With the renovated areas remaining in full operation throughout construction it was imperative that the renovations not disturb the ongoing operations for the emergency room, day surgery suites or the adjacent patient rooms.  ICRA plans were formulated well before the beginning of each phase and modified as necessary during the project in close coordination with the hospital’s infection control officer.  Due to the rapid turnover of each phase, it was critical that DPR not have a punchlist to allow the hospital to occupy the renovated spaces immediately upon completion.  Through our Zero Defects program we were able to turn over each phase the day following final inspections and immediately begin work on the next phase.

Modifications to the space included various electrical, architectural and miscellaneous structural upgrades.

The entire construction process was completed without ever compromising the day to day activities of the department.

DPR’s design-build partner on the project is PageSoutherlandPage. Together they have completed approximately $200 million in data centers in Texas.

Technical Details: The data center will be outfitted with 12 MW systems over 30,000 sq. ft. of white space with the following equipment set:

• 1 N Utility Feed At 161 KV (By Others)
• Single-Ended 161 KV Substation Rated At 20 MVA With Provisions For Double Ending (By Others)
• Tri-Bus 15 KV Switchgear With Auto Transfer Capability
• Underground Medium Voltage Distribution In Tri-Bus Configuration For Critical Power
• Overhead Low Voltage Distribution To White Space
• Underground Medium And Low Voltage Distribution In Traditional A/B Bus Configuration For House Power And Mechanical Loads.
• 3 Mode (Single Bus, Double Bus, And Tri-Bus) Medium Voltage N+1 Diesel Rotary UPS (DRUPS) Plant With 24 Hour Fuel Storage
• 120/ 208V Remote Distribution Panels (RDP’s) And Remote Power Panels (RPP’s) For White Space Legacy Equipment

Renovation work included, but was not necessarily limited to, refurbishment of existing
areas with paint, new base and flooring, wall coverings, new machine room-less passenger
elevator, projection screen and repair and refinishing of Portland cement terrazzo flooring.

To allow the facility to remain operational during the day; construction was completed during
the night hours from 6:00pm-4:30am Monday-Friday. The entire project was divided into
9-phases to maintain functionality of all existing areas.

New areas of the expansion/renovation consisted of the following:
Phase 1: New Doctor’s Wing
Phase 2: Health Promotions Area
Phase 3: Renovation/Relocation of Psychiatry Area
Phase 4: Expansion/Relocation of Medical Records
Phase 5: Expansion/Relocation of Pharmacy with new retail space
Phase 6: Expansion/Relocation of new North wing of Medical Clinic
Phase 7: Renovation of existing Administration Area
Phase 8: Renovation of existing Allergy Care Area
Phase 9: Expansion/Relocation of new South wing of Medical Clinic

The three-story, 66,000-sq.-ft., OSHPD Level 3 facility houses a diagnostic imaging center, non-invasive vascular lab, infusion center, endoscopy services and a pharmacy.

The project also included shell spaces for a future Library and future Dialysis unit.  Through intricate coordination, DPR was able to incorporate the finish out of both future units during the construction of the main project. General conditions were shared between projects, saving the facility considerable expense. These savings contributed to making the build-outs affordable to complete during the main project.

The project had several challenges, both expected and unexpected. Availability of manpower was an issue due to the after-effects of hurricane Katrina. DPR’s strong relationships with national subcontracting firms helped the team staff the project. The national firms supplemented the local forces that were available, and were instrumental to the success of the project.

What was unexpected was that Louisiana had the wettest, coldest winter in seven years.  This resulted in more than 142 rain days during construction of the tower.  The owner allowed a 20-day schedule extension; the remaining 122 days were made up through overlapping trade schedules, and off-hours and weekend work.

The project is located in the middle of an occupied campus. Limited space on site has necessitated the use of just-in-time delivery for all construction materials. Surrounded by dorms and classrooms, noise, smell and dust protection measures are in full force to protect building occupants and neighbors from the effects of construction. As an environmentally sensitive campus, the use of windows rather than forced air is common, increasing the need for the construction team's sensitivity.

The conference center, with 1,800 seats for lectures or 700 seats for banquets, is the largest facility of its kind in Forsyth County. It was designed with maximum flexibility, providing 10 different configurations from 650 sq. ft. to 14,000 sq. ft. for college and community events.

The space includes a fluoroscopy suite, x-ray rooms and multiple exam and clinical support spaces. Included in the project was the structural upgrade of the floor system to accept the x-ray imaging equipment and the fluoroscopy equipment. This renovation took place in an existing operational building and required coordination with staff and building functions.

