Kaiser Permanente San Marcos Medical Center | San Marcos, California

The project’s schedule was aggressive for a ground-up, OSHPD-1 hospital tower, spanning four years from start of design to Certificate of Occupancy. Pandemic-related challenges threatened on-time completion, as did existing campus operations, site constraints, and rigorous permitting and inspection processes. From day one, the project team worked closely with the City of San Marcos, HCAI, and Kaiser Permanente to find solutions.

The process of closing up ceilings and walls was a major effort as trades made their way up the 7-story tower. OSHPD inspections involve finalizing complex MEP work and related support, insulation, and seismic requirements. Also, the team’s ability to hit milestones was affected by labor availability amid market- and pandemic-driven shortages of skilled craft.

Building next to four active medical office buildings, our limited site access, parking, and laydown became even more challenging as the pandemic progressed. One major disruption to campus was removing the existing loading dock and relocating the medical offices’ deliveries to the hospital’s new (shared) loading dock. The new loading dock, CUP, and basement required a total excavation of 134,000 cubic yards of dirt and blasting of 77,000 cubic yards of rock.

The team took an ambitious design-assist and “One Model” approach, bringing on 24 trades as design-assist partners in strategic waves. Designers and detailers shared the same BIM model, and subcontractors created both permit and field drawings simultaneously. When crews showed up on site to begin work, their materials were ready, the budgets were set, and permits were approved.

Instead of a traditional floor-by-floor approach, the team designated four crews per subcontractor and four respective zones that functioned as “projects within the project.” Scripted work planning within and between these zones reduced downtime and rework. This also helped “dissect” the building on more complicated floors featuring diagnostic and treatment areas or kitchen space. In addition, the team worked closely with key trade partners to prioritize strategic overtime for critical-path trades and provide early access to critical and larger areas leading up to turnover.

To maintain loading dock access for the occupied campus, the new hospital loading dock and CUP were turned over nine months before the completion of the hospital. The early turnover required detailed coordination and sequencing for deliveries, crane movements, and installation of seven new underground tanks in a constrained space.

The team also elected to prefabricate risk-prone and trade-intensive building components, including medical gas headwalls for patient rooms. These were built on a shared jig by trade partners at the project’s off-site warehouse, hauled two miles to the site, and craned into place. This approach also saved time by increasing quality and consistency, and proved critical to keeping the fast-track schedule.