Sutter Health, Eden Medical Center
Design Innovation

How BIM is changing construction

An interview with Michael Pearson, BIM Manager for DPR Construction, from our YouTube channel.

Bryan Daylor

Bryan Daylor

By Bryan Daylor, Vice President, Ancillary & Support Services, Eden Medical Center

In my previous posts, I described how our “user” team approach to planning the new hospital Those of us who head up different functional areas at Eden worked in teams (consisting of managers, supervisors, staff and physicians) to determine the best way to improve the delivery of patient care in the new hospital by implementing industry best practices.

Our focus all along has been on patient safety and quality of care, efficient patient flow and effective use of skilled resources. This work has been an important opportunity to design a building that supports the process of care and enhances the experience for patients and caregivers. We were challenged with the puzzle of creating work space and flow in a new building, but in the end we feel we have achieved an excellent design for the new hospital.

While the construction teams are busy working on the visible sign of progress, we are planning for what goes inside the new building. Our teams are working with the project engineers and architects and some of the key users on what fills the space that we have so carefully designed: the structures and equipment that will be in each room of the new hospital. This space planning includes reviewing the elevations of casework, cabinets, counter tops and work surfaces to ensure that the work areas and surfaces align with work flow and support functions.

Although we have not selected the final medical equipment, we must plan for the equipment that goes into every room. We are taking inventory of the equipment needed and documenting the space allocation and utility needs (electrical, plumbing, data, cooling and ventilation) required for every piece of equipment in every room. There are more than 8,500 pieces of equipment inventoried for the new hospital that must be accounted for in the room-by-room layouts. Over the past four weeks, the team has worked together to review each floor to ensure the drawings are accurate and inclusive of the specific details required to support the equipment and functionality of the space.

The group is also researching and evaluating technological advancements in every discipline to anticipate changes and ensure that, when the new hospital opens, we will have the most up-to-date equipment for our staff and our patients.

I welcome you comments and questions.

George Bischalaney, President and CEO, Eden Medical Center

By George Bischalaney, President & CEO, Eden Medical Center

Health care reform is on the agenda, again. The stakes are high, but our President is determined to make some significant changes. As the discussion moves from general to specifics, special interests are staking out their positions. None of the stakeholders—hospitals included—wants to feel the impact or be at a disadvantage.

Amidst the demand for cost reduction and health care coverage for all, there is and must be continued investment in care. Physicians demand it. They expect to be able to practice with state-of-the-art equipment and facilities to produce outcomes that meet national, state and local quality standards. Patients demand it. They want to know that their local hospital has the right number of well-trained staff as well as the latest diagnostic and treatment equipment, and contemporary facilities.

With this backdrop of conflicting needs, Eden Medical Center is about to begin a three-year project that will result in the replacement of the Castro Valley hospital. The project cost is estimated to be $320 million. The current 55-year-old building is anything but contemporary. With few private rooms, small operating rooms and inadequate support space for clinical services, a new hospital is very much needed.

Eden Medical Center has served the community well, but it was not designed for patient comfort and needs, more for staff needs and functionality. While our project may seem ill timed given the uncertainty of hospital reimbursement, we are required to meet California legislated standards for seismic safety in hospitals. And it truly is needed.

We’ll celebrate our long sought goal with a ground-breaking ceremony on July 1st. Then we’ll spend the next three years continuing the investment in the new buildings and equipment, while observing and hoping that decision makers do not enact legislation that essentially penalizes us for the commitment we are making. When we celebrate the grand opening and our new beginning early in 2013, it should be with the same hope and dreams as those who celebrated the first ceremony in 1954.

By Digby Christian, Project Team Leader

We are proud to tell you that on April 7, 2009, the Sutter Medical Center Castro Valley (SMCCV) project team received the 2008 FIATECH CETI Award at the award gala held in Las Vegas.

FIATECH is an industry consortium within the building industry. Its primary mission is to get all the “players” involved in capital projects to adopt new ways of thinking and new technologies to deliver higher value for the funders and end-users of construction projects.

Here is why our team won the award…

As most of our readers know, California’s deadline for retrofitting or building earthquake-proof hospitals from scratch is 2013, less than four years from now. The hospital project in its current form was validated as viable in August 2007, and design work was authorized to start in October of that year, leaving us just over five years to have the building be ready and open for business. Typically, in California, it takes at least seven years for a project of this magnitude.

