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Articles
"Hospitals Use ‘Lean Construction’ To Save Time and
Money", (c) Richard
Haugh, Health Facilities Management, March,
2008
The Boldt Co. faced a challenge early last year. A
client wanted to add a 70,000-square-foot ambulatory
surgery center and medical clinic to its campus, but set
a dollar-per-square-foot cap nearly $25 below the
Appleton, Wis.-based construction company’s historical
average. Adapting principles pioneered by Toyota Motor
Corp., Boldt met the client’s needs—for $2 per foot less
than budget.
Only a few health systems are using so-called lean construction techniques
for their new projects. Sutter Health System, Sacramento, Calif., is widely
viewed as the leader in the field, although SSM Healthcare and BJC Health
System, both in St. Louis, have big projects in the works using lean
construction, as do a handful of other systems around the country.
Paul Reiser, Boldt’s vice president and general manager of California
operations, explains that improved planning early in the project leads to
improved productivity down the road. Instead of the top-down command and control
approach common in construction, subcontractors and field personnel working on a
lean project get involved in planning from the bottom up.
“Lean construction involves intense collaboration up front and having teams
really designing to cost,” says Reiser. “Budget becomes an influence on design,
rather than an outcome of design.”
St. Elizabeth Hospital, Appleton, part of the Affinity Health System of
Menasha, Wis., finished a $23 million parking structure and new hospital
addition in March 2006, on time and on budget. Boldt used lean processes for
that project such as:
- Applying software to front-end design to spot conflicts between areas such
as structural, mechanical, electrical and plumbing. Avoiding those conflicts
saved $50,000 in change orders.
- Using scheduling software called Last Planner to track each week’s
schedule.
- Selecting subcontractors, especially mechanical and electrical, based on
their experience using lean manufacturing in their fabrication facilities,
with an eye toward accurate prefabricating and just-in-time delivery of
concrete prefabs to the job site.
That expertise cut costs for Affinity in the project’s foundation phase.
Using prefab panels instead of a poured concrete meant significant savings, says
Gary Kusnierz, Affinity Health’s director of development and construction.
“They would deliver things just in time, take them off the truck and bring
them right to the point of use where it was being installed,” he says.
Alberici Healthcare Constructors, St. Louis, is working on a project for
SSM’s Cardinal Glennon Children’s Medical Center in St. Louis. The
130,000-square-foot addition includes a basement, three floors and a mechanical
penthouse. It comprises 10 operating rooms, a 60-bed all-private neonatal
intensive care unit, a 10,000-square-foot central sterilization area, and nearly
50,000 square feet of shell space available for additional fit-out. The $60
million project initially was slated to be finished in October 2007, but that
was moved up to July 4, 2007.
Using lean principles, Alberici engaged the mechanical, electrical, plumbing
and fire protection contractors early in the process to avoid conflicts and
coordinate designs. The result: a common, embedded unistrut hanger system for
pipes, ducts and cables in the ceilings; a common seismic bracing system; and a
common fire-stopping system at all penetrations in walls and concrete decks.
Every aspect of the project was examined for efficiency and savings. For
example, some subcontractors shared certain pieces of equipment, and during
excavation only one fuel truck showed up on-site instead of each sub operating
its own separate truck.
Financial incentives led everyone to adopt lean principles, says Martin
Hague, SSM Healthcare’s director of construction and facilities.
In the traditional way construction is done, subcontractors bid, design and
work independently of each other. “That becomes an issue of herding cats,” says
Hague. “Everybody is out there concerned only with their little piece of the
puzzle.”
Instead, SSM wanted everybody focusing on the end product. So as an incentive
for using lean principles to achieve that goal, Cardinal Glennon made the
project’s $2 million construction contingency fund into an incentive pool. If
everybody works together to bring the project in on time and on budget, they
will share equally in the pie, he says. Even with using the contingency fund,
the project will save money over conventional construction.
With 65 percent of the project complete, the construction contingency is
nearly intact, notes Hague.
Few projects are being built using lean construction principles, says Gregory
Howell, co-founder of the Lean Construction Institute, Louisville, Colo. But
that’s likely to change—as growing requests for his consulting services prove.
“What we’re putting forth here is not a kind of motivational program or
group-hug thing,” he says. “It’s a completely different way to conceive and
produce the work itself. It really is a deep change.”
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