The project, situated alongside critical patient care areas on the 14th floor of Lutheran Tower, required a disciplined approach to infection control. Constant communication with the facility’s staff, doctors and nurses was a necessity. DPR coordinated all activity with staff, working around the day-to-day needs of the patients, with their safety and comfort a driving focus.

Critically ill patients occupied adjacent floors. As part of a rigorous infection control plan, DPR sealed draft stops and ductwork to ensure debris from the construction area did not enter patient rooms. Negative pressure machines, tacky mats, HEPA filters and other barriers were used as well.

• The 183-bed UCSF Benioff Children's Hospital at Mission Bay with an urgent care/emergency department, pediatric primary care, and specialty outpatient care
• The UCSF Women's Specialty Hospital with 36 beds, cancer care, specialty surgery, and birth center
• UCSF Cancer Hospital at Mission Bay, Part of the Helen Diller Family Comprehensive Cancer Center which will house 70 beds and offer inpatient and outpatient surgery for cancer specialties
• A 207,400-sq.-ft. outpatient building
• 36,000-sq.-ft. energy center, helipad, parking and support services

DPR is working with UCSF, Anshen + Allen - part of Stantec Architecture, Cambridge CM, and 17 subcontractors at the Integrated Center for Design and Construction (ICDC) to deliver the ground-up, 878,000-sq.-ft. hospital complex. This project aims at LEED Gold certification and will feature 16 individual gardens, creating a total green space totaling 4.3 acres. Over an acre of these will be rooftop gardens which will help to reduce storm water runoff. The complex will deliver 100 percent outdoor air, rather than re-circulated, to every space.

The DPR team that recently completed this CCRC was well aware of the personal impact the entire design and construction process would have on its end users. That awareness set the tone from the beginning and increased the team's commitment to delivering a top-quality project, on schedule and budget, that met both the tenants' and the owner's needs.

Representative of DPR's increasing foray into the growing senior housing market, The Covington project for Episcopal Homes is a multi-building retirement community that provides a full continuum of care for seniors. The 460,000-sq.-ft. complex consists of the following, set within a campus-like atmosphere:

• A separate independent-living facility with 131 resident units, two guest suites and numerous amenities, such as pool, dining hall, full-service kitchen, arts room and fitness center;
• A 30-bed, two-story assisted-living facility;
• A one-story, 24-bed Office of Statewide Health Planning and Development (OSHPD)-regulated skilled-nursing facility;
• 24 private cottages; and
• A two-story, below-grade parking structure with 273 stalls.

When completed, the new Alta Bates Summit Medical Center Patient Care Pavilion will house 243 medical/surgical and acute rehabilitation beds. The Patient Care Pavilion building consists of two major components: a patient care tower and a basement and rooftop central utility plant. The new tower will be 13 stories tall, with 11 stories reaching approximately 184 feet above ground, and two levels below grade, wrapping around the existing Merritt Pavilion and providing approximately 230,000 sq. ft. of new space.

Construction of the new facility was adjacent to the existing Eden Medical Center, which remained in full operation until the new medical center was completed. The new Sutter Eden Medical Center opened to the public on December 1, 2012.

In addition to building a landmark regional medical center that will integrate the latest medical technologies, the project is truly breaking new ground in healthcare construction:

• Integrated Project Delivery (IPD): The team used an 11-party Integrated Form of Agreement (IFOA) contract. In previous cases, only the owner, architect and general contractor have signed the agreement and formed the core IPD team.
   
• Building Information Modeling (BIM): This was one of the first instances where model-based estimating was used to generate estimates quicker and more frequently, giving the team greater access to real-time cost information.
   
• California OSHPD phased plan review system: This was one of the first projects to use this system, resulting in an overall schedule savings of nearly 12 months.
   
• California SB 1953 earthquake safety law: This was the first new medical center in Alameda County to be built in compliance with this law.

• Remodeled emergency department with five additional treatment bays for a total of 13 and a much larger waiting area
• 4,000-sq.-ft. addition to the obstetrics wing that increased the overall square footage by 50 percent, providing the ability to offer some private labor/delivery/recovery rooms
• 3,000-sq.-ft. renovation and 10,000-sq.-ft. addition of a new outpatient surgical support center.

"It was a very complex project that required good communication and customer service skills by the entire project team," said Fred Ford, assistant administrator for Sutter Tracy Community Hospital. "DPR began working with the nursing managers, hospital staff and management to game plan safety processes and procedures and prioritized the most important issues as a team even before project start. This helped establish a higher level of trust and rapport over the course of the expansion. DPR rates among the best of the general contractors I have worked with."