So the team had to throw out all historical concepts of how design is done and come together as a wide-ranging, multi-company team involving the owner, the designers and the builders, and transform the design and construction process to drive two years out of the schedule. The team is now on track to achieve just that and did it primarily by redesigning the design process in a rigorous and unrelenting fashion, so that it no longer bears any real resemblance to tradition!

If you are familiar with the classic design process, you’ll know that it’s typically abbreviated as “SD-DD-CD”: Schematic Design (broad concepts typically discussed and agreed to by the owner and the architect exclusively); Design Development (often a General Contractor might have some involvement in this); and Construction Drawings (some trades might be brought on board to inform how these are put together). Then, the work goes out to the building community and those companies develop what are known as Shop Drawings. These drawings show in detail how every little and large item in the building will be fabricated, i.e., the structural elements, including steel, metal, glass, concrete, etc.

On the SMCCV project, all of the people who typically are brought in at the end are already on board, and most of them have been on board since August 2007. By the time this project completes its approval process through the County and State we will already be at the Shop Drawing stage. The building is being designed for fabrication now, while the design approval process is underway.

While this concept has been discussed for the last few years within the industry, and parts of the above have been implemented on other projects, no project has implemented this concept as broadly and as deeply as the SMCCV project; certainly not on a project this large and this complex. It is one of the reasons our project won the FIATECH award!

The other primary reason we won the award is because of how thoroughly the building has been designed in three dimensions (as opposed to the typical two dimensional paper drawings we are used to seeing). There are many very attractive shots of 3D design that you can find on websites, and in trade magazines but you can’t tell if the designs are any good—all you know is they look “cool.” But on the SMCCV project, we bring the entire team together at least every two weeks to work through the coordination effort. It’s painstaking and difficult, but utterly critical to a successful outcome in a shorter timeframe.

What is not often understood outside the industry, and to some extent even within the industry, is that different design disciplines use different software, and they can’t see each other’s work in real time while they are designing. Each company has to either import a converted file of each other’s work or send both files to a third package, such as Autodesk Navisworks, to see both designs at the same time. So it’s all too easy to have a poorly coordinated, unbuildable, three dimensional design—no different in fact than having a poorly coordinated, unbuildable, two dimensional design.

In addition, we have focused the team on the larger goal of designing for fabrication rather than the industry convention of designing to produce the construction documentation, which is then coordinated by the construction team. The team’s goal to design for fabrication means we are swimming against the tide. We are allowing our companies to each use their own best-in-class software and then developing a process that allows a high level of coordination and constructability to ensure that what is being designed is actually what we will build.

The above might seem dry and technical; however, by a) having a multi-company team involving all the construction trades from day one; b) throwing out the baggage of a poor design process and starting from scratch to build a better one; and c) having a goal of designing for fabrication will allow us to build a new hospital on schedule, within budget, and without any last minute compromises on the finished product.

On the Sutter Medical Center Castro Valley project, we are breaking new ground ahead of any other project in the country in the way such projects are handled. That, in essence is the reason why the team that is building your hospital won the 2008 FIATECH CETI Award.

In addition to the Sutter Health project team, I want to personally thank The Devenney Group, DPR Construction, Capital Engineering, The Engineering Enterprise, TMAD Taylor & Gaines, GHAFARI Associates, J W McClenahan, Morrow Meadows, Superior Air Handling, MPS Project Management, Navigant Consulting, Greenwood & Moore Engineering, Herrick Steel, Otis Elevators, Strategic Project Solutions, Royal Glass, Clark Pacific, Candela, Sparling, and numerous other specialty trade vendors for making it possible to receive this award—and to meet our 2013 deadline!

For all you construction buffs, or for anyone who is interested, check out FIATECH at http://www.fiatech.org/.

I welcome your questions and comments!

revised-rendering-1-1.jpg

By Cassandra Clark, Project Communications Director

This week, the Alameda County Planning Department presented the final Environmental Impact Report (EIR) for Sutter Castro Valley Medical Center and related documents to the Castro Valley Municipal Advisory Council for review and approval. The Council is an advisory board of seven community members who work on behalf of the unincorporated town of Castro Valley and serves as advisor to Alameda County Supervisor Nate Miley.

