Improving the Design and Permitting for Acute Care

Report
Improving The Design and
Permitting Process for Acute Care
Facilities in California
Developing a Future State Map For
California Healthcare Projects
June 2007 Update
Challenges to Design of
California Healthcare Projects
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Very Complex
Projects
Three or More Years
From Design Start
to Permit
OSHPD Review
Changes in
Technology
Limited Resources
Large Batch Process
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Ineffective Cost
Control During
Design
Poor Integration of
Design and
Construction
Technology
Loss of Team
Members
Poor Construction
Phasing
The Current State
Significant Construction Cost Overruns
 Multiple Permit Re-submittals
 Poor Drawing Quality and Coordination
Between Disciplines
 Loss of Team Continuity
 Designers Losing Money
 Owners Frustrated
 OSHPD Defensive
 Contractors Avoiding
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Time for A Change
Industry Leaders Deciding To Create a
Change in the Design Delivery Model
 Boldt, Mazzetti, HGA, Herrero,
Southland, Rutherford & Chekene,
Rosendin
 Application of Lean to Design Model
 Tried to Generate Current State VSM
 Determined need for industry wide
visibility and participation
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Value to Customers
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Healthcare Provider
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Meets Functional
Program
Requirements
Meets Cost Goals
Completed On-Time
Built-In Quality
Meets Life Cycle
Requirements
Satisfies Community
Served
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OSHPD
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Code Compliant
Submitted On
Schedule
Coordinated Design
Complete
Easily Interpreted
Plans and
Specifications
High Quality
Accurate
What Are We Trying To Achieve?
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Meet Program
Requirements
Level the Design and
Construction Work Flow
Create More Accurate
Submittal Packages
Integrate Cost with
Design to Manage in
Real Time
Create a Baseline
Starting Point for the
Design Process
Deliver Only What “the
customer” needs
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Keep the Design and
Construction Team
Integrated Throughout
the Project Lifecycle
Shorten the Time to
Market
Provide Flexibility
Where Needed to Meet
Program Requirements
Create a Process that
Will Encourage Truly
Collaborative Behavior
When Used Together
with Other Lean Tools
and Methods
Progress To Date
Created Format for Five all day
Workshops Sponsored By Industry and
Hosted by UCB/P2SL Group
 Invited the Community to Participate
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Owners
 OSHPD
 Architects/Engineers/Designers
 GC/Specialty Contractors/Vendors
 Education
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Progress To Date
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Received Excellent Participation by
Management from:
OSHPD (5 People)
 CHW, St. Joseph's, UCSF Medical Center,
Kaiser, and Sutter Health
 A&E Community
 CM/GC and Specialty Contractors
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Between 60 and 88 participants
throughout the 5 full day workshops.
Progress To Date
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Workshop One - Focus and Results
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Introduction of the Ideas and Intent of the
workshops.
Hear from “Customers” what value is to them and
what they are doing to improve today.
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OSHPD, CHW, Sutter, St. Joseph, Kaiser
Break into four groups to map current state of
each of the four Owners.
Cross functional teams pre-assigned.
Developed Initial Current State Maps
Team by Team report out of Progress and Lessons
Learned
Progress To Date
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Workshop Two - Focus and Results
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Discussion and Identification of 8 Wastes
Completion of Current State Maps
Identification of Opportunities For Improvement
based on Waste Identification During Current
State Mapping Process
Completed Current State Maps
Identified over 200 areas of waste in existing
process.
Shared results with all teams
Progress To Date
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Workshop Three - Focus and Results
Discussion and Identification Future State
Characteristics and Goals.
 Identification of Near Term (future state)
and Long Term (ideal state) opportunities.
 Started work on both Future State and
Ideal State Maps
 Shared results with both teams
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Progress To Date
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Workshop Four - Focus and Results
Continued work on both Future State and
Ideal State Maps and specific OFI areas.
 Created a framework for continuing with
this process upon completion of the five
workshops.
 Shared results with all teams
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Progress To Date
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Workshop Five - Focus and Results
Identified Actual Pilot Projects that will
implement one or more process
improvements from this workshop.
 Reviewed the results of our waste priority
survey.
 Completed the framework for continuing
with this process upon completion of the
five workshops.
 Shared results with all teams
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Accomplishments
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Heard from our Customers what is important to them and where they believe opportunities
for improvement exist in the industry and their own existing process. OSHPD, Sutter
Health, Kaiser, CHW, and St Joseph’s.