Maintaining the schedule proved to be a major challenge and required ingenious thinking and flexibility from our team. By modifying our approach and/or the sequence of activities, DPR was able to maintain the original completion date. For example, in coordinating the above ceiling mechanical and electrical systems installations, DPR identified a conflict between the ductwork and the structure. We submitted the conflict to the design team and then worked with our construction team to resequence the actitivities to work around the delay.

DPR also found deficiencies in the millwork just before it was delivered to the site that required some redesign. DPR worked with our millwork subcontractor to reduce some of the installation durations and added craft people to our crew to keep the original schedule intact. We also identified major electrical needs with the owner's medical equipment, which required the design team to redistribute the power and make changes to the equipment power sources. After working through these changes with our electrical subcontractor, DPR was able to change the sequencing and add manpower where necessary to recover the schedule.

The facility houses new microbiology, cytogenetics, cytology, flow cytometry, special chemistry, and virology labs as well as a cold room, a new sterilizer room, staff lounges, a locker room, and a new administrative area. The project included the installation of a deionized piping system as well as medical gas systems for nitrous oxide, carbon dioxide, oxygen, argon, nitrogen and three mixed gases. It also included a new generator. Due to the limited space in the ceiling cavity, intense MEP coordination was required to install 101 variable air valve (VAV) boxes and approximately 100 exhaust valves.

The greatest challenge was cutting four months off Stanford's already aggressive schedule. DPR received occupancy 14 weeks ahead of schedule by increasing the overlap between activities, tightening the durations, drilling down on the critical path and, in some cases, increasing the crew size to improve the efficiencies of the craft labor.

Working in a partially occupied space presented its own challenges. To accommodate the users of a laboratory on the second floor of the building, DPR provided a temporary generator during the five complete power shutdowns that were required to complete this project.

The footprint of the new patient tower was directly over the location of the original utilities' path to the hospital. Rather than shut the water off to the hospital while tying into the new line, the team used this new approach: temporary “saddles” were attached to the exterior of the 8-inch water main in two sections, and then connected to a nitrogen source. The water in the pipes in the work area froze, allowing workers to cut open the pipe and install the new line. Work had to be performed quickly, before the frozen water could melt, potentially sending hundreds of gallons of water through the open pipe.

To drill 20-foot piers inside the occupied pharmacy, DPR built temporary walls to encapsulate work activity within the partitions. A Bobcat was brought in to drill the piers and worked within the temporary walls. Exhaust from the Bobcat was released from the building via a 50-foot flexible steel tube attached to the muffler. The tube extended out of the work area, down the hall and out of a side door of the hospital.

To install the structural steel into the piers, a hole was cut in the roof for cranes to "fly" the steel in. To protect staff, DPR timed the incoming piers with the staff; each time a new piece came in, the staff would leave the area for 20 minutes (it is against OSHA regulation to allow major lifts over occupied spaces) then return when the coast was clear.

The project required the relocation of the employee parking lot. The owner's original schedule called for a new lot to be built prior to beginning construction of the new building. DPR recommended several approaches to “parking control” to allow work to begin on both phases at once. DPR built sidewalks, covered walkways, brought in a shuttle van and built a bus stop pavilion to make the employee's trek from an outer lot easier. By starting the new lot and building at the same time, six months were shaved from the schedule.

• 450-sq.-ft. C-Section addition
• 4,000-sq.-ft. Cardiac Catheterization addition
• 20 Med/Surg Patient rooms, 9,600-sq.-ft., buildout of shell space
• Relocation of existing utilities

The C-Section suite was tied into the building in an alcove space of the central courtyard of the hospital. Because of this “locked-in” location, cranes were used to excavate, dump in select fill and place structural steel – from the staging area in the parking lot, over the building, to the inside of the courtyard. To comply with OSHA and DPR safety requirements (which do not allow any load to be lifted over people), the team coordinated with the hospital to lift in and out when there were no scheduled C-Sections (the area under the lift path is the birthing center). DPR used spotters inside the hospital along the lift path to keep people from walking through during a lift, and to alert the team when an emergency C-Section needed to come through. In those instances, work was halted immediately and resumed only when the team could be sure there was no traffic.

One of the most critical challenges was removing exterior precast panels to expose the building substructure. Field measurements for steel tie-in points, exact dimensions of concrete edges, and structural openings all had to be verified. However, removing the panels left the building's exterior skin exposed to weather and environmental breaches to Infectious Disease Controls. This condition was more exaggerated in some cases because some of the panels were three stories tall, opening three floors at a time to the exposures referenced.