This is one more essential step toward approvals to allow the new hospital project to move forward. The meeting drew a large crowd interested in the future of Eden Medical Center and in health care in the region. Many audience members spoke highly of the project and showed their support for Eden and the new hospital.

There were several members of the audience in attendance who voiced their concerns about the future of San Leandro Hospital, located 4.5 miles from Eden and struggling to survive in these tough economic times. The 93-bed hospital is part of Eden Medical Center and provides services to the San Leandro community.

There has been much discussion about the future of this hospital due to significant financial losses and decreased utilization. While the future of San Leandro Hospital is still unknown, it is clear that it cannot continue as it is today.  Sutter Health and the Eden Township Health Care District (the owner of San Leandro Hospital) are working toward a solution for the hospital so that it continues to provide health care services in a way that meets the needs of the community.

While members voiced their concerns about San Leandro Hospital, they moved forward and approved the issue before them: the land use entitlements and EIR for the Castro Valley project. There was no opposition based on the merits of the project, the land use, nor the environmental impact. What the Council did ask was for the Board of Supervisors, in their approval process, to consider if San Leandro Hospital’s future has an impact on this project.

The next step in the approval process is the Alameda County Planning Commission (April 6) and the Board of Supervisors (April 28)—and both of these are opportunities for us to address how this project will serve the region’s health care needs. But without these land use approvals, the Castro Valley project cannot move forward. And, as we have stated so many times before, this essential project must advance on an accelerated timeline in order to meet the state-mandated deadline of January 1, 2013. After that date, the existing hospital can no longer function as an acute care hospital and must close its doors.

Solving health care problems requires intensive and collaborative efforts. It’s a regional issue, not one that can be solved by one organization alone. What is certain is that we have a new hospital project before us that is fully funded, without tax or public funds, and the first to come forward in Alameda County to meet the State’s earthquake safety standards. It is an amazing project, and one that should not be held back while health care providers in the region work toward a viable solution for San Leandro and other hospitals that are struggling to survive.

We’ll have more information on these issues as they evolve, from experts far more experienced than me. So, in the meantime, I encourage you to view the video prepared for the Castro Valley Municipal Advisory Council by our architects, the Devenney Group. The animation is a fly-over and fly-through of the new hospital and campus. Enjoy!

Main Entrance at Twilight

 

 

 

 

 

 

 

 

 

 

 

We’re hosting another Community Open House on Wednesday night, March 18th, from 7:00-8:30 p.m., at the Eden Hospital Conference Center, 20103 Lake Chabot Road, in Castro Valley, California. You’ll be able to see more of the architectural renderings of the beautiful new Sutter Medical Center Castro Valley and get an update on our progress. You’ll learn more about the proposed schedule for construction, and get answers to your questions and concerns. We’ll be serving refreshments, and members of our project team will be available to talk with you. We look forward to seeing you there!

You can also stay informed by reading this blog regularly, especially if you subscribe by email or RSS feed. Just click on the orange RSS icon on the right side of the blue bar above for simple subscription instructions.

If you’re on Twitter, Facebook, LinkedIn, YouTube, FriendFeed, or other social networks, you’re invited to connect with us online. The links to our social network communities are in the right side bar. Our blog is also now featured in Alltop, in the Health section!

Please let us know if you’re a member of another online neighborhood, health care or business network that members of our project team might join to discuss plans for the new medical center. We would be glad to participate!

Dr. Sidney Wanetick

Dr. Sidney Wanetick

Sidney Wanetick, M.D.

My name is Sidney Wanetick. For 26 years, I was in practice as an OB-GYN in Castro Valley, and I delivered more than 3,000 babies at Eden Medical Center.

In 2008, I retired from practice to accept the position of Vice President of Medical Affairs at Eden Medical Center. Today, I serve as the administrative liaison between the medical staff and administration, helping to support our physicians as they provide high quality care to our patients now and as we look to the future of Eden.

In addition to other duties, I am actively involved in assisting our physicians in recruiting new physicians to the community.

I’m very excited about the new Sutter Health hospital that is replacing Eden. Several major benefits stand out. In particular, having all private rooms for patients will make a huge difference, bringing more services to their bedsides and giving them more quality time with their doctors.

