Replacement Hospital Rising

The SSM Health Saint Louis University Hospital will be a state-of-the-art facility when it welcomes its first patient in September 2020. For the project team, including SSM Health (owner), Alberici (construction manager), Lawrence Group (designer), and Northstar (program manager), it’s only fitting that the construction of this facility incorporate some of the latest trends in hospital construction.

Lean Construction
Lean construction methods are nothing new to SSM Health or Alberici, who embarked on their first lean project together almost 15 years ago, at Cardinal Glennon Children’s Hospital. Drawing upon experience on three previous lean projects, the team is applying lean practices to the SSM Health SLU Hospital project. The project’s contract documents include a Collaborative Project Charter, which formalizes the partnering relationship and clarifies roles among team members, including the owner, designer, program manager, and construction manager. This encourages cooperation, transparency and innovation among key participants to ensure that the design and construction of the new facility provides the most value with the least amount of waste.

The heart of the team’s lean effort is the Last Planner System (LPS). Designed by the Lean Construction Institute, LPS is a production control system which minimizes waste, maximizes productivity and reduces workhours. LPS relies on input from craftspeople and subcontractors, who confirm that work is progressing on schedule through weekly work plans and daily huddles. Their input helps develop a detailed milestone schedule and associated look-ahead schedules. These look-ahead schedules give the team the flexibility to rapidly adapt to modifications and unforeseen changes.

The team developed a detailed procurement plan, which included design-assist for critical scopes of work. In the plan, they defined design-assist for the project, clarified roles for each team member, and established deliverables based in the AIA requirements of SD, CD, and DD. They also identified deliverable needed between design intervals to meet the project’s procurement strategy.

Based on this procurement strategy, the team engaged design-assist subcontractors for MEP and curtainwall at the end of schematic design. The design-assist partners were selected based on qualifications, team, and fees, and worked with IMEG (the engineer of record) to incorporate their technical expertise into the construction documents.

By engaging key subcontractors for design-assist, the team is providing higher quality and budget certainty for these critical scopes. Design-assist partners included AGC members Murphy Company, Guarantee Electrical Company, Corrigan Company Mechanical Contractors, Ahern Fire Protection, Kaiser Electric, Inc., and C & R Mechanical Company.

Prefabricated Work Components
A critical element to the previous and ongoing success of the project has been the utilization of prefabricated, unitized, and modularized building components. Major elements of the building that were fabricated off-site included the patient bathrooms, patient room headwalls, and the exterior curtainwall system. Fabricating building systems in an off-site warehouse provides the trades with a controlled work environment that allows for repetitive tasks and is not subject to weather or the congestion of other trades. The controlled environment enables increased efficiencies in labor productivity while maintaining a high level of quality.


Photos left to right: Prefabricated bathroom pods, prefabricated headwall and pods in warehouse.

Beyond the efficiencies in production off-site, the project site greatly benefited from the ease of installation and site decongestion that resulted from prefabrication. In earning the workhours associated with each task off-site, the team advanced work that typically must wait for other work to complete. For instance, many of the patient bathrooms were constructed and delivered to floors of the building before any wall framing had begun in that area. This early production will prevent the overcrowding of tradespeople and materials in work areas later in the project, leading to future efficiency gains.

Mock Up Construction
Throughout the project, several critical building areas were identified by SSM Health and the design team to be constructed as a mock-up. The areas included a patient room and the surrounding corridor, a sampling of spaces that are included in the attached ambulatory care center, and a representation of each of the exterior enclosure materials and systems. Each of the areas were reviewed by SSM, the design team, and the construction team for value engineering opportunities and constructability concerns. Additionally, the hospital’s end users - including nurses to maintenance staff - could view the space and provide feedback on improvements. By reviewing the end product at an early stage, decisions such as finish colors or counter heights could be made or changed before construction had proceeded to the point that any revision would need to be made hundreds of times. The major benefit to mock-ups was cost avoidance, and the costs associated with the construction of the mock-ups were potentially offset by preventing potential changes to work already in place.

Once the mock-up was complete, it was memorialized using a 4K 360-degree camera, allowing for future virtual walkthroughs. In addition, the design team provided SSM Health with a virtual reality (VR) walkthrough of other hospital spaces. The consensus among the team was that the VR walkthrough provided a larger than expected benefit. While the VR technology does not appear to currently present an outright replacement for ‘real’ mock ups, advancements in the technology area should be monitored for extended future use and potential cost savings.

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