Inspired Project Delivery

September 19, 2011
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The design of the Sulpizio Family Cardiovascular Center, a glass-wrapped jewel box created by RTKL, reflects the unusual nature of the facility itself. Located on the University of California San Diego’s (UCSD) Medical Center Campus, the complex is the first in the area to combine cardiovascular research, education, and patient care. The building’s 360-degree vistas of the La Jolla coastline, nearby canyons, and the Torrey Pines State Reserve are symbolic of the transparent, interconnected healthcare processes housed within its walls.

The 128,000-square-foot structure, located adjacent to Thornton Hospital on the La Jolla campus, combines everything from clinical diagnosis to treatment to the final stage of recovery. The center features 12 intensive care, 15 intermediate care, and 27 acute care rooms, as well as echocardiogram rooms, cardiac catheterization labs, an emergency department, cardiology operating rooms, and research facilities.

The design process itself provided an unusual roadmap that led to the success of the final result. It started in 2005, when the UCSD Medical Center first approached RTKL. The initial set of goals was ambitious: It needed to relieve pressing space limitations, consolidate outpatient and inpatient cardiovascular services, ensure capacity for a projected increase in demand for services, and prepare for more complex cases from a fast-growing over-65 population. As if that weren’t enough, the facility also needed to maintain a financially sustainable payer mix.

Seven years later, with construction completed, those involved marvel not just at the project’s ability to meet those goals with a cutting-edge design, but at the intensely collaborative process that allowed them to do so on time and under budget.

This unique approach—the success of which is all the more remarkable for having overcome unexpected obstacles, challenges, and shifting budgets—can only be described as “inspired project delivery.”

 

High-performance team

Early on in the development process, it was apparent to the owner that an innovative approach would be necessary in order to fully realize the facility’s delivery potential.

With the idea of bringing together a single group to formulate a complex plan, RTKL worked with UCSD to create a multidiscipline and collaborative team structure. An initial five-person board of directors was created to reach the goal of achieving the best value for the project. The board, which later expanded to 12, comprised leadership from the hospital, builder, architect, and engineering team.

The project’s participants understood that in order to develop a superior facility, there was a need to first develop working relationships based on trust and open lines of communication. The goal was the same for everyone: to get the job done well, on time, and under budget. The original, or “core,” team of five representatives comprised the original board of directors: UC San Diego (the owner), RTKL (the architect), DPR (the construction firm), KPFF (the structural engineer), and exp, formerly X-nth (MEP engineer).

Mission statements emphasized core values such as integrity, openness, enjoyment, progressiveness, and determination. A special emphasis was placed upon trust and open lines of communication, and while some board members were initially skeptical about joining such a team, strong relationships developed throughout the first year.

Monthly face-to-face, half-day meetings began. Cell phones were turned off. Required reading was doled out. Relationships were built and eventually trust took shape. Even as new members joined and others filtered out, everyone who participated in the project quickly bought into the core values and continued moving forward as a collective unit. The goal was to make the team feel like a small corporation, but by the time the entire seven-year process was completed, it felt more like members of a family who had learned to balance their lives in order to make the project better.

Together, they formed a high-performance team—later dubbed an inspired project delivery team—that, through the creation of founding principles and team-building sessions, took collaboration to an entirely new level. Along the way, the team learned to use the trust and collaboration they had attained to tackle major challenges.

 

Changing scope midstream

In 2005, a year after the project budget was established, two major problems surfaced:

  • The demand for cardiovascular services at the existing Thornton Hospital increased significantly, so much, in fact, that the new project, as originally envisioned, would not meet current needs, much less allow for growth.
  • An unprecedented 30% cost escalation in the California construction industry became a seemingly insurmountable problem.

With the project at a standstill, the team’s commitment to “never settle” was put to the test.

RTKL helped UCSD prioritize capital and services, and examine all possible ways programs could be arrayed to generate needed revenue. With the board of directors’ help, RTKL prepared and presented to the UCSD Board of Regents the valid business reasons for these decisions and the related financial needs. As a result, the project stayed alive by receiving two phases of additional funds, and it experienced only a minor slip from the original schedule.

As in any development of this size and scope, additional obstacles inevitably emerged and tested the group’s resolve. Six months into construction with onsite work well underway, hospital leaders came to the team with a sudden, drastic change of plans: The fourth floor of the structure—originally designed to host offices—was now going to be repurposed for patients.

To achieve these considerable modifications in utilities (mechanically and otherwise) and to gain agency approval, the project schedule would need to expand by four to six months.

 

Clearing the regulatory hurdles

The board of directors immediately targeted clearing OSHPD (California’s Office of Statewide Health Planning and Development) regulations as its largest hurdle. If not addressed properly, the governmental regulatory agency’s requirements could stall the project for months. The team went directly to OSHPD in search of a collaborative approach to the changes underway at UCSD. They talked its representatives through all the necessary changes and sought their guidance on how best to achieve the desired goals and how to expedite the review process.

At the same time, MEP subcontractors Dynalectric and Umec, which had just joined the project board, were working alongside the design team to discover how to get all the mechanical necessities into the fourth floor, which wasn’t built or sized to accommodate patient care. Both subcontractors conducted 3-D modeling while the design team worked on the pivotal OSHPD review—a 150-page change order—that the agency wound up reviewing in an astonishing 30 days with final approval coming in just three months.

Having brainstormed ahead of time any other potential roadblocks, in particular, possible holdups with the regulatory agency, the team took a page from its own book and focused on direct, specific communication with OSHPD, asking, “How can we help you?” and “How can you help us?” In turn, OSHPD gave the team input on what, how, and when to submit any particular item. The result was a project review process that only took 20 months, several months less than the normal minimum time for a project of this caliber.

 

LEED certification

The finished product is one of the first LEED-certified hospitals in California under the U.S. Green Building Council’s latest green building rating system, LEED for Healthcare, which was launched April 8, 2011. It is on track to achieve LEED Gold status. Initially targeting a LEED Silver rating, the cardiovascular center’s push for the next level is further proof that the board of directors was looking at how best to apply its resources to the project from every angle. As it turned out, reaching Gold status wound up costing much less than anticipated because many of the design/construction elements were already in place.

From the outset of the project, the team put an open-book policy on the table, searching every available outlet to gather the best ideas. Every idea was heard, from official board members on down to the hospital staff. When construction made it necessary to reroute a road in order to keep it open, one of the hospital’s doctors suggested a pathway through a nearby parking lot—a perfect solution from an unlikely source.

In order for the team to remain dedicated to open communication, dynamic collaboration, and efficient results, there was absolutely no room for inflated egos—a characteristic often present among veteran architects, developers, owners, and others who oversee aspects of high-profile projects. However, for this project, the owner, consultants, contractors, and subcontractors remained dedicated to the team philosophy and focused on open communication. As a result, the team was able to target the best solutions quickly and then move forward.

Those who were part of the team that envisioned, designed, and constructed the Sulpizio Family Cardiovascular Center walked away from the project inspired to not only utilize and share this experience on their next project, but to implement the lessons they learned from it in their own daily lives. HCD

 

Patrick McCurdy is a vice president and Juli Smith is a principal with RTKL. For more information, visit www.RTKL.com.

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