Learned/Best Practice

With HCA’s ever evolving design standardization there needs to be a fixed point where design is frozen for each specific project. 


Suggested Actions for Future Projects

Document date and version of HCA standards utilized within CD drawing set,  validate HCA standards with planning manger, design manager, HCA engineering and construction manager.


Keywords

HCA Standards, MEP guidlines

Sign-off for Shutdown Process

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: 139
Impact: Quality, Safety, Scope


Lesson Learned/Best Practice

Ensuring that all existing utilities are up and fully functioning after shutdown is complete


Suggested Actions for Future Projects

Add line items on MOP form/paperwork for facility approval and completion of work. Prior to the shutdown occurring walk existing space with facility management personnel and have form signed at the beginning of the shutdown. After the work is complete and GC/sub believe the hospital should be back up and running re-walk all spaces with facility management personnel to confirm and have them sign off on the form saying they have walked and verified that the work is complete

MEP PreAudit

Facility name: North Austin Medical Center

Project name: NRTAUS-022019M-Rehab/Peds Relocation
Location: AUSTIN, TX
Project classification:
Project type: Acute Care
Project number: 0822400025
Lesson Learned number: 131
Impact: Cost, Schedule, Scope

Cost impact: $10,000


Lesson Learned/Best Practice

Perform audit of all mechanical, electrical, plumbing systems & security systems., including complete T&B audit prior to start of any work in renovation areas. This will help ensure full scope of mechanical renovations is captured early


Suggested Actions for Future Projects

Perform a pre-audit of any MEP systems that are to remain in place. Should be completed during design phase. This can weed out issues such as water not heating up quick enough or security systems not working. Conduct an audit of mechanical systems during design phase if possible. At a minimum, conduct measurement of existing systems prior to starting work. 


Keywords

Test & Balance, Exiting utilities, Air changes, Air Exchanges

State Recertification Requirements for Renovations

Facility name: North Austin Medical Center

Project name: NRTAUS-022019M-Rehab/Peds Relocation
Location: AUSTIN, TX
Project classification:
Project type: Acute Care
Project number: 0822400025
Lesson Learned number: 130
Impact: Cost, Schedule, Scope

Cost impact: $7,000


Lesson Learned/Best Practice

Better define within the  project documents what the state requires for documentation & recertification of existing systems in spaces with only finish upgrades. THHS inspector required several systems which had not been touched to be recertified.


Suggested Actions for Future Projects

Confirmation with the state, stating precisely which state requirements will be applicable to the project, including recertification of existing systems not within project scope, if applicable. Include clarification in bid documents. Discuss with state during Feasibility Conference. Verify with local AHJs as well.


Keywords

Recertification

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

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.

Coordination of steel and shell packages complete at DD

Facility name: North Florida Regional Medical Center

Project name: NRFLMC-032018M-South Tower Vertical Expansion
Location: GAINESVILLE, FL
Project classification: Hospital – Vertical Expansion
Project type: Acute Care
Project number: 3091600012
Lesson Learned number: 49
Impact: Schedule, Quality


Lesson Learned/Best Practice

During the EDI process it was decided by the integrated team to start BIM processes after the completion of the steel shop drawings.  This decision was based primarily on avoiding rework of possible changes due to misc steel and bracing and any changes that may occur during design up until the ERP steel package.  This allowed for two additional months compared to pulling from hanger setting and prefab which would have resulted in the coordinating starting later.  The net effect however was that the BIM coordination took longer than expected and the project resulted in having BIM signed off model just in time for prefab and embed coordination.

Two main root causes involve the contractual requirements for multiple bids on steel asbuilts necessary for the steel shops and the steel shop review process coming still late in the process compared to ideal.  The ideal time for steel shops to be complete is closer to DD.  This would allow BIM coordination (re: MEP and electrical) to occur prior to CD’s being complete.


Suggested Actions for Future Projects

Emphasize the locking of the steel and shell packages by DD.


Actions Taken / Current Status

See attached Process Improvement Memo #3 regarding new steel procurement process.


Related files. Click to view/download.

File 1:
53206HCAHealthcareProcessImprovementMemo3_SteelProcurement12192019.pdf

Method of Procedures review with facility personnel

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.

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

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: 30
Impact: Scope

 


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

 

Cluster or break-out groups in Early Design Involvement (EDI) projects

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: 29
Impact: Quality, Scope

 


Lesson Learned/Best Practice

Incorporate trade break out and/or cluster groups earlier in design; cluster (break-out) groups should be scheduled in coordination with Big Room meetings and started at beginning of project; We suggest the breakout meeting start the Big Room days so that items that are brought up in the breakouts that need to be discussed with the larger group there is still time to it.  Also, this would insure that the breakouts happen.


Suggested Actions for Future Projects