Marlborough, MA – Marlborough Hospital, a member of the UMass Memorial Health Care system, will be constructing a new 14,740 sf, $11.7 million cancer treatment wing to be built at the rear of the Union Street hospital. Marlborough Hospital currently offers outpatient medical oncology. The new center will contain a healing garden as well as areas for relocation of its outpatient medical oncology service and the addition of radiation oncology services, not currently available in Marlborough.
Marlborough Hospital opted to utilize integrated project delivery (IPD) to deliver the project that will result in a speedier and more cost efficient project. The Cancer Pavilion will be the first finished health care construction project in New England to use the IPD contract. Currently in the design phase, the hospital has partnered with the architectural firm The S/L/A/M Collaborative of Glastonbury, CT/Boston, and the Tocci Building Corp. of Woburn. Fitzmeyer & Tocci of Stoneham is providing MEP engineering.
IPD is a trademarked method pioneered in Florida in which key players such as the architect, technical consultants, general contractor, and subcontractors work as one group from the beginning in order to optimize project results, increase value to the owner, reduce waste, and maximize efficiency through all phases of design, fabrication, and construction of the project.
A key component in the set-up for an IPD project is the joint development of a project manual, which defines how the team will achieve the project goals. The project manual includes the communication plan, project execution plan, and BIM (Building Information Model) execution plan.
The IPD team for Marlborough Hospital’s new cancer pavilion is currently in the process of refining the BIM execution plan (BEP) to determine how to use BIM on the project, and the protocols and standards required to meet those goals. The overarching goal is to leverage the BIM toward a more efficient design and delivery process.
At the project outset, Tocci coordinated a laser scan of the existing hospital; that data will be integrated into the BIM to support coordination of the addition and future BIM uses that require tie-in to GIS. The team plans on using Robotic Total Station for concrete, wall partition, and RCP hanger layout to expedite the construction schedule and increase accuracy. The team will make use of the BIM during the design process as well; The S/L/A/M Collaborative using it to analyze and communicate design intent while Tocci extracts data to provide iterative price validation and constructability analysis. As more content is developed in the BIM, the team will use it for basic coordination (i.e. clash detection) as well as more advanced analysis (i.e. code and clearance analysis). As subcontractors are brought on the team, they will contribute to the modeling process: developing fabrication models that will be fully coordinated and then used to fabricate and execute work. According to Chuck Thomsen, FAIA, FCMAA, who recently led the team that prepared the white paper on IPD for the Houston chapter of the CMAA, integrated project delivery is an approach to agreements and processes for design and construction, conceived to accommodate the intense intellectual collaboration that 21st century complex buildings require. In today’s healthcare market, using an IPD approach will allow Marlborough Hospital to conserve precious capital dollars by setting aggressive cost targets and developing a design as a team, owner, architect, and contractor that meets mutually agreed goals.
Integrated design and integrated practice can reduce much of this waste. IPD, as a project realization approach, can optimize delivery of buildings. This is enabled by new project business models such as “project alliance” type agreements. The IPD approach requires a common contractual arrangement between the owner, constructor, and designer focused on common goals. The specialized IPD agreement was surprisingly easy to put together, requiring an open discussion that allowed team members to identify and respect each entity’s goals and to establish the project as a common, shared outcome or a win-win-win situation.
Candra Szymanski, MS, RN, chief operating officer of Marlborough Hospital noted that the hospital’s goal is to provide local patient-centered comprehensive cancer care. During the initial phase of discussion it was clear that Tocci, SLAM, and the hospital all shared similar missions and visions, which facilitated a great partnership from the outset. “As a team, there will be times when we are challenged; we have discussed our approach to meeting those challenges up front based on the IPD process. We make decisions as a team at various organizational levels so that our goals remain aligned,” she said. Szymanski pointed out that “each company has been at the table since the first day, all working toward the common goal of building great patient-centered services where not all patients will necessarily come for a cure but all will come with hope of living with the best quality of life possible.”
She continued, “The hospital has been using PDCA (a Plan-Do-Check-Act lean process) for many years to continue to make patient care safer. Applying these principles to drive value and eliminate waste as part of IPD is a natural progression.
Using BIM also helps the process by allowing healthcare experts look at a building in 2D or 3D prior to the start of construction. For example, members of the staff are able to see doors open, the walk to supplies, location of patient bathrooms, and the distance patients must walk to the treatment areas. Wasted steps are eliminated upfront and having patients on our planning team has been helpful to appreciate the challenges they face getting to treatment on a daily or weekly basis.”
The team established a meeting schedule and set up a dedicated team workshop on-site, referred to as the Big Room, to promote full team co-location and collaboration right from the start. In addition, all members were linked by a project website that also hosted the BIM model with real-time coordination of all trades. David Neal, AIA, SLAM’s Project Manager described a recent design meeting that had the design team identify areas in the BIM of the exterior skin to receive different materials and then a menu of proposed and alternate material selections which were brought to the workshop for the owner’s hands-on review. At the same time, Tocci extracted the material quantities from the model and factored in installation costs with a cost matrix in the model so that the team could review material selections against the project budget and inform the decision process from that side at the same time. “This meeting provided the decision-makers with real-time information so that a decision could be achieved quickly and also conveyed to the entire team at the same time,” he said. Traditionally this form of decision could be a back and forth that might extend through design and construction phases with a loss of time and resources for all.
This is just another benefit of the IPD process and why it looks to be the future of project delivery.