Jacobs Carter Burgess Planning and Design for the New Chinese Hospital May 7, 2008 Jacobs Carter Burgess with ARUP Mazzetti Associates FW Engineers SJ

Jacobs Carter Burgess

Planning and Design for the New Chinese Hospital

May 7, 2008

Jacobs Carter Burgesswith

ARUPMazzetti Associates

FW EngineersSJ Engineers

Herman Miller for HealthcareDavis Langdon Associates

Treadwell RolloWeAreSure

KCADPR

Chinese Hospital Progress Update


Born November 27,1940at Chinese Hospital

Chinese Hospital?


Epidemic outbreaks caused by the state of atmosphere or poor sanitary conditions affecting local atmosphere. Chinatown with its “foul and disgusting vapors” was the primary cause for atmospheric pollution in San Francisco.

Jacobs Carter Burgess Chinese American History

Health in Chinatown

• Board of Health demanded that the Chinese Six Companies clean up overcrowded boarding houses and residences, and “take their sick countrymen outside the city limits.” Chinese continued to be denied care at hospitals.

• Chinese Six Companies leaders resolved to build a hospital on the outskirts of the city, but the City Council denied the plans, because they questioned the effectiveness of Chinese medical treatment and hospital care.

• 1876 - Smallpox epidemic hit San Francisco. Public health officials traced the source of smallpox to “unscrupulous, lying and treacherous Chinamen” and “their willful and diabolical disregard of our sanitary laws.” Chinatown was more than a slum, it was “a laboratory infection.”

Jacobs Carter Burgess Health in Chinatown

1900 City Officials were reluctant to finance any health services for the Chinese population even though viewed as a “laboratory infection.”

Chinese Consolidated Benevolent Association spearheaded efforts to provide health care services for the Chinese community. They were able to fundraise $26,000 to build the first health care dispensary.


Chinatown After San Francisco’s 1906 Earthquake

City Officials proposed to relocate Chinatown to a less desirable location away from the center of the city.

Jacobs Carter Burgess Chinese Hospital History

1906 Tung Wah Dispensary was rebuilt after the Earthquake

1918 Demand outgrew capacity of Tung Wah Dispensary. Fundraising committee formed to expand and remodel the building. The remodeling plan was suspended when the committee decided to build a completely new hospital at a different site.

1922 Fifteen local Chinatown community organizations participated in a fundraising drive for the construction of the hospital. One representative of each organization later became the Board of Trustees of the hospital. Donations came from the Chinese throughout the U.S. as well as internationally from Hong Kong and Shanghai.

1923 Approval of hospital project by the city’s Board of Supervisors

1925 The opening of Chinese Hospital

Jacobs Carter Burgess Chinese Hospital History

Chinese Hospital opened on April 18, 1925 at 835 Jackson Street with sixty patient beds.

Jacobs Carter Burgess Chinese Hospital

Jacobs Carter Burgess Integrated Delivery System

Chinese Hospital

Chinese CommunityHealth Plan

Chinese CommunityHealth Care Assn.

CCHCA

CH

CCHPIDS

Three partners form a “fourth” enterprise and jointly share in its success independent of

individual operations


“It's not the plan that is important, it's the planning. “

Graeme Edwards

”Plans are nothing; planning is everything.”

Dwight D. Eisenhower


“The trouble with the future is that it usually

arrives before we're ready for it.”

Arnold H Glasgow

Jacobs Carter Burgess Our Approach

• An Integrated Design Approach• Process Mapping• Target Costing• Systems Integration and Optimization• Decision Management

Jacobs Carter Burgess Goals

To Provide Affordable New State Of The Art

Facilities From Which Chinese Hospital Can

Efficiently Meet It’s Role And Mission In The

Community


To Recognize Site

Limitations and

Optimize Site Use


To Optimize Construction Value Through

Optimization of Engineering Systems, and the

Building Envelope


To Develop the Smallest Code Conforming

Workable Spaces and Use Modular and

Movable Systems Where Appropriate


To Use Proven and OSHPD Approved

Materials, Assemblies and Systems Without Frills


To Minimize Cost Escalation by Using

Integrated Project Delivery and Lean

Practices to Reduce Time and Wasted Efforts


To Respect the Unique Nature of Chinese

Hospital and Its Relationship to the Community

and Between the Hospital, Health Plan and

Physicians

Chinese Hospital

Chinese CommunityHealth Plan

Chinese CommunityHealth Care Assn.

