The Sutter Medical Center Castro Valley project has been recognized throughout the construction industry as a unique project in design and approach, catching the interest of architects and builders throughout the world. We sat down with Digby Christian, Sutter Health Project Manager, for a closer look at what makes this project unique.
Q. Why is this project different than other projects you and the team members have been involved in?
One of the unique features of the project team is that we have an 11-party contract, with the non-owner members putting all of their profit at risk. I’m very confident that’s a unique set-up in the United States.
Another unique feature is that the trade contractors involved in the design and construction of the new hospital have a goal of achieving a fully coordinated, constructable, affordable design, complete with fabrication drawings, before the facility is even built. We do not want to resolve issues in the field during construction. We want to resolve them all as part of completing the design rather than in the field during construction when change orders are costly and time-consuming.
Q. There is a lot of emphasis on the team approach to this project. Who participates in the regular project team meetings? How do they work together?
The Project Team is managed by a six-member team called the Core Group. I’m on it representing Sutter Health, as is Bryan Daylor, Eden’s Vice President of Ancillary & Support Services, representing Eden Medical Center. The other four members are from DPR Construction (general contractor), Capital Engineering (mechanical and plumbing design), Devenney Group (architectural design), and J.W. McClenahan (plumbing). We meet every two weeks to ensure the project is managing all the risks as optimally as possible. All decisions are required to be unanimous, and for the two years that we’ve been meeting, we have met that requirement.
A much larger group comprising all the designers, builders and specialty consultants meets at least every two weeks to resolve any strategic issues affecting the whole project. There are also subgroups that meet almost daily to keep information flowing fast and efficiently through the project team.
What are the benefits of this team approach?
You get a fully informed designed. You get an efficient plan for construction. But the main thing you gain is certainty about scope, cost and completion date. These large projects traditionally go a long way over budget and finish very late and with compromises to the goals that the owner had. We worked hand in glove with each other for close to 18 months to get the cost of the project down without altering any of the goals for the building, and now for at least a year I have been completely confident of our ability to get the triple victory of on budget, on time, and with all the goals intact. That’s a tremendous difference from traditional delivery of these complex, expensive, long duration projects.
What have you learned by this approach?
That it works. To make it work requires that a very large team of people works very hard all day, every day for years. But if the owner’s goals are clear, and the team is working under a contract that puts their interests completely in alignment with the owner’s interests, that that monumental level of effort is exactly what you can get out of a team. Hospital construction in California is some of the most complex, most strictly regulated, construction in the world and it is extraordinarily unforgiving of oversights and errors. To deliver a hospital on time, on budget with no compromises to what the owner and community want is about as ambitious as it gets in construction at this stage in our industry’s evolution.
How has this changed construction projects for the system? For the industry?
It’s been a tremendous proof of concept for how Sutter Health would like to deliver its projects. And because the project has been written about in various trade publications and has now won two awards for its delivery model, it does have the potential to be a game-changing project in the industry. I would like it to be just that. Our modern society deserves a rock-solid reliable delivery method for these critical facilities, and until now, in my opinion it has not had that.
If you have any questions for Digby or any member of the team, please feel free to let us know or send us your comments.
By Digby Christian, Project Team Leader
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!
By Jesús Armas, Government Affairs Liaison
As we discussed in previous posts, acute care hospitals must meet certain earthquake standards by 2013. Failure to meet these standards means that hospitals must cease operations. Recognizing the critical role Eden Medical Center plays in meeting the health care needs of the community, Sutter Health previously expressed its commitment to build a new, state-of-the-art hospital in Castro Valley. Yet, this important project can move forward only if it obtains certain approvals from the County.
We are pleased to report that this project is getting closer to becoming a reality as a result of important decisions by the Alameda County Planning Commission.
On April 6, the Commission voted unanimously to recommend to the Board of Supervisors that it certify the Environmental Impact Report (EIR) and modify various General Plan and zoning regulations to allow this project to advance closer to the start of construction.
During the Commission meeting some public speakers expressed concern about the future of San Leandro Hospital. While the Commissioners acknowledged the points expressed by the speakers, they also expressed their unwavering support for this project, and stressed the importance of not imposing obstacles to the start of construction.
With a favorable recommendation from the Commission, project consideration now advances to the Board of Supervisors. UPDATE: On May 12th, the Board will hold a public hearing on the project (postponed from the original date of April 28th). At that time, the Board will be asked to approve the project based on overwhelmingly favorable public testimony to date, and positive recommendations not only from the Alameda County Planning Commission but also the Castro Valley Municipal Advisory Council and County Planning Staff. Assuming a favorable Board action, site work will commence this summer. Overall, construction will take between 24 and 30 months.
We will update this blog with additional information about the Board of Supervisors meeting on May 12th when we are notified. As always, we welcome your questions, concerns and comments.
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!
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!
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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!
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!
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.
One of the most important elements we’re trying to take into account in designing the new Sutter Medical Center Castro Valley hospital is the experience patients and their loved ones want from their hospital stays, and the positive experience employees want from their work environment. There are a number of outcomes the design team is working to accomplish, innovation being an underlying theme.
First of all, gone are the days of patients sharing a hospital room with a complete stranger. Our new building features all private patient rooms with adjoining zones of space designed for the patient, the caregiver and a family or guest zone.
We’re even bringing design innovation to patient room doors, making them wider than standard to allow for safe assisted ambulation. And no more squeezing in to tiny patient bathrooms; sliding doors will be used for easy access.
