Leveraging Lean, VDC and IPD to Enhance Efficiency

Sutter Health’s (Sutter) new regional ambulatory center addresses the need for medical services in underserved Santa Clara, CA. The East Santa Clara campus will convert roughly 300,000 sq. ft. of 1980s office space to medical facilities focused on primary and specialty care, along with an ambulatory surgery center, and urgent care.

Conversions can pose challenges, such as structural limitations. For this project, the existing roof could not support the weight of utilities needed for new equipment. A collaborative preconstruction phase guided by Lean principles enabled the team to devise innovative solutions and stay on track.

“Our team worked to maximize the six tenets of Lean and we are really seeing some interesting and innovative results in the field,” said Dan Tran, DPR project manager.

Critical to success was having the right team in place from the beginning. Sutter ensured collaboration by implementing an Integrated Project Delivery (IPD) - Integrated Form of Agreement (IFOA). In an IFOA, parties share risks and rewards, working as equal partners.

“An IFOA sets up the needed framework to support an integrated project team, because for a single team member to succeed, the whole team needs to be successful,” said Cal Lieb, Sutter’s senior project manager. “Investing in upfront planning, design and preconstruction reduces project costs and lowers the overall risk compared to more traditional delivery methods; specifically for complex healthcare projects such as this one.”

IFOA supports the first tenet of Lean, "Respect for People," by enhancing communication. The mindset shifts from one focused on individual liability, and early conversations enable planners and designers to see and respond to input from trade partners expeditiously.

“The team is definitely the biggest driver and the innovation everyone brings to the project is making the project successful,” added Lieb.

Efficient decision-making is critical—and enhanced by working under an IFOA. Throughout preconstruction, a group of Sutter’s doctors and clinic managers met with designers to help drive decisions. This shortened the time needed for design and reduced iterations.

It’s become routine for this team to identify issues, assess and resolve them in a very streamlined way,” said Karva Sykes, principal at HGA. “Seeing all the downstream effects of anything we do is eye-opening.” She goes on to say, “It builds empathy between all of us, understanding the work we have to execute.”

Another Lean tenet, "Focus on Flow," guided decisions to maximize efficiency. The team considered the whole job as a manufacturing process and ensured the drawings and models supported the workflow. TAKT planning facilitated this effort.

“IPD increases safety by using TAKT planning to make the construction process predictable and organized; prefabrication also eliminates a great deal of risk,” said Lieb.

To meet the schedule, the team worked to find all prefabrication opportunities. “Doing more work in a controlled fashion yields a better, higher quality product,” noted Tran. Installing prefabricated walls also meant having fewer tools in the space, thereby increasing site cleanliness, which helps improve safety and leads to a more productive pace of work.

All these practices contributed solutions to the structural challenges posed by the roof. A post and panel system on the upper floors sits on a slab-on-metal deck below to carry the required weight. The team also developed a unistrut system, allowing a single point of attachment for the prefabricated walls.

The application of these innovations, driven and executed by a unified team, is delivering on Sutter's vision for a new facility and a better way of project delivery.