Chinese Hospital’s net operating margin has defied the odds.

Chinese Hospital

All California Hospitals

1995 1.06% -1.20%

2000 4.35% -5.20%

2003 5.60% 3.35%

2006 10.24% 2.02%

Jacobs Carter BurgessThe Planning and Design Process

– Integrated Planning and Design

– “Inside Out and Upside Down”

– Over 280 Meetings and Work Sessions with hospital staff, nurses, and physicians



– “A Mixture” vs “A Solution”


To Choose Optimal Solutions

and Maximize Value

Establish a Value for Each Decision

Choose the Sequence with the Highest Maximum Value

The Planning and Design Process

Jacobs Carter Burgess The Planning and Design Process

Jacobs Carter Burgess An Integrated Delivery Process


Programs and Medical Systems

Architectural and Building

Systems

Civil and Structural Systems

MEP Systems Interiors / Modular Systems

An Integrated Delivery Process

Design Documentation

Finalize Preliminary Design

On Site Construction

Cost Model Reconciliation

Decision Point # 1: Confirm decision process, communications, protocols, meetings

Decision Point # 2: Confirm all current conditions, project budget elements, project schedule, and quality expectations

Decision Point # 3: Confirm process maps, room diagrams, equipment lists, floor plates, building exterior, and cost model

Decision Point # 4: Reconcile and confirm space program, architectural finish, massing and floor plates, and parking scheme

Decision Point # 5: Conduct and confirm “building level gaming,” location of all major building systems, all departments, exiting, and reconfirm cost model

Decision Point # 6: Conduct and confirm “departmental gaming,” layouts for all departments, and reconfirm cost model



– “Inside Out and Upside Down”

– Process Mapping

– Room Diagrams

– Equipment Lists

Patient is diagnosed/referred by Physician

Registeredpatient?

Patient arrives at MadronaMedical Center

Patient is directed toIntake for registration

(5-10 min)NO

YESPatient is registered

Patient directed toOncology departments

Patient arrives at Reception (45min prior to appointment if lab/x-

rays req’d)

Patient signs in withreceptionist

Patient directed to Labto get blood work done[done within Oncology]

(10 min)

New patient toOncology?

YESPatient waits in

Waiting area (1-5 min)

Patient is called in by Receptionistand directed to _____________ tohave vitals signs taken by Nurse (5

min)

Patient taken to Exam room byNurse and waits for Physician

Physician arrives at providesinitial consultation (1 hr)

Nurse/receptionist doesscheduling/educating patient[in exam room] (30-45 min)

Patient directedto Imaging

Patient directed toExam room

NO

Patient (de-gowns and )returnsto Oncology waiting area [interimwaiting area that is separate fromgeneral waiting for those waitingfor lab results or infusion station]

to wait for results (5-45 min)

Patient gowns for x-ray,x-ray taken (5 min)

Lab results/x-rays comeback

Patient directed to Exam roomwhere Physician/Nurse review

results

Is patient readyfor treatment?

YES

Infusion stationavailable

YES

Patient assigned tostation and is treated (5

min - 8 hrs)

NO

NO

Requiresfluids

Blood counttoo low

NO

Patient checks out atReception (5-20 min)

Patient goes home (andis called back next day)

After hours?

NO

YES


ICU Single Patient Room


Exam Room

Operating Room

R/F Room

Office CubiclesOffices



– Systems Optimization

– Structural Systems

– Mechanical Systems

– Electrical Systems

– Plumbing Systems

– Building Envelope

Jacobs Carter Burgess Mechanical Systems

Integrated Optimization Concepts

• Use 100% outside air, two duct system to reduce the amount of ductwork.

• Use multiple vertical drops on the perimeter of the building for the plumbing system to minimize above ceiling conflicts and allowing for prefabrication of risers.

• Use a prefabricated mechanical plant on the roof. The plant will be fabricated off-site and lifted into place in three stages, substantially reducing the on-site construction work and speeding the construction process.