The DPR staff engaged in many creative methods to get this segment of work done and still keep the areas behind the precast in operation. It was necessary to constantly come up with new ways to install temporary weather protection and monitor the installations. Coordination with the facility and end user for shut downs of the space was continuous. The work was completed with no incidents to patients, staff, or the facility.

The team created an electronic model of the concrete structure using Building Information Modeling (BIM) tools. Because the details could be accurately modeled electronically, potential clashes were resolved before workers broke ground. DPR was also able to give the subcontractor a 3D view of what the underground work looked like, resulting in a higher level of quality.

The electrophysiology (EP) laboratory renovation project included the renovation of a PACU bay, isolation room, and two existing laboratories into new EP labs. One of the labs was particularly challenging as it required changing the function of the room and involved heavy major utility changes and coordination. The team also had to overcome space limitations in order to fit a state of the art imaging robot, lighting, HVAC, sprinklers, and other items, into the required 9-ft., 6-in. ceiling height with a concrete deck height of just 9-ft., 9-in.

Urban development on a zero lot line is not without its challenges. With the lack of a material storage area, DPR developed a "just in time" material delivery system. Materials were delivered and installed on the day needed and not a moment before. In addiiton, the project team developed a site specific safety plan that ensured the safety and minimal disruption to the residents of an apartment complex that was in close proximtiy of the site. 

The Mercy Midtown Medical Center, DPR's second project for the developer, is occupied by more than 91 doctors representing a full range of medical specialties. The six-story, 122,000-sq.-ft. building includes diagnostic imaging technology, an onsite medical laboratory, electronic medical records, administrative offices, and specially designed exam rooms.

DPR's collaborative spirit was evident from the onset and sustained itself through the duration of the project to ensure the owner's and tenant's interests were of utmost concern. One of the most important aspects of the preconstruction efforts on the Midtown Medical Center was the early selection of quality MEP design/build subcontractors. The preconstruction time period was sufficient for owner-driven changes to take place without affecting the project schedule. With the exception of a few owner-driven changes early in preconstruction, there were zero change orders on the project.

One challenge to the team was that the project was constructed on a “postage-stamp” site with a zero lot line making space extremely tight. DPR had to be creative when scheduling subcontractors. Just in time deliveries to the site were required as there was nowhere to stage or store the materials.

Another challenge to the project team was a four month delay due to permitting issues and owner/tenant contractual negotiations. With the delay, the building enclosure activities had to be performed during the rainy season. Schedule activities had to be re-sequenced so that the building would be water-tight to proceed with drywall and other interior finishes. Despite these challenges DPR delivered another successful project, again exceeding the customer's expectations.

The emergency department expansion added 25,000 sq. ft. and 16 additional ED beds to the facility. The two-story vertical expansion added 40,000 sq. ft. to be used for labs, offices, materials management on the first floor and four ORs, a 15-bed PACU and 27-bed ICU.

Both the vertical and horizontal expansions were built concurrently, increasing the already high level of importance on strict infection control procedures. The team constantly monitored particulate counts and enclosures around temporary walls. Throughout months of construction directly above occupied operating rooms and inside the active emergency department, no unplanned shutdowns occurred.

Project won Best of 2012 Healthcare Project by ENR Southwest Magazine.

Achieving this milestone was all the more notable in light of the highly challenging and intensive journey the team faced when it took over the construction management (CM) of the $660-million (construction cost) project in 2008, after construction had already begun in 2007. Even with reshaping the construction process midstream the team met the critical target date for delivering this landmark healthcare facility, which opened to the public in August.

Designed by CO Architects, and dubbed the “hospital of the future” for its many cutting-edge features, the 740,000-sq.-ft., 11-story Palomar Medical Center accommodates up to 360 patient beds, 12 operating rooms, a 50-room trauma center, a 60,000-sq.-ft. undulating green roof and a 40,000-sq.-ft. central plant, among other features. The hospital incorporates many sustainable design principles and reflects the owner’s commitment to creating not only a healing environment for patients, but one that also supports the well-being of the staff through features such as skylights and light wells that deliver natural lighting into employee-only spaces.

The team made a midstream shift to a hybrid integrated project delivery model and kicked of the process with a series of meetings between the owner, Palomar Health, the architect and engineering team, an outside facilitator, Lou Bainbridge, and key trade contractors to align goals and expectations and establish a high-performance team to focus on continuous improvement and project/team success.

The expansion and renovation project nearly tripled the size of the existing emergency department. As part of the 12,000-sq.-ft. expansion, the hospital added a new main entrance, waiting area and 16 new treatment bays. Included in the renovation was the patient registration area and direct elevator access to the second floor surgery rooms from the emergency department. Outside the hospital, improvements were made to the central plant along with the parking lot to accommodate the increased volume of visitors.

