610 team-driven project modifications and innovations led to $200 million in savings and a better quality facility. Photos by Rien van Rijthoven
One of the most effective ways to build collaboration and enhance communication was to co-locate in the ICDC in the design phases.
UCSF Medical Center is ranked as the eighth best hospital in the country in the 2015-2016 Best Hospitals survey from U.S. News & World Report.
The medical center will employ approximately 2,600 faculty and staff and will handle close to 10,000 inpatient and outpatient surgeries in its first year.
“Everything we were building was with the patient in mind,” said J. Stuart Eckblad, Executive Director of Major Capital Projects for UCSF Medical Center.
The complex is comprised of three hospitals: Benioff Children’s Hospital, Bakar Cancer Hospital, and Betty Irene Moore Women’s Hospital.
The $1.5 billion, world-class medical center provides highly specialized, quaternary care.

Building a World-Class Hospital Complex with Care, Compassion and Collaboration

Team Players

CUSTOMER: UCSF Medical Center

ARCHITECT: Stantec Architecture

CONSTRUCTION MANAGER: Cambridge CM

High-performing integrated team “flexes for change” without making sacrifices to cost, schedule, quality for on-time opening day

How did the team for the UCSF Medical Center at Mission Bay in San Francisco successfully accommodate $55 million worth of changes to the project midway through construction without adversely impacting the budget and scheduled opening date?

“By embracing and planning for change,” said J. Stuart Eckblad, Executive Director of Major Capital Projects for UCSF Medical Center. “On a seven-, eight-year project, change is inevitable. One of the things that our team is really proud of is that we organized from the beginning with a process for managing change to ensure the best outcomes for the project.”

The UCSF Medical Center at Mission Bay story is one of a team committed to “flexing for change” during the design and construction of a $1.5 billion, world-class medical center providing highly specialized, quaternary care. For example, one major scope change was reprogramming 175,000 sq. ft. of the outpatient building for a change in patient services. By implementing collaborative behavior, effective processes and efficient tools, the team was organized to adapt quickly to necessary changes in healthcare equipment, delivery of services and patient needs without compromising cost, schedule or quality.

The final results were $200 million in savings, improved quality, and completion eight days ahead of schedule for an on-time Feb. 1 opening. 

Collaborative Behavior: Building the Integrated Approach

Because UCSF Medical Center is a public-sector project, the owner was unable to adopt a multi-party contract where the risks and rewards are shared among the owner, designer and contractor. Such a contract is often considered crucial to creating an integrated team equipped to accommodate change, reduce cost and schedule while maximizing scope, quality and performance—all the things UCSF sought.

By focusing on the best interest of the project, UCSF was able to create an integrated team and see extraordinary results even without a tri-party agreement. Creating the team required defining the rules of engagement, setting expectations, communicating vision and co-locating in the Integrated Center for Design and Construction (ICDC).

One of the most effective ways to build collaboration and enhance communication among the 250 key owner, architect, consultant, engineer, contractor and subcontractor participants was to have them co-locate in the ICDC months before starting in the design phases.

At first, “people, who were sitting 50 feet away from each other, were emailing each other with questions,” recalled Jack Poindexter, DPR’s project executive. “To change that behavior, you had to get up out of your seat, grab them, and say, ‘Come on. We’re going to talk face-to-face about this and figure this question out.’”

The project team formulated rules of engagement, aimed at fostering collaboration and efficiency. These rules were re-evaluated and updated throughout the project. Among the core rules were:

  • No emailing until documenting;
  • No remote participation;
  • Resolve simple issues at the lowest possible level in 30 minutes or less;
  • Resolve complicated issues in two days or less; and
  • Set metrics for measuring accountability.

Effective Processes: What’s Best for the Project

The project team developed formalized processes to encourage a working environment conducive to collaboration and creative ideas, resolving issues and making decisions quickly, dealing with changes efficiently and effectively, and devising a needs-based assessment strategy.

“What’s best for the project is what’s best for the patient, what’s best for the visitor, what’s best for the staff,” said Eckblad. With that viewpoint, “you can actually get people really lined up to think differently about change.”

One of the most effective processes, which removed a big stumbling block to decision-making, was mandating that all discussions about a change or an issue be separate from the discussion of entitlement and have people focus on what is the best for the patient. That “was the catalyst for our team to be able to adapt and work together on changes,” said Eckblad.

Project modifications and innovations (PMIs) provided a way for anyone to suggest an improvement that could enhance scheduling efficiency or cost savings without compromising the scope, functionality or quality. The team came up with 610 PMIs, such as eliminating 100,000 pounds of ductwork and 7,000 linear feet of piping. These, along with other PMIs, led to the $200 million in savings and a better quality facility.

The Project Solutions Group, comprised of all disciplines and trades, convened daily to listen to ideas and requests for changes to make the project or the process of building it better. The goal was to resolve issues and implement solutions and/or change as quickly and efficiently as possible for the good of the project. Direction was given solely on the basis of value and what was good for the project regardless of the funding source.

The Dialog Alignment Meetings provided a forum for frank discussions on how to pay for changes, disputes and entitlement issues, sharing savings, contract issues, risk allocation and other big issues. The discussion focus was solely on resolution. Finger pointing was not allowed. “In the end, we didn’t have any claims,” noted Eckblad.

Efficient Tools: BIM

Building information modeling (BIM) not only enabled changes to be made more efficiently, but also removed uncertainty from the project schedule, saved time and reduced waste. BIM allowed the project team to test that proposed changes really added value before making them. BIM also allowed the 1,200 people working in the field to implement changes more easily and quickly.

Getting the right people to look at the model was also crucial. UCSF’s facility engineers and the chief information officer were included in the project team, constantly reviewing the model for access and usability. That, said Eckblad, “created a very powerful opportunity for us to reexamine change and improve quality.”

Read more in the UCSF Medical Center case study.