From the physician’s standpoint, this is a much better way to take care of patients and have important conversations with family members in private, as well as offer patients the privacy and rest needed for recuperation. The nurses’ stations will have a view of every patient’s room for faster response to patient needs.

The whole atmosphere of the new hospital will feel less institutional and more supportive, soothing and restful.

Today, even though Eden has 176 beds, we are unable to utilize all of these beds. Most rooms are semi-private, with very few private rooms and even a few four-bed wards. Yet, we can’t put men and women together, and we can’t mix patients with infections in with the general patient population. So even though Eden is larger, the Sutter replacement hospital will end up with a much better capacity for utilization of services.

Moreover, we are seeing a steady decline in the number of patients admitted to the hospital for more extended periods of time. When I first started my practice we admitted twice as many patients for surgery as we do today. My patients stayed in the hospital for five days or more! Also, if patients were scheduled for surgery, they would be admitted the night before. Today patients often have surgery and are discharged the same day, or, if they are admitted, the average length of stay is much shorter.

In addition to the 130 acute care beds, we’ll have a 34-bed, multi-purpose Universal Care Unit (UCU), which also supports the shorter hospital stay. Let’s say an Emergency Room patient has been treated and needs to stay for observation, but not necessarily be admitted. He or she can rest comfortably in the UCU. Or, if a patient is recovering from same-day surgery, we could have him assigned to a UCU bed where he’ll get the attention he needs.

There will also be vast improvements in our information technology systems that just aren’t possible at Eden; our current system has reached capacity. With the new electronic medical records system, our clinical staff will have access to lab reports, x-rays, medication, etc., right at their fingertips. Recent studies have demonstrated improved outcomes and fewer errors in centers that have electronic records, and the new hospital will have innovative, secure electronic records and data systems.

I welcome your comments and questions. Please feel free to leave a comment by clicking on the title of this post (if you are on the front page of the blog), and a comment box will appear below.

Jeff Moore

By Jeff Moore, Co-Owner, Greenwood & Moore, Inc., Civil Engineering

Many of you may be wondering why we chose the existing site of Eden Medical Center to build the replacement hospital. In Chapter V of the Environmental Impact Report, the project architect and environmental impact report consultant (ESA) prepared and analyzed alternative sites and concluded that 20103 Lake Chabot Road was still the best choice for building Sutter Medical Center Castro Valley, an affiliate of Sutter Health.

However, building a new hospital next to an existing one presents some interesting challenges. The construction and design teams had to come up with a multi-phased approach to building the medical campus while keeping the existing Eden Medical Center in full operation. The construction of the hospital is to occur in seven main phases. So, it is necessary to provide seven sets of civil construction drawings where one set is normally provided!

For example, phase one begins with the demolition of the Pine Cone Apartments at 20004 Stanton Street, and four existing medical office buildings located next door to Eden. Right now, we have no access to portions of the site because certain structures are in the way. Demolition of existing buildings is a logical and intuitive start to the construction process.

Phase two consists of what is referred to as “make ready” work. This is work that must be completed before construction on the main hospital can even begin. A good example of “make ready” work is the relocation of the existing helistop (helicopter landing pad, used for the emergency transport of trauma patients). The existing helistop is located next to the new hospital. Helicopters cannot land safely at the existing helistop location during construction of the new hospital. Therefore, the helistop must be moved just 150 feet before work can start on the new hospital. In order to move the new helistop, we need to level a hill, provide drainage, provide flight path clearance, ensure adequate lighting, etc. And remember, full access to the new or existing helistop must be maintained at all times during the construction process!

Other types of “make ready” work include:

- Construction of a large retaining wall to surround a portion of the site. The wall supports a critical roadway around the new hospital site.
- Construction of a temporary path from the new helistop to the existing Eden Trauma Center so that patients can have access to the existing Trauma Center
- Build a new bridge from the new road to the existing parking garage (where handicap parking will be relocated during construction)
- Finally, demolition of the current helistop.

These are just a few examples of “make ready” work that will need to be performed. As you can see, it can get pretty complicated. The need for significant construction phasing is what creates a lot of the site design complexity.