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Created a current state map of the design and permitting process for four major health
care organizations.
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Identified specific waste in each of those process maps, where there was resistance to
changing the current process and additional areas where significant opportunities for
improvement exist that need to be mapped in greater detail.
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Identified goals and attributes of a future state map that would reduce much of the waste
in the current state processes on our way to creating an ideal state.
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Began the creation of several future state maps including both near term innovation and
long term ideal state opportunities.
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Identified Five Actual Pilot projects where new processes will be implemented to reduce
waste and increase value to the customer.
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Initiated the actual mapping of four of the five pilot projects.
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Defined a framework for a committee under the guidance of P2SL to continue with the
development, experimentation, and implementation of this future state process through
the use of pilot projects, continuing education, project specific coaching, reporting and
recording, design and tracking of metrics associated with each experiment, and organizing
future workshops.
Breakthroughs
Realizing what can happen when all of
the right people are in the room at the
right time focused on the right thing
with the right behavior.
 Understanding and accepting our own
roles and barriers to the elimination of
waste.
 Mapping is hard work but creates high
value by helping the team focus on the
real value added work.
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Images From Our Workshops
Images From Our Workshops
Images From Our Workshops
Images From Our Workshops
Images From Our Workshops
Images From Our Workshops
Images From Our Workshops
Images From Our Workshops
Images From Our Workshops
Images From Our Workshops
Pilot Project Update
Palo Alto Medical Foundation (PAMF)
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Sutter’s Palo Alto Medical Foundation,
San Carlos Center Project
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Current primary focus points
 Integrated
OSHPD review
 Elimination of waste in production of design
 Target Value Design
OSHPD Process
Palo Alto Medical Foundation (PAMF)
Reduce the design & permit cycle time.
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Eliminate redesign
Establish processes for acceptance.
Identify the size of batches/packages and to
what disciplines.
Establish clear and consistent
communication procedures.
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Interface protocol + Frequency
Protocol for changes.
Assigned staff stays on the job.
What’s done is done.
OSHPD Process
Palo Alto Medical Foundation (PAMF)
Developing a Standard Plan
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Three Sutter Teams
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Palo Alto Medical Center
California Pacific Medical Center – CHH
Sutter Elk Grove – Prototype #1
All Under IFOA Contract
Creating Common Approach to
Design/Development/Permitting where
possible
Presenting Standard Plan for OSHPD
Engagement Consistent with IFOA and “Five
Big Ideas” and Integrated Lean Project
Delivery Process
Draft of Sutter Proposed
OSHPD Engagement Plan
Define team members with roles, responsibilities and authority (all members: OSHPD (field and
office), S-FPD, SHA, Design and Construction Group, IOR,) Includes Org Chart Template that
captures this information.
Define communication plan to include:
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Create macro level proposed design, permit, construct, occupy, value stream map indicating approval
packages.
Create Schedule to inform the development of rolling Six Week Look Ahead and Weekly Work Plans.
Identify workshops to have with team to address:
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Methods of communication (email, memos of understanding, drawings, digital models, Web X, meetings, etc.)
Channels for all communications.
Identifying Batching of data.
Expected response times for each type of communication.
Regular meeting times if and when appropriate.
Common language and lean principles.
Delivery model.
Design of the drawing and review process that makes the final review process for permit approval a validation of
previous decisions and agreements.
Expectations of both sides
Identify Specific deliverables by package (what does OSHPD need to see vs. what design group thinks they want to
see)
Drawing and document model, packaging, content
Define methodology to document agreements clearly
Define methodology to clearly identify common design thread throughout approval packages as it relates to code
requirements
Define failure response matrix to address breakdowns in the process so that we can learn and respond to the
inevitable (Plan Do Check Act loop)
Define first run study to test the complete process with a small piece.
Identify how OSHPD can get paid for their involvement, per pending legislation (SB306).
Train all members of the team (both sides)
Additional Challenges and
Ongoing Work
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Legal Boundaries for OSHPD (SB306)
Creating Ideal/Future State Map
Publishing a “Current Best Practice”
Document
Presenting to Industry to Maintain
Momentum (AIA, CII, ASHE, Etc)
Investigating Alternate Ideas to Aid or Speed
the Process
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OSHPD Review/Use of BIM/VDC models
Use of technology vs. capital limitations
Celebrating and Promoting Successes to
OSHPD and Industry
Questions?
Suggestions?
 Input?
 Volunteers?
 Ideas?
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