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2 2 N D A N N U A L

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IPD Behaviors without the IFOABrandon Moore, Bill Fusco & Tammy McConaughy, JE Dunn | Ashley Aye, HCA Healthcare

T H E P L U S A N D D E L T A S : A G E N E R A L C O N T R A C T O R A N D O W N E R ’ S P E R S P E C T I V E

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Early Design Involvement (EDI) Process• Understanding the factors that drove the development of the EDI Process• Basic Understanding of the EDI Process• EDI Case Studies• Opportunities for improvement• Next steps with the EDI Process

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JE Dunn Healthcare Stats• 8th Largest Healthcare Builder by Engineering News Record (ENR)• Completed over 1,970 healthcare projects totaling $17.1B

• Rebecca Snelling, JE Dunn National Lean Director• 13 Lean Support Staff Nationwide

JE Dunn Lean Stats

• 1st Last Planner System and Integrated Project Delivery Projects• Minimal Involvement in the Lean Construction Community• Feedback from Clients telling us to get involved in Lean

Multiple Events in 2012 Drove a Corporate Commitment to Lean

W E B U I L D I N S P I R E D P L A C E S T O H E A L

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HCA Healthcare Operating StatisticsHCA has a significant presence in 16 of the top 25 U.S. MSA’s with the strongest Economic Health Index

The 16 HCA MSAs ranked in the top 25 MSAs, shaded in blue with the white outline, include 3 MSAs in Utah.Source: American City Business Journal’s 2017 Economic Health Index, a ranking of the relative economic viability of the top 100 MSAs in the US.

186

49kLicensed

Beds

Hospitals

AcuteCare

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2019201820172016

201520142013

5

HCA Healthcare’s Lean Journey

Create 1st building design standard

Kickoff 1st EDI trial @ Riverside Community

Hosp.

2012

Hire FTEs for Lean implementation

Explore prefabricating building components

Develop sourcing standards

Introduce prefabricated patient

room module program

Launch Lessons Learned Database

Establish 15% schedule reduction goal, Roll out

EDI Implementation Guide, Develop HCA’s

approach to LPS in Construction

Develop HCA’s approach to LPS in

Design

Announce Deployment Advocate

Program

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Why Early Design Involvement (EDI)

• Significant involvement of Trade Partners (TP) does not occur until Construction Document (CD) drawings are generated

Standard Project Delivery Model• Bringing General Contractor (GC) and Trade

Partners onto the project after the design process has started

• Competitive bid process is time consuming• Numerous drawing modifications and

submittals once the trade partners are brought onboard

• Late change orders and possibly significant drawing modifications

• Client would not often realize benefit of process optimization opportunities

Disadvantages to Standard Model

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Expected Outcomes• Collaborative design process• Designed for constructability• Well coordinated drawing set

Objectives

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• Speed to market• Lower project cost• Increased overall quality• Predictable results

Early Design Involvement (EDI)

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Significant capital investment

1Opportunity for innovation

2Complex problem to solve

3

How HCA Picks Projects for EDI

Traditional Delivery Model New Delivery Model

Design Bid/Permit Build

Design/Permit

Manufacture

Assemble/Construct

Act

Plan

Do

Check

Act

Plan

Do

Check

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Types of Projects Which Utilized

Greenfield/Horizontal Expansion To Existing Structure• Medical City Plano – Dallas, TX• Medical City Frisco – Dallas, TX• Swedish Medical Center Tower Expansion

– Denver, CO• Medical City McKinney – Dallas, TX

Big Renovation Project• Swedish Medical Center, Master Plan –

Denver, CO• Rose Medical Center, Various Projects –

Denver, CO• Wesley Medical Center – Wichita, KS

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Kicking off EDI on a Project