Ceiling mounted bed lifts are being built into a number of patient rooms. These lifts use remote controls to lift patients on to gurneys or into wheel chairs. Talk about avoiding back strain! Not to mention patient falls. Portable bed lifts will also be widely available.
The power of natural light in promoting a healing experience has been well documented, so our design team has incorporated the use of natural interior light wherever possible. Sound absorbing materials are also being incorporated into the building design to promote a natural, calm and therapeutic setting. And all bedsides will be equipped with flat screen TVs and a full array of cable stations.
We’re implementing cool new technologies to make life easier for everyone as well.
While the lobby will have the typical staffed patient registration desk, we’ll also have walk-up kiosks for patients who are comfortable checking themselves in (think airport terminals). And visitors will be able to use the same HIPPA-compliant systems to locate their family and friends who’ve been admitted.
Most of us have sat long hours in waiting rooms sifting through magazines. At the new hospital we’ll have cool kiosks with WIFI access in patient rooms so you can be productive while your loved ones are getting the care they need.
Visitors (and staff) will have separate elevators and corridors to improve the visitor experience through a “front of the house” versus “back of the house” experience.
A number of other innovations will give the hospital staff greater functional improvements. Sutter Health will be rolling out a system called Vocera, a wireless, hands-free voice communication device, which allows key patient information that can be pushed out to the care giver to increase patient safety and improve response time, and dramatically reduces overhead noise by essentially eliminating overhead paging.
Electronic Medical Records (EMR) will be installed, as well as an automated “command center” to coordinate staffing, patient admissions, placement and discharge, patient flow and room turnover. The command center will also track patients and resources, manage process flow bottlenecks and maximize organizational efficiency.
The Universal Care Unit (UCU) is a one of the exciting innovations—an all-in-one patient care room. Whether the patient has to go to a post anesthesia care unit, surgical pre-op care, recovery, injections or short-term observation, the UCU can serve all of these patient functions. It can be used during an ER (emergency room) overflow when all inpatient beds are full. And in a large-scale disaster scenario, the UCU may also help to meet surge capacity needs. This will be a high activity area where patients who are in this unit will have actions being taken to improve and expedite their care process with the intent of improving outcomes and reducing the length of stay.
If you have any questions for the project team or want to comment about these exciting new hospital innovations, please click on the title of this post, and you’ll see a comment box (or it should appear below, if you’re just reading this one post). We really appreciate your feedback and suggestions…and, on behalf of our entire team, we wish you and your loved ones a healthy, safe and Happy Thanksgiving!
By Andrew Flanigan, Senior Planner/Designer with Devenney Group
One of our other main goals is to design a high performance, sustainable and truly green medical center. In fact we’re going for LEED Certification, which is the recognized standard worldwide for measuring building sustainability.
Progress towards this goal has been made through the integrated team process, which ensures that we are working together to achieve our desired certification level and build the new hospital in the spirit of LEED. Extensive team meetings focus on introducing the core LEED team and determining which credits were available and applicable to our project. As we move forward, the appropriate team member is extensively researching each credit, and the challenges and benefits are being discussed and worked through.
Some of the exciting goals we have identified as necessary to act as a role model in sustainability are listed below:
- Producing an active education program to showcase these efforts to the visitors of the hospital, while also highlighting the importance of sustainability in their lives.
- Reducing construction waste dramatically by diverting the debris away from landfills through reuse and recycling.
- Reducing water usage throughout the hospital with low flow plumbing fixtures.
- Optimizing energy performance before the building is even built with the use of a virtual energy model.
- Protecting our occupants from toxic chemical emissions by using Low VOC materials and having an indoor air quality management plan to improve air quality before the occupants even enter the building.
- Using a green roof and other strategies to reduce heat island effect.
Please let us know if you have any questions or concerns by commenting on this post. We’ll be glad to respond within a few days, and we look forward to your comments.
By Cassandra Clark, Project Communications Director
On October 22, 2008, we invited the community—and particularly the neighbors—around Eden Medical Center to come to the hospital to learn about the new Sutter Medical Center Castro Valley project. We had representatives from the hospital, Devenney Group (the architectural team), Sutter Health, the social media team, and others available to meet our neighbors, hear their feedback and answer their questions. We’ll be posting video clips from the event in the next few days, so keep an eye on our Video Gallery and the featured video box in the right sidebar.
The good news was that the project was well-received, with high praise for the design and sensitivity to the community. We had great questions asked of us, and excellent comments for us to consider as we move ahead (regarding traffic patterns, noise abatement and other important concerns). While we had a very active and interested audience, we hope even more people in the community will join us at future events we plan to host in the coming year. Keep reading this blog, because we’ll announce upcoming community events here.
We realize that people are very busy, and going to the hospital isn’t something most people like to do even when they are healthy! So, we plan to take our presentation on the road, attending events and meetings to hear what folks have to say. We’ll post any future meeting dates and times in our News Room. And, of course, we will use this new blog site to reach a much wider audience, particularly those who live in our community who may not otherwise get involved.
There is a misperception that the people in Castro Valley, San Leandro, Hayward and beyond are not too familiar with social networks, blogs and all the new ways to communicate with each other over the Internet. I hope to change that perception by grabbing new readers and subscribers in our area and far beyond.
So, think of this site as our community meeting. Stay informed. Subscribe to this blog to get regular updates by email or RSS feed. Tell us what you think by commenting on individual posts. Together, we have a great opportunity to shape the future of our medical center.