The biggest challenge to the hospital was maintaining access to the facility during construction, as all the main entrances were closed during construction. To assure uninterrupted access by visitors, DPR constructed temporary entrances to the hospital and the ambulance/emergency entrance prior to the start of construction.

• Medical office building
• New central plant and IT building
• Surgery center
• Onsite and offsite developments including street improvements

The campus includes a four-story medical office building including a basement level radiation therapy center which houses linear accelerators, a cat scan machine, and a Ximatron. The 131,000-sq.-ft. structural steel building was built to OSHPD 3 standards. The central plant and IT building, also built to OSHPD standards, consists of 11,000 sq. ft. of masonry construction. Also included in the complex is a single-story, 55,000-sq.-ft. steel and stud framing surgery center that will house outpatient care.

Kaiser's Palm Court I & II will provide training to their administrative support (1,195 employees) for members, as well as Fontana Medical Center. Member and administrative services include: Preventative Medicine, Health Education, Patient Business Services, Patient Support Services, Pharmacy Administration, Conference Centers, Extended Care/Geriatric Services, Recruitment Services, Education and Training, Riverside Call Center, Fontana Call Center, Surgical Services Call Center, Psych Call Center, Pharmacy Call Center, and OPAS/HealthConnect Training and Support.

Mechanical systems had to be upgraded to handle the increased number of beds for the department. This included adding dedicated exhaust fans, a return air fan for the existing labor and delivery department's air handler, fan coil motors, and replacing the medical air dryer for the entire North hospital. Medical gas shutdowns and tie-ins were successfully accomplished while the facility remained in operation. Kaiser Permanente's standards for using green products for their interior finishes went hand-in-hand with DPR's ever forward desire to utilize sustainable building practices.

The project features decorative metal paneling housing the interactive screen array and video walls in the main space. Conference rooms with operable partition dividers allow for flexible use of meeting space and fabric-wrapped acoustic wall panels, located throughout the facility, mitigate sound in public spaces and meeting rooms. Strategically placed BASWAphon acoustical plaster ceilings also aid in the control of sound transmittance. The briefing room is equipped with a Cisco Telepresence system, comprised of three display screens. The visual and interactive details were crucial in creating the environment envisioned by Kaiser Permanente. Examples of these elements include graphic image wall coverings displaying Kaiser branding and information about technology displays. Various technology demonstration areas are located in the facility, each containing display niches which demonstrate how doctors utilize technology for the betterment of the patients. Graphic image shades along the front windows are used not only to reduce light transmittance indoors but also to provide a visual display for passersby on the street, grabbing their attention and inviting them in to learn more about Kaiser Permanente.

Along with a commitment to green, the project team utilized some of the latest technology to improve the design and construction process. DPR utilized BIM for several purposes on this project including the coordination of the large amount of self-performed concrete work, totaling some 32,000-sq.-ft., as well as helped the team coordinate the extensive under slab plumbing work. DPR estimates a 375% return on investment, based on the savings realized through increased productivity and avoided rework when divided by the total BIM implementation costs.

The three-story structure with a stucco finish has wing-like parapets on all sides which provide sun shade during hot summer months. Stair towers are positioned at both ends of the long axis of the building.

More than 80 percent of the space is for OB-GYN, pediatric and dermatology care, with the remainder for pharmacies, laboratories, health education and physician's office space. All areas are arranged for maximum efficiency in a series of clinical modules, with offices on the perimeter and examination rooms in the center.

Kaiser Permanente's executive vice president for Northern California, David Pockell, toured the completed Santa Teresa medical office building and gave it high praise. “He sees buildings all over the region, and so the fact that he was very impressed with this one is really important. He is not an easy person to impress, and he was very, very impressed,” said Yvone Hobbs, Kaiser's facilities development team leader.

DPR's services for this project have been retained under a Guaranteed Maximum Price contract for both Preconstruction and Construction services. During preconstruction DPR worked closely with the Architect, Developer, and Owner to develop a cost model that incorporated all the required systems outlined in the Schematic documents prepared by the team. From this cost model and through scheduled Quality Control work sessions DPR was able to assemble a GMP on 100% Design Development documents.

The project is a total of 140,000 sq. ft. The medical center has surface parking incorporating every available square foot of usable landspace to meet the parking requirements for a medical facility of this type. The five-story facility utilizes a steel frame on shallow concrete spread footings. Exterior wall skin components include architectural precast, standard size brick, curtainwall, storefront and mechanically fastened membrane roofing.

