In one of the last sessions of the day Monday at the ASHE Annual Conference and Technical Exhibition in Seattle, attendees remained glued to their seats despite the reception that was getting started downstairs. The reason was the Sutter Medical Center Castro Valley and the intriguing integrated project delivery (IPD) program that has been implemented for its construction.

In the session titled “Sutter Medical Center Castro Valley: The Real Risks and Rewards of IPD,” team members presented a case study on the challenges, best practices, lessons learned, and benefits of the IPD application. Speakers included George Hurley, project executive, DPR Construction Inc., Aptos, California; Digby Christian, project manager, Sutter Medical Center Castro Valley, Sutter Health, Sacramento, California; James W. Mobley, AIA, architect, Devenney Group Ltd., Phoenix; and Zach Sargent, healthcare division manager, Superior Air Handling Corp., Medford, Oregon.

The scope of the project is a 130-bed facility with seven floors totaling 223,000 square feet. The total project cost is $320 million, with $225 million of that designated for design and construction.

Challenges of the project were plenty. They included a new contract and delivery model, a new clinical care model, expectations for the project to be delivered 30% faster, an absolute cap on funding, plans for LEED Silver certification, an adjacent hospital and adjacent residences, a limited laydown area, and a location in the most severe seismic zone in California.

Christian explained that IPD was primarily pursued for the project due to what one may call the most significant of all those challenges: ownership’s absolute cap on funding. IPD offered the option to bring more certainty into the delivery, he says.

Another huge part of the undertaking was Sutter’s own goals, which included designing within the budget, building exactly to 3-D modeling, and requiring designers and builders to validate the project before it would be funded. There were a total of 11 parties that together signed a document that was used to bind all of them into a single contractual agreement to not only follow those goals with absolute precision, but to share both the risks and the rewards.

What this meant is change orders were not an option—the only change orders acceptable would be if Sutter changed its mind on something, if a law changed, or if an issue was discovered underground. Otherwise, all risk had to be absorbed by those parties to the contract. So how was this actually carried out? The group put together a list of best practices to offer on this unique use of IPD:

• Risk management—A number of meetings were held to discuss what typically goes wrong on healthcare projects and how best to work together to prevent them on this one.
• The contract—All parties had to sign on to ownership’s goals and absorb the risk if there was a failure in meeting those goals.
• Target value design—The team would target the price of the project and break it into batches to have more predictability throughout the process. This included getting the entire team involved early in the process, using cost as a design parameter, displaying design and budget data clearly, and using model-based quantities and having automated responses to design changes.
• Bringing the team together—During the pre-design stage of the project, a collaboration space was leased to bring members together, and during the construction phase a larger trailer on site was used to permanently co-locate personnel.
• Live file sharing—For all team members to always have the same information in front of them, each company had a server with identical information in every location, which also provided necessary redundancy.
• Visual control of design—Visual graphics were used so everyone was speaking the same design language.
• Visual control of construction—Crews needed a better way to know where they were making their next moves, so visual cues were used to determine milestones and what had to be done in order to accomplish it.
• BIM—The team heavily leveraged building information modeling, going as far as modeling rebar and all MEP systems.
• Enhanced constructability views—All components were modeled to an extremely high level of detail to avoid any conflicts.
• Direct digital exchange and prefabrication—Prefabrication was used for to allow for the seamless delivery of exactly what was modeled.
• Laser scanning—Laser scanning allowed the team to check their work against the model to find out immediately if there were issues and have more time to evaluate and address any issues that did exist.
• Information handover to ownership—This allows ownership to know precisely what is in the walls and systems in order to plan for future renovations, etc.

While still under construction, so far the effort has paid off. The team reports that, as planned, there was a $0 cost increase, no compromise to the LEED goals, and six weeks shaved off the schedule. With an original open date of January 2013, today the hospital is scheduled to open on November 15, 2012.

Christian, representing ownership, offered some of his lessons learned, including the need for smart risk management, necessity for ownership to take the lead until IPD becomes the norm, and requirement of a new vision, new contract, and new software to create an environment for success.

“It works. You have to work really hard, but it works,” he says.