A case study of the design and construction of the Camino Medical Center in Mountain View, Calif., analyzes the work structuring and collaboration efforts on the part of the project team. On this project, several lean practices were used in combination, namely the willingness of project participants to experiment and learn; recognition that collaboration among project participants is crucial to project success; implementation of an owner-provided incentive sharing plan; support for reliable planning; use of the “Big Room” (obeya in Japanese); development of a Building Information Model (BIM) that allowed for integration and coordination of trade-specific design details; and extensive use of offsite fabrication and assembly.

Case Study Background

Sutter Health is a major healthcare provider in northern California. To date, it appears to be the largest owner organization in the United States to embrace lean project delivery for all of its projects. By choosing to “go lean,” Sutter wants to be the owner of choice at a time when hospital construction is booming.

Sutter is spurring industry participants to engage in its lean journey by promoting its lean thinking through “Five Big Ideas”:
1. Collaborate, Really Collaborate
2. Manage as a Network of Commitments
3. Increase the Relatedness of the Project Participants
4. Tightly Couple Learning with Action
5. Optimize the Project as a Whole

These ideas were pursued in the delivery of the Camino Medical Center, a project for the Camino Medical Group (CMG). CMG is a division of the not-for-profit Palo Alto Medical Foundation, which is a Sutter affiliate. Construction of this $100-million, 250,000-sf medical office building with surgery center and urgent care clinic is among the first in Sutter’s portfolio of lean projects comprising $6 billion of investment over approximately eight years. Design of the Camino project began in October 2003 and construction in February 2004. The project is now completed and the facility is open for business.

Trade Coordination and Priority Walls

Contractors determine means and methods for construction, but means and methods are not the only factors that affect production performance. Work sequencing, not only within a trade but especially across trades, can have a major impact on production performance because of trade interdependence. For example, by installing wall studs and drywall, open floor space is partitioned into room-size areas. This breaks up the flow of work that is preferred by contractors installing floor-wide systems, such as sprinklers and HVAC ductwork.

Interdependence can—in part—be managed through work structuring and coordination. Work structuring includes determining who is in the best position to do what, together with how and when each participant is to apply their abilities and fulfill their commitments.

On this project, “priority conversations” served as a driver for sequencing work among specialty contractors. These meetings were especially helpful in coordinating the work when it came time to install drywall and ductwork.

For example, a “priority wall” is a full-height—usually a fire-rated—wall where drywall cannot be put in-place if ductwork (or other specialty trade work) has been installed. The alternative to full-height walls are walls that reach up only to the plenum space. The drywall contractor must work on a priority wall before other trades to do their work. However, the contractor may not be able to complete all drywall work at once; that is, steps in the installation process of a priority wall have reciprocal dependence. Specialty trade work other than mechanical ductwork installation tends to be smaller in size and therefore has less or no impact on priority wall decisions.

The designation of priority-wall status must be finalized during the priority conversations. Each specialty contractor prepares for the meeting by analyzing their work relevant to the design (using blueprints or a 3D model) and highlights which walls should be a priority, in their opinion. During the meeting, all suggestions are considered and disagreements are resolved. Depending on the circumstance, a priority wall can take two to four times longer to build than a regular wall, so it is important to prioritize judiciously.

Priority-wall designations benefit the project as a whole, but they typically impose the use of a work sequence that is less-than-optimal when viewed from each individual trade’s perspective. Some specialty contractors would like to minimize the number of priority-wall designations and go in first because their productivity decreases when they must work around drywall. In the give-and-take discussion around priority walls, the drywall contractor who goes in first will also see its productivity decrease by having to install “priority” drywall in different locations and at different times.

About 60 to 70 percent of all walls within the extremely complex surgery unit at the CMG were identified as priority walls. About 15 percent of the walls in the remainder of the facility received priority, which is more typical of office buildings in general.

Lean Project Delivery Tools

The uniqueness of the Camino project stems from several factors, including the willingness of project participants to engage in experiments, to allow for learning in the course of delivering this project, and to carry lessons learned forward to other projects.

Unlike broker-contractors who do not self-perform any work, the general contractor (GC) on this project self-performed concrete as well as drywall installation work, which is an exceptional practice for a GC. The GC can use this work to establish rhythm on the job, or to act as a throttle for other work. Willing to experiment and motivated by an incentive sharing plan, the GC allowed other trades to work ahead of drywall installation in judiciously-chosen locations even though this impacted their drywall productivity significantly.

Delivery teams on complex projects know that effective collaboration among all participants is crucial to overall project success. Collaboration on the Camino project was supported by a unique relational contract combined with process experimentation and refinement during execution. This contract included the beginnings of the “integrated form of agreement” that Sutter is using on more recent projects.

On the Camino project, key specialty contractors held Guaranteed Maximum Price (GMP) contracts with the GC. Here however, the owner working with the GC enhanced these GMP contracts with an incentive sharing plan, according to which specialty contractors with GMP contracts were to contribute to a project purse—the “Total Cost-of-Work Savings Pool.” Funds in this pool would be distributed three ways: 50 percent going back to the owner, 25 percent being divided among the contributors, and 25 percent being the first contribution to the “Total Incentive Pool.” The second contribution to the Total Incentive Pool is 50 percent of unused design contingency and construction contingency during construction. The other 50 percent of the unused contingencies would go back to the owner. The Total Incentive Pool would be divided between the architects and the GC, each of which was to award 40 percent of this amount to their respective sub-consultants and subcontractors.