On the interior Inova dedicated the two lower floors to ambulatory surgery care, while the three upper floors are for a medical office building fit-up. Detailed coordination with the Owner purchased medical equipment was critical to the successful outcome of the interior buildout.

The DPR Team exceeded expectations with a "no excuses" approach to meeting the project schedule. Major schedule "rocks in the road" were overcome including adding a second floor expansion, site permit delays, gas service delays and one of the worst years for weather on record.

These issues were creatively incorporated into the original project schedule and DPR delivered the project on time on the original contract completion date - "no excuses"!

TENANT IMPROVEMENT
The DPR office in Falls Church was challenged to construct a 50,000-sq.-ft. multiple-owner expansion in the Inova HealthPlex.

The fully operational facility necessitated vast expansion of the physician offices and procedure rooms. Fifteen individual doctors, specializing in podiatry, cardiology, obstetrics and orthopedics, each required specialized custom-spacing, individual design plans and various finishes all within a tight schedule timeline.

DPR worked with each doctor individually, meeting permit needs, inspection requirements and providing physicians with multiple walk-thrus and plan reviews.

The soil in Clear Lake is sandy, requiring massive footings. Rather than dig individual footings, DPR excavated the entire area, poured footings and plinths, then backfilled around them. Excavating a single large area meant there was no risk of the cave-ins associated with digging footings in sandy soil, and two weeks were shaved from the schedule.

With three of four floors in place, the owner added two floors to the scope of the project. Designs were not complete, and rebar—which had a lead time of six weeks—is typically not ordered until drawings are farther along. Rather than push the schedule out, DPR pre-ordered the rebar, estimating quantities based on the previous floors and allowing for changes in the field to accommodate the larger ductwork required for floors five and six. The anticipated field changes were made quickly, ultimately saving time on the scheduled compared to ordering rebar when designs were complete.

The addition of two floors of cast-in-place concrete would have exceeded the soil bearing capacity of the site, so the design of the roof was changed to steel, which is long lead. To keep the project moving forward, a temporary rubber roof was installed so finishouts could begin on the first four floors. Waterproof sheetrock was used on top-out walls in some areas where wall framing and ductwork installation could begin. The cost of the temporary roof—approximately $70,000—paid for itself in time saved four times over. It also allowed the team to essentially stay on the same schedule proposed before the addition of two floors. Installation of a connector bridge from the heart hospital to the main hospital also presented challenges. Created using more than 100 tons of steel, the 400-ft. bridge was installed over a busy county road. The team was required to coordinate with several entities to close the road while sections of the bridge were installed.

With patients on floors above and below, the team focused on infection control and minimizing disruption from noise and vibration.
Materials were moved in and out of the building in covered containers to minimize construction-related debris from entering clean hospital areas. Tacky mats were placed inside entry points to construction zones to capture dust. Workers were required to wear booties in the work area, and to remove them at designated exit points (to keep used booties from being scattered around the jobsite).

Workers were reminded daily of the level of professionalism required when working in an occupied hospital. A DPR representative was onsite at all times to monitor noise levels, ensure workers know to keep voice levels down and don't drop materials on the floor.

When noisy work was unavoidable, DPR coordinated with occupants of the floors above and below to plan around patient needs when work took place.

The centerpiece of the project is the Alex G. Spanos Heart and Vascular Center, a 121,130-sq.-ft., four-story (plus basement) building that will enhance Mercy General's cardiac and heart program. Also included is the complete remodel of the existing hospital's North Wing and additional work on the “Get Ready” projects.

The new building design features craftsman-style architecture with brick exterior skin and cultured stone accents. Additional elements include a unique “healing garden” and interior features designed to promote a healing atmosphere, including extensive use of natural lighting and features to reduce noise and enhance patient safety. Stained glass from an existing chapel will be removed and reused in a new chapel planned within the Heart Center.

Highlights of the project include: Cardiac Surgery and Cardiac Catheterization Center, Cardiopulmonary Conditioning Center, and Chapel and Healing Garden.

Sensitive to the concerns of neighbors and the existing operational facility, the team designed a foundation system that uses drilled auger cast-in-place piles rather than driven piles, for a less disruptive installation.

Due to the tight project site, the team faces logistical challenges ahead with tying the new heart center into the existing Medical Office Building via an underground tunnel, all while maintaining complete patient access and full operation of the existing facility.

Ultimately, the finished product will be well worth the wait and team effort: an architecturally stunning, state-of-the-art facility that will meet the growing healthcare needs of the Sacramento area.

The 91 bed, OSHPD approved facility is anticipated to be complete in 2013.