We estimate that phases one and two will take six to eight months to complete! Hospital construction can begin in earnest upon completion of the “make ready” work.

Where are all the pipes & wires?!

Even more complex than all the preparation to erect the new hospital is figuring out where all the underground utilities are. We’re talking about 50-plus years of modifications of pipes, wires and sewers, some of which have been abandoned and no one knows exactly where they are. The contractor needs to know where all critical utilities are located so they can abandon or re-route them to fit the needs of the new construction. In order to locate them, the contractor needs to “pothole” (dig them up) to make sure that they are located where we think they are. This is an expensive and time-consuming process. We’ll also have to build a temporary storm drain system to capture rainwater during construction. The final storm drain system will not be completed until 2012, with the completion of the new hospital.

Taking Down Eden—It’s Not a Quick Good-Bye!

Demolishing the existing hospital—a process we call deconstruction because of the selective, targeted work involved and the recycling process—won’t take place until the new hospital is up and running and all patients have been safely transferred. Since the main entrance road to the new hospital is just ten feet away from the existing hospital building we can’t exactly get in there with a wrecking ball or explosives! So special safety precautions will be provided by the contractor to ensure that the hospital is removed safely and efficiently. We are all concerned about getting things done safely, so deconstruction will be slow and methodical over a six month period.

Being in compliance with environmental safety laws also presents challenges during deconstruction. Eden’s ripe old age means that there will be a certain amount of hazardous material that needs to be removed and properly disposed of before demolition and recycling of the old materials can begin.

North View When the deconstruction is finally completed, the bottom basement floor will most likely be left in place (to save money) and stay intact since it will be located underground. So you could say, a little bit of Eden will remain forever!

If you have any questions, concerns or comments, please feel free to leave them in the comment box below this post. (Click on the title of the post, and the comment box will appear below it.) We will respond as quickly as possible. We want to hear from you.

Bryan Daylor

Bryan Daylor

By Bryan Daylor, Vice President of Ancillary and Support Services at Eden Medical Center

Technology is critical to convenience & efficiency…

As I mentioned in my previous post, our collaborative team has been very focused on how we would use technology, innovation and design to improve work flow and increase efficiency. You may also want to read the previous post by Andrew Flanigan, Senior Planner/Designer with Devenney Group, the architecture firm for Sutter Medical Center Castro Valley.

For example, in our clinical lab today, we have clinical space that is not fully utilized. The lab was originally designed when equipment was much larger and therefore required more space. The current lab was designed as a “decentralized” service, meaning that different sections of the lab, i.e., blood bank, hematology, chemistry, microbiology, pathology were divided into separate areas. We have learned over the years that this concept is outdated, as well as inefficient to operate and impractical to rebuild.

The new “best practice” is to create a centralized service where the work flow is organized and instruments are closely aligned. In this type of design the work flow is much more efficient, and staff has fewer steps between tasks and can be much more expedient in processing specimens. Ultimately this increases turnaround times of critical test results for physicians and patients, and results in a better work environment for the staff. With the advances in technology, one person can do multiple tasks in one area using state-of-the-art instrumentation.

Another mechanism to provide efficiency and convenience for the patient is the new Control Center, located on the first floor close to high activity areas. The Control Center functions similar to an “air traffic control” room. It is staffed with a variety of people representing key functions within the hospital. The area is designed for maximum communication and collaboration among the teams.

There will be multiple computer screens that will provide large visual displays of the various activities and flow of resources—patients, staff and key equipment. Bottlenecks in processing and movement of patients through the care continuum will be readily apparent and the Control Center staff will be able to quickly resolve issues. This will allow us to be much more efficient as we’ll see problems before they occur. The computer monitors will show us bed status: full, vacant, ready for cleaning; patients scheduled and waiting for discharge; expected completion times for surgical procedures; ER patient flow status, etc.

What does this mean for patients? It means less waiting time, more convenience and more time for personal care. For example, the Control Center can monitor patient wait status to ensure no one waits too long for testing. The necessary alerts will be displayed to the staff so they can provide efficient service. If surgical cases are running late, staff will be able to more effectively plan so resources of the OR and other support areas will be efficiently utilized, including communication to other affected physicians, patients and families. We’ll know on a real-time basis if we’re not performing at optimum levels and what the barriers might be. This knowledge will allow us to take the necessary action—e.g., deploy additional resources such as staff or equipment, and return the hospital to optimum performance levels.