Through this incentive plan, the owner implemented the Big Idea “Increase the Relatedness of the Project Participants” and wanted to encourage project participants to give and take for the benefit of the project overall, i.e., pursue the Big Ideas “Collaborate, Really Collaborate” and “Optimize the Project as a Whole.” As a result of this agreement combined with priority conversations, the drywall contractor, i.e., the GC, delayed some of its work and took a productivity hit in order to allow MEP contractors to be more efficient.

Another contractual requirement was for all design detailing work by specialty contractors to be done on site. Detailers working for the MEP contractors were co-located in a double trailer that became known as the obeya, which simply means “big room” in Japanese. Toyota has used the obeya as a project management tool, especially in product development, to enhance effective and timely communication. An obeya contains charts and graphs depicting program timing, milestones, and daily progress, and countermeasures to existing timing or technical problems. Throughout the project, team leaders have desks in the obeya to shorten the “plan-do-check-act” cycle. The visual tools used in the obeya along with the structure and discipline required to use them effectively have enabled a few companies to dramatically shorten project cycle time and quality.

On the Camino project, the obeya facilitated the Big Idea “Tightly Couple Learning with Action.” Specialty detailers held priority conversations, coordinated work, and readily worked out solutions with other specialists because they were co-located. Conversations were further aided with the use of 3D CAD modeling. Although beneficial, specialty detailers found working in the obeya difficult when it came to commuting to and from the site to conduct their work because it was computer work that could easily be done elsewhere.

Building Information Modeling (BIM) enabled lean project delivery on this project by integrating and coordinating the architectural design and trade-specific design details. The project architect created the overall 3D model, and design specialists and subcontractors were responsible for modeling their respective building systems. In order to create a virtual model that incorporated all specialties, all key design teams met early on in the design process and established protocols that generated an integrated, comprehensive 3D model.

Several benefits resulted from developing a virtual model early and using it throughout the life of the project. With detailers all present in the obeya, systems could be easily coordinated. Furthermore, specialty contractors could design and detail their work while finding opportunities for standardization and offsite prefabrication. Using relatively detailed design information, combined with the promise of reliable construction scheduling, and visualizing detailed logistical planning, specialty contractors could plan to bring in even larger assemblies. During installation, this avoided collisions and field modifications, resulting in a significant reduction in onsite labor hours.

Reports from various project participants consistently showed that the cost of generating a 3D model was small relative to the cost of construction. For example, the GC and its project team, including designers and subcontractors, estimates its costs of modeling beyond 2D to be about $415,000, or only 0.44 percent of the total construction cost.

Reliable Planning

The link between these innovative approaches is reliable planning, a pillar of lean construction. On the Camino project, “trailer meetings” attended by specialty-contractor representatives and the GC, and led by a senior engineer working for the GC, were set up to coordinate work. Prior to the start of construction, these meetings were conducted to create an integrated 3D model based on detail work completed by the different specialists, to flag interferences, and to promote priority conversations for the designation of priority walls. Based on these commitments, specialty trades could then further detail their work plans. During construction, these meetings were “communication central” where weekly work plans were shared and agreed upon. Although 2D drawings were used to some extent, reliance on the 3D virtual model was extensive.

Specialty contractors could easily coordinate their work thanks to early design details, systems coordination across specialist boundaries, planning and BIM development, and the willingness of team participants to assess the need for priority walls. For example, the mechanical contractor was able to standardize the “handed-ness” of variable air volume (VAV) boxes. They pre-assembled larger modules of ductwork off site, while knowing no obstructions would prevent them from rolling materials-handling carts from point-of-delivery to point-of-installation or impede installation work. This yielded significant productivity gains, such as the mechanical contractor using 30 percent less manpower on site.

Gains were not uniform across the board, however. The mechanical contractor’s shop labor hours increased and the drywall contractor suffered from worse-than-estimated productivity. However, the overall production system was remarkably more efficient because of better design and planning, as well as reducing various work flow patterns. The incentive sharing plan was construed exactly to compensate and reward parties for such contributions and sacrifices.

Conclusions

As building systems become increasingly complex, better management practices are needed to deliver them. These practices must involve many parties, as in the Camino project, where MEP and drywall contractors had to have priority conversations. The implementation of the priority-wall designation for certain walls is not necessarily a unique practice for trade coordination. Priority-wall designations were successful on the Camino project because they were combined with the willingness of all parties to actively participate in a learning experiment, an incentive sharing plan, co-location of detail specialists in the obeya, a BIM, the creation of reliable plans, and standardization of off-site fabrication and assembly.

Use of the obeya, BIM tools, and reliable planning allowed project participants to have priority conversations earlier on in the project than might normally be the case. The incentive plan goes far beyond filling the many gaps that are left when a divide-and-conquer approach is used in setting up work breakdown structures and contracting out work. It offers an incentive to project participants to give-and-take with the “good” of the project in mind. What was perceived on this project to be a sacrifice for the greater good, in particular by the drywall contractor, should be accounted for when estimating, planning, and pricing work of future projects. In hindsight, the drywall contractor felt it deferred too much of its work on this project and incurred a bigger penalty than perhaps it should have. Rules must be articulated so that priority walls can be designated early, coordination efforts can be explicit, and work can be structured accordingly. Work structuring agreements may then foster further priority conversations.

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ISSN: 1096-4894