Spanning 15 months, the projects featured installation of a new 32-ton chiller in the central plant; the complete mechanical system remodel of a 40,000-sq.-ft., 99-bed skilled-nursing facility; and construction of a new 32,000-sq.-ft. special care assisted-living facility consisting of 18 apartments.

Frequent communication and extra measures taken by the team and owner helped to nurture a well-informed resident base and keep the seniors up-to-date regarding the changes going on around them. DPR held weekly meetings with 20-25 resident representatives who served as a conduit for questions to and from the community. In addition, holes punched in the project's barricades (both at walking and wheelchair height) and streamed real-time footage made available through the community's website web-cam allowed project viewing both personally and remotely.

The structure includes a skilled nursing care facility on the east end, with more than 100 residential units stepping down toward the ocean. The center was built on five separate levels and covers 223,000 sq. ft. Four elevators were installed, each rising from the below-grade parking garage to the top floor of the nursing facility.

The west end of the facility opens on to a central courtyard overlooked by a curved patio that runs toward the ocean between flanking residential units. This luxurious community includes a swimming pool with adjustable current, computer room, high-end finishes throughout such as granite, custom woodwork, and plush carpeting.

DPR also constructed a separate complex with six additional premium apartments on a bluff leading down to the ocean. This site, just across the street from the present complex, required more complex underpinnings, including foundation piers buried in the ocean bedrock.

The project was delivered using lean construction techniques designed to maximize overall production value, reduce waste, and maintaining the highest quality. For example, over 90 percent of the demolished Emporium building was recycled. DPR reused all of the concrete from the demolished building, which saved approximately $450,000 in transportation, material and landfill fee costs. The steel and aluminum went to American Steel in San Jose, finding new life as cars, cans and other products made from recyclable materials.

Along with lean construction practices, DPR developed three-dimensional (3-D) and four-dimensional (4-D) virtual building models that resulted in a more efficiently delivered project. Early on, the virtual building models, which incorporate the element of time into 3-D computer-aided-design drawings, helped communicate sequencing issues during design coordination. The models were used during the MEP installation and have enabled the prefabrication of most of the materials for a just-in-time delivery. This process, according to the MEP subcontractors on the project, is improved productivity by as much as 20 percent on this part of the project.

Although this tower expansion was designed in 2D, DPR modeled all major components of the project's structural, mechanical and electrical systems in 3D to determine, review and prevent potential clash detection problems. Additionally, DPR modeled interior components of the building to allow the owner to virtually walk critical spaces and make adjustments to locations of medical equipment prior to construction in the field.

Construction was not always on continuous floors - i.e., the second and fifth floors were under construction while others were fully occupied - so site cleanliness took on an elevated role. Subcontractor crews continuously moved from one floor to another, creating tracks of construction dirt and debris. Each subcontractor was required to have a dedicated cleaning crew that cleaned throughout the day, rather than just day's end.

Hurricane Gustav caused the schedule to be delayed early on. Everyone stepped in to get the project back on schedule, and to ensure end-users and Christus' leadership knew where the project stood schedule-wise throughout. The project was completed within the contractually agreed-to timeframe.

The 33,000-sq.-ft. GLP lab includes 13 double lab modules, four single lab modules, seven tissue culture rooms, three linear equipment rooms, a darkroom, microscopy, histology, office, conferences rooms and workrooms. This portion of the project was completed in a fast six months to accommodate the owner's need for research space.

The GMP lab was constructed in space adjacent to the occupied GLP lab, and will be validated by the FDA. The 7,700-sq.-ft. space includes four production rooms, a quality control room, cell freezing room and offices. The vivarium, located on the opposite side of the building, houses small animals and includes animal holding, cleaning and sterilizing areas.

A SketchUp model was used to coordinate shop drawing with the stainless steel wall vendor in Colorado, which saved time on the schedule and improved the quality of the final product.

The first floor houses the Blood Bank and Stem Cell Laboratory (approx. 18,000 sq. ft.); the second floor houses the Donor and Therapeutic Aphaeresis, National Donor Program and support areas (approx. 18,000 sq. ft.). The project has achieved LEED®-NC Silver Certification, making this City of Hope's first LEED-Certified structure on their campus.

While the parties ultimately entered into a different form of agreement for the project, they did employ certain processes consistent with principles of IPD.

“DPR has worked on several IPD projects, and we are a huge supporter of lean, integrated project delivery systems, along with the use of BIM,” said Seastrom. “City of Hope, particularly Dick Thompson, wanted to implement processes consistent with IPD on the Gonda project.”

During the design phase, the team brought on design/build MEP subcontractors to participate in the Target Value Design (TVD) process, a lean construction tool that incorporates cost as a factor in design to minimize waste and create greater value. The idea is that once a target cost is set for a project it should never be exceeded.

