Providence Saint Joseph Medical Center (PSJMC) in Burbank, California, is no stranger to challenges. Like many California institutions, the hospital was damaged by the severe 1994 Northridge Earthquake. With the assistance of the Federal Emergency Management Agency (FEMA), the hospital secured a portion of the funds to help renovate or replace those facilities that had been damaged. The three-phased Northeast Building Project began in 1996.

Phases 1 and 2 consisted of department relocations, site preparation, and the addition of a 213,000-square-foot inpatient building. Phase 3, which began in early 2006 and is scheduled for completion by July 2007, consists of several department relocations, demolition of an 189,000-square-foot building, construction of elevated pedestrian connectors, and creation of a new cafè with an adjacent healing garden.

“One of the unique characteristics of our project,” noted PSJMC Facility Services Service Area Director Waldo Romero, “is that it was regulated by the Seismic Hazard Mitigation Program for Hospitals, a FEMA grant program.”

Retained to help PSJMC through the FEMA process, as well as to verify the facility master plan, our team at the JCM Group discovered early in the process that the project had exceeded the approved budget. The challenge was determining how to get the project back on track without reducing revenue-producing programs.

“My job was to review the architect's functional and space program to find opportunities to reduce cost without reducing business viability,” explains JCM Strategic Consultant Doug Graham. An architect and medical programming and planning specialist, Graham not only understood how to work collaboratively with administrators, doctors, and nurses, but also how to translate their objectives into viable actions for the project team. “The medical center staff embraced JCM personnel as our own,” adds Romero, “and in return, gained a greater depth of understanding and appreciation of project management.”

After brainstorming and discussing more than 20 possible initiatives with the architect and core team members, PSJMC decided on a course of action. The primary strategy was to use existing inpatient, nonhospital, code-compliant bed floors that were still in good condition for outpatient diagnostic and treatment services (i.e., radiology, physical therapy, outpatient clinics, and physician and administrative offices), which would not be subject to the same stringent building codes as for new construction. This reduced the required scope of new hospital-code–compliant acute care facilities while preserving the hospital's business viability. It also enabled the hospital to leverage staff because the facilities would be in such close proximity.

With the budget aligned, the JCM team assumed the role of project and construction manager for the hospital replacement program. The three closely coordinated, complex phases had to be executed on a densely massed campus during ongoing operations. Authoring a program master plan that conformed to the original budget requirements was viewed as critical to achieving project goals. This master plan was the project bible—all team members were required to adhere to it to ensure project success.

Another important contributor to success was the application of a “best-value procurement” rather than “low-bid” strategy to secure the best team and best value for facility dollars spent on the project. Extensive value engineering during the preconstruction phase of the hospital's new 200,000-square-foot patient tower resulted in $1.5 million in savings. For example, a technique called “pipe jacking” was used instead of the more traditional auguring to install a new utility tunnel. This eliminated the need for concurrent soil stabilization and saved $150,000.

Yet another innovative, time-saving strategy was to create an early site package that unbundled project construction documents to facilitate the purchase of scarce materials or equipment on long lead times, or to accommodate local market fluctuations. This allowed the team to manage demolition, utilities relocations, excavations, and shoring, all while the patient tower was awaiting Office of Statewide Health Planning and Development approval. A separate bid package for the early purchase of structural steel saved 180 days of what would otherwise have been downtime.

This advance work proved invaluable when the medical center responded to changes in medical technology, demographics, and treatment cost/reimbursement models midway through the 36-month construction period by undertaking a substantial redesign of the diagnostic and treatment facilities. Working with the contractor on “alternate sequencing” mitigated the cost and time impact of this redesign by allowing us to reschedule build-out of the redesigned area until later in the project. Overall change-order costs were exceptionally low for a medical center project—4.7%, excluding the 4.3% owner-initiated changes discussed above (for a total of 9%).

Construction Detailing Activity (CDA) also played a crucial role in maintaining the schedule while minimizing change orders. Projects of this complexity pre-sent constant challenges because of the need to fit all the specialized mechanical, plumbing, and electrical components in limited ceiling space under constrained site conditions. All too often, contractors work on shop drawings on their own without coordinating with the other trades. The CDA approach requires the architects, engineers, and subcontractors to meet on a regular basis and share their designs, concerns, and challenges before installation.

The reason for stressing the importance of CDA is that conflicts are common on any project site. Electrical distribution systems have interfered with access to and placement of mechanical systems; sloping plumbing lines have interfered with other systems; fire-sprinkler systems have been placed inappropriately; and things as simple as racks that hold ductwork have been misplaced by as little as an inch—which might not seem like much but can add thousands of dollars to the cost later in the process when the work has to be redone.

Kim Stephens, project manager for McCarthy Building Companies, Inc., PSJMC's contractor, noting the strength of the teamwork between JCM and the other core team members, observed, “JCM did a solid job of making sure the design and construction teams were fully participative and resolving issues in the CDA process. When we overlaid the various drawings during CDA, we could see where we were going to take a hit ahead of time. Consequently, we found other routing paths before installation.”


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Our JCM team was recently honored with a CMAA (Construction Management Association of America) Project Achievement Award for its efforts on this facility. While it's certainly an honor to be appreciated by industry peers, the greatest honor is to enable a client to meet its goals in a timely, fiscally responsible manner. “We have sincerely appreciated JCM's ability to navigate through changes in the construction environment—from labor shortages and increased material costs to the avoidance of unstable general/subcontracting firms,” Romero says. “This effort enabled us to mitigate ‘cost creep.’ The inpatient building was completed two months ahead of schedule and within the estimated cost.” Given the strong team in place, there is no doubt that these results will continue through to the completion of Phase 3. HD

Freddy Rayes is a Project Director with The JCM Group, a Heery International company. A nationally ranked design and construction management firm, Heery International is a 1,000-person program management, construction management, architecture, interior design, and engineering firm with annual revenues of nearly $250 million. For more information, visit