• Determine required attendees for kickoff/project alignment meeting

• Project alignment meeting• Establish project goals• Prefabrication and other innovative or

creative options• Establish roles and responsibilities• Develop meeting structure• Develop Key Process Indicators (KPI) and

reporting structure• Develop charter to capture information

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AGENDA

MEETING PLANNER MEDICAL CITY PLANOMCP Tower – Week 6 – Co-Located Team Meeting 11/30/2017 | 08:00 am – 9:30 amWSP: 3102 Oak Lawn Avenue, Dallas, TX 75219 & JE Dunn: 12 Cadillac Drive, Brentwood, TN 37027

# TIME ITEM FACILITATOR

01 08:00 – 08:10 Project Summary Ashley Aye

02 08:10 – 08:40 Work Register Review Justin Vauthier

03 08:40 – 08:50 Budget Discussion Russell Templin

04 08:50 – 09:00 Big Picture Overview on Design Omar Cantu

05 09:00 – 09:25 Cluster Group Report Out Cluster Leaders

06 09:25 – 09:30 Red Flags / Risks Discussion All

INVITEES (25)

KEY DISCUSSIONS• Ashley Aye reviewed the MCP Tower Executive Project Update with the team highlighting the new updated

sections. It can be found under the ‘Program Summaries’ folder in the MCP Tower project’s eBuilder public folder.

• MCP Tower Work Register was reviewed and updated. It can be found in the Public Folder. The Action Item Log had no open items.

• Omar Cantu provided the design update, highlighting some plan changes forthcoming based on errors on drawings of existing building.

• Todd Curry, Matt Moore & Kelly Whitney provided the City update. Meeting scheduled 12/4 with the head of P&Z to discuss City Entitlement issues.

• The Building Envelope Commissioning cluster was designated as complete.• An updated Cluster Roster, ‘Cluster Teams Chart_2017-11-30.pptx’ was posted to eBuilder in the Cluster

Folder.

• BIM modeling progress was highlighted as being much farther ahead than on previous projects and was highlighted as a big win for this project.

• The team reviewed the process for closing out cluster groups that was introduced in the 11/16 Co-Located Team Meeting, with advocates to assist cluster leads with Lessons Learned and with the Cluster Summary A3.

Jenna Taylor HCA Todd Curry HCA Josh Tenisci HCA Ashley Aye HCA Rob Crotty HCA Kelly Whitney P+W Omar Cantu P+W Scott Barnhill P+W Brian Svedman P+W Justin Hughes P+W Jessica Narvarro WSP Roger Koppenheffer WSP Justin Vauthier WSP Lance Munger LAF Morgan Allford LAF Matt Moore CE Russell Templin JED Marty Corrado JED Bill Fusco JED Sara Curry JED Nelson Beaver BR Kyle Holmes BR Marty Diebold ENT Eric Sheffer SSR Amanda Moore WEVR

QUALITY CHARACTERISTICS GOALSCost 10% Reduction

Schedule 10% ReductionPrefab 60% Moved Offsite

UPCOMING MEETINGSMEETING CITY LOCATION DATE

Blue Beam Page Turn(Site Architectural, Structure)

Dallas WSP 12/6/17

Blue Beam Page Turn (MEP) Dallas WSP 12/7/17

Plano Co-Located Meeting Dallas/Nashville P+W / JED 12/14/17

CLUSTER UPDATESPrefab Comp Ph II Work session held last week, with multiple spin off sessions being wrapped up this week.

Fire Alarm Simplex completed survey and is finalizing drawings. Meeting to follow to put narrative together.

MEP Standard Deviations Ongoing analysis pending generator manufacturer selection & VE Lighting package.

Interior / Finishes No updates until next meeting with facility.

Structures Continuing detailing of design. Ongoing coordination w/ Exterior Wall Panels, Elevators & MEP Racks.

Building Envelope Cx Will not bring on additional consultation, with testing to be coordinated by Josh A., Robert L., BT & JE Dunn. Mary D. from P+W is coordinating specs for Cx. Cluster designated as closed.