The new four-story research laboratory facility, targeting LEED-NC Silver certification and connected to an existing structure, will double the space for investigations into diabetes and other serious metabolic diseases.

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The owner's initial plan called for two distinct phases: shell construction and data center finishout, with demobilization from the site between the two. This was to accommodate the company's fiscal year and funding availability. DPR recommended compressing the shell construction by two months and starting later, eliminating the need for additional demobilization/mobilization and saving on the overall budget.

The electrical underground design would not be ready in time to meet the new accelerated schedule. Completion of the building slab was a critical schedule milestone, as it was to serve as the casting bed for the tilt-up panels. However, the electrical underground design would not be ready in time for the new accelerated schedule. Under the original schedule, the massive amount of electrical conduit needed would have been installed below the slab prior to it being poured. To allow construction to proceed while electrical design was in progress, the project's structural engineers analyzed the foundation grade beam structure and made recommendations for proceeding with the slab. The approach was to utilize the four feet of flowable, lightweight concrete under the exterior grade beams for access. When the building construction was complete, a portion of the interior slab was removed and sections of the lightweight concrete excavated. Electricians were then able to run conduit from the interior of the building to the exterior yard while the interior build-out progressed.

The city utility also did not have sufficient infrastructure to support the facility by the accelerated completion date. They agreed to have power ready in time for the original completion date but could not guarantee service for the compressed construction schedule. The team enlisted a temporary services design and implementation company to design and provide temporary cooling and dehumidification of the interior to allow sensitive activities to continue without hindering the schedule.

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The team, including UCSD, DPR, RTKL, and the engineering and subcontracting firms embraced a collaborative, high performance team approach and achieved unprecedented success in healthcare, sustainability and collaboration. “At the onset of the project, we determined that the only way to succeed was to do this as a team,” according to Randy Leopold, the university’s principal architect for the project.

Recognizing the need for a roadmap to drive the team towards the same goals, the stakeholders developed a mission statement, “As a team, inspire,” and core values; integrity, openness, enjoyment, progressive, and determination, which provided a clear focus for the entire team. Delineation between companies was blurred and the team was able to function as a collective unit and perform effectively in the office and in the field. When ever-changing activies ensued, individulas joining the project observed the level of cohesion and followed suit.

“As unexpected and highly complex issues arose while building the Sulpizio Family Cardiovascular Center, our foundation of trust allowed our team to find timely and non-traditional solutions to problems that could have led to delays of many months,” said DPR Project Manager Carlos Crabtree overseeing the Sulpizio Family Cardiovascular Center. “Because of our creative strategies, this project is ahead of schedule and under budget.”

Also contributing to the success and taking collaboration even further was the use of full-scale Building Information Modeling (BIM); leadership from all disciplines pooled resources to accomplish pipe routing, conduit and ductwork, systems, assemblies, and sequencing for use by all trades, including interior drywall partitions and equipment supports.

The construction was completed in December 2010—four weeks ahead of schedule, with a public opening spring 2011.

When the project team of Banner Health System’s newest facility set out to build the hospital for the future, they tapped into some of the best minds in healthcare to help co-create a hospital that would not only meet today’s needs but those of 2010 and beyond. Well before Banner Health opened the doors of Banner Estrella Medical Center in January 2005, the 172-bed Greenfield hospital project was already a notable award winner. The project captured “Best of ‘04 Award” for Private Projects over $5 million from Southwest Contractor Magazine, the AIA Arizona Honor Award in the “Distinguished Building” category, and most recently, an “Award of Excellence – Built Projects” from Modern Healthcare magazine, with a leading panel of architects calling it “the closest thing to the hospital of the future.”

Phase one of an extensive master plan for the campus, the facility is anchored by a 133,000-sq.-ft. cancer outpatient center and supported by 76 patient beds on two floors inside of Banner Gateway Medical Center. Utilizing the multi-disciplinary care approach pioneered at MD Anderson, services include medical, radiation and surgical oncology, pathology, laboratory, diagnostic imaging, as well as other supportive clinical services. The new, state-of-the-art design merges the “high tech” world of medicine with the “high touch” needs of cancer patients and their families to provide an unmatched environment for cancer care in the valley.

The building also features a “Lantern of Hope,” a symbolic beacon for patients and their families, lighting the path of hope along the cancer journey– hope for healing, acceptance and personal wishes. The four-story metal structure is constructed of water-jet cut metal and steel, and is patterned to reflect the leaves and branches of the palo verde tree, known for its healing properties. The lantern is illuminated by the sun during the day, and from within at night with beautiful colors of light.