• Alternate the Electrical Rooms on the floors with IT Rooms. This allows the reduction of space consumed for these functions on each floor, and has allowed the connection at all levels.

• Use a exhaust fans on each floor eliminates the need for a central exhaust system which consumes floor space for shafts and reduces the number of ducts.

Jacobs Carter Burgess Relatively Short Floor to Floor Heights

Careful Coordination with Structural Systems

13’6” and one floor at 12’0”

Jacobs Carter Burgess Area = Cost

Jacobs Carter Burgess Desire Meeting Affordability

Jacobs Carter Burgess Building Cost Comparisons


– Decision Management

– Target, Scale and Value

Jacobs Carter Burgess Cost Comparisons

– The Benefits of Cost Targeting and Control: More Space

– $775 per square foot compared to estimated costs of well over $900 per square foot for other hospitals in California and San Francisco

– The cost per bed is approximately $2 million per bed compared to estimates of up to $3 million per bed on other projects in San Francisco and California

Jacobs Carter Burgess Current and Future Space



– Architectural Image

– Context

– Community

– Sustainability

Jacobs Carter Burgess Development of Exterior Design




The Work Continues

Dependent Decision Logic

Criteria

Calculation

“Component”

Anchorage

DPR Added To Team


A Demonstration Project

Steps and Incremental Packages Which Include Criteria, Calculations, Drawings and Related Specifications for Review and Approval

Step 1 CompletedDevelopment and Confirmation of Required Essential Program Elements

Step 2 CompletedDevelopment and Confirmation of Essential Building Systems Approach

Step 3 CompletedDevelopment and Confirmation of a Basic Life Safety and Exiting Approach

Preliminary Submission

Dec-07 Preliminary Plan Set


The Increments and Packages



Est. Date

Steps and Incremental Packages Which Include Criteria, Calculations, Drawings and Related Specifications for Review and Approval

Increment / Package 1

Jun-08Development, Submission and Confirmation of Site, Accessibility and Life Safety Plans Including Partition Types and All Life Safety Related Building Systems


Jun-08Development, Submission and Confirmation of Underpinning/Shoring Systems


Jul-08Development, Submission and Confirmation of Foundation, Structure and Envelope



Est. Date

Steps and Incremental Packages Which Include Criteria,Calculations, Drawings and Related Specifications for Review and Approval

Increment /Package 4

Sep-08Development, Submission and Confirmation of Mechanical, Plumbing and Electrical Components and Anchorage


Oct-08Development, Submission and Confirmation of All Other Architectural and Interior Elements


Dec-08 Compilation and Submission of Composite Documents

Jacobs Carter Burgess Status

– Challenges

– Eliminate all deferred approvals

– Integrate detailing

– Continuous Cost Targeting

– Team growth

– Intuitive and counter intuitive

– Habit and culture

– Sharing all information early and often

Jacobs Carter Burgess Activities

– Acquire and Integrate

– Sub-contractors

– Vendors

– BIM models

– Decision management

– C-VSM (continuous VSM)

Jacobs Carter Burgess LEED

2 points to Gold!

Jacobs Carter Burgess Activities

– Other Important Owner Decision Related Initiatives

– Mock-up Rooms

– Equipment Analysis and Selection

– Transitional Space

Jacobs Carter Burgess Considerations

– Scariest Statements (FEARS)

– “Regularly Scheduled” Meetings

– “Tell me what to do.”

– “When you’re through, send me the drawings and I will review them right away.”

– “Let’s keep going, it should be OK.”

– “Why are so many people involved?”


My interest is in the future because I am going to spend the rest of my life there.

Charles F. Kettering 1876-1958

Before beginning, plan carefully.

Marcus T. Cicero c. 106-43 BC

A man who does not think and plan long ahead will find trouble right at his door.

Confucius 551-479 BC

The Planning Continues


Born November 27,1940at Chinese Hospital

Chinese Hospital?


Thank You

Jacobs Carter Burgesswith

ARUPMazzetti Associates

FW EngineersSJ Engineers

Herman Miller for HealthcareDavis Langdon Associates

Treadwell RolloWeAreSure

KCADPR

Chinese Hospital Progress Update