LEED Scorecard & Matrix updated, 53 ‘Yes’ & 13 ‘Maybe’, near Silver Range. 5 of remaining 13 possible points TBD by end of CD, with remaining 8 to be determined over the course of construction.

MEP Racks Meeting held 11/29 w/ rack teams and trade partners, with focus on corridor racks and patient room racks, leading to most utilities being included in racks. Doing BIM coordination early, with trial run on uploading rack models for review in December.

Work Sharing BIM Execution plan updated with JE Dunn protocols, pending final MEP scope definitions.

RED FLAGS OWNERAdditional energy code requirements for Bathroom Pods. Jessica / Amanda

Additional plumbing fixture requirements for first floor Omar / Jessica

MANAGEMENT HRS (37.5)

• Teams consisted of cross-sectional support, including subject matter experts for specific systems and from trade partners

• Once the team had fully vetted all concerns with the utilization of the premanufactured component the group disbanded and follow-up report capturing lessons learned was developed for future projects

Design: Collaboration & Innovation

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7.21%

4-STORY (132,000 SQ. FT.) 90 PATIENT BED

Medical Center Plano

• TEXO’s Merit 2020 Distinguished Building Awards Recipient

• 1st LEED Gold for v4 in Healthcare ever

• RFI metrics: 93 (typical project sees 980)

($8.7M)Cost reductions

48%Man hours moved offsite vs target*

6.7%(3 mos)

Schedule/Time gains

*Man hour percentage was based on estimate of man hours that were deemed practical of being moved offsite, and not based on the total onsite project manhours

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Swedish Medical Center – Master Plan EDI

• Over 200,000 sf of renovation• Project had over 120 phases• 30-month schedule• With the use of EDI, JE Dunn was able to

complete the project on time and stayed within HCA’s budget

• After research of Action Item List – did a cost comparison between change order versus bid price

• Discovering items in documents we were able to get the scope priced in a competitive bid environment.

Added value credit of $808,730 realized

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• Kick-off meeting in Dallas with HCA and Design Team• Big Room Meetings every 6 weeks• Breakout Group Meetings - Every Week• Broken out By Scope of Construction• BIM was utilized for MEP coordination

Project Scope – Currently in Design

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4-STORY HORIZONTAL EXPANSION TO EXISTING FACILITY (107,000 SQ. FT.) 8,000 SQ. FT OF RENOVATION

At completion of CDs all MEP Racks were designed and complete

Swedish Medical Center – Tower Expansion

Identified optimal time to bring trade partners on so the owner’s money and trade partners' time weren’t wasted.

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• Select the right project team who will engage in the process and are wiling to learn • Set the tone from the start with the team alignment • Identify roles and responsibilities

• Identifying proper tools needed• Metrics development and maintenance, • Time demands, meeting requirements not only for the beginning of the process but

throughout the execution of the project• Alignment of behaviors (development of trust)

The Challenges That Were Overcome were:

Lessons Learned for JE Dunn

What went well:

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HCA What Has Worked Well

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HCA Areas of Improvement• Team collaboration

• Less owner driven

• Innovations with prefabrication

• Progression Model sharing

• Inconsistent execution• Lack of role clarity• Establish conditions for upfront

EDI investment• Nonstandard measures of

success• Timing of team on-boarding• How to scale down for smaller

projects

Lessons Learned for HCA

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What questions can we answer for you?

https://www.hcacapitaldeployment.com/Learn more about EDI:

Questions

?

Slide Number 1Early Design Involvement (EDI) ProcessJE Dunn Healthcare StatsHCA Healthcare Operating StatisticsSlide Number 5Slide Number 6Early Design Involvement (EDI)Slide Number 8Types of Projects Which UtilizedKicking off EDI on a ProjectSlide Number 11Slide Number 12Swedish Medical Center – Master Plan EDIProject Scope – Currently in Design Lessons Learned for JE DunnSlide Number 16Questions