Patient-focused clinical flow…

We also looked at clinical flow, from the patient’s perspective. One of our major goals from the beginning has been patient-focused care, creating convenience and comfort for our patients. We have effectively eliminated unnecessary trips within the new hospital for both patients and staff, starting with pre-op registration and diagnostic testing before surgery.

In the new hospital once the patient is registered and accompanied to their suite, clinical staff will come to the room for laboratory and other portable diagnostic testing. The goal is to minimize the amount of travel and disruption for the patient. We are also putting more services at the bedside. Due to the new hospital design of all private inpatient rooms, which are larger than our current rooms, we will be able to deliver more therapies at the bedside. This is an improvement for both patients and staff.

Please email me if you have any questions about the internal layout of the new medical center, or feel free to leave a comment here. We welcome your input!

Main Entrance By Bryan Daylor, Vice President of Ancillary and Support Services at Eden Medical Center

My name is Bryan Daylor, and I am Vice President of Ancillary and Support Services at Eden Medical Center. I’m also on the “user” team that has had significant input on the design of the new Sutter Medical Center Castro Valley. Those of us who head up different functional areas at Eden worked collaboratively with our respective teams (consisting of managers, supervisors, staff and physicians) to determine the best way to improve the delivery of patient care in the new hospital by implementing industry “Best Practices.”

Our focus is on patient safety and quality of care, efficient patient flow and effective use of skilled resources. This work was an important opportunity to design a building that supports the process of care and enhances the experience for patients and caregivers. We were challenged with the puzzle of creating work space and flow in a new building, but in the end we feel we have achieved an excellent design for the new hospital.

It’s noteworthy that the replacement hospital for Eden will serve as a prototype for “best practices” operating models to be deployed to other Sutter Health affiliates that are building new hospitals of similar size and scope.

In the beginning…

When our user teams initially convened, the project size and scope had already been defined. We were challenged to look at how we do things today, and then be creative in how we could design this building to improve they way we provide care in the future. Some of the key goals of these teams were to look at quality and safety of care, efficiency for providers and an enhanced experience for the patient. All of these concepts had to be balanced with ways to drive down the operational cost of the hospital—hence efficiency! We looked at things like distances traveled by providers, adjacency of departments and services that work together, etc.

Acting as stewards of already-scarce resources, we decided that the hospital building would be designed for predominately clinical and direct patient care services, while almost all administrative functions would be housed in the adjoining medical office building. Hospital space costs more than twice that of regular medical office space to build and operate. So, our goal was to maximize clinical areas within the hospital and minimize the administrative functions. With the convenience of the connecting medical office building, placing the administrative services there helped us meet our budget goals without compromising the project or the future operations of the organization.

We deployed twelve different teams representing the various functional areas of the hospital, each looking at their role along the patient continuum of care and planning the layout of the hospital to support the care process. The user group contributed a wealth of knowledge that was invaluable to the development of the design of functional spaces for patient care.

Staff from all functional areas, including nursing, interventional services (surgery), sterile processing, radiology and imaging, women’s health, emergency and trauma, cardio-diagnostic testing, therapeutics, pharmacy, laboratory, and support services such as plant operations, facilities, food service, housekeeping and shipping & receiving, worked on the design of their respective units and then determined which services fit together. Efficient processing, and patient flow and experience, were key factors considered in these collaborative design sessions. Physicians from the emergency department, surgery, medicine, obstetrics and radiology also participated in the design discussions to ensure the efficiency of their part of the care process.

We worked with architects from The Devenney Group on the rough design of these areas, examining the most effective alternatives for organizing these services with consideration of services that are complementary to one another. The teams worked through several iterations of plans, building on the previous ideas and concepts from team members. The architects revised these layouts several times in draft form before a final schematic design was reached. This collaborative approach brought together years of healthcare delivery experience, as well as years of hospital and operational design experience to result in an efficient and aesthetically pleasing design that met Sutter Health’s project and budget goals.

The management team and physicians are proud of the work they have done and are excited to be a part of building the health care services of the future. Please feel free to comment here, or email me if you have any questions about the internal layout of the new medical center.


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