IPD in Real-Time: Designing and Building the New Parkland Hospital

Our project management leadership team successfully led the design for the master plan of the 64-acre healthcare campus and the 862-bed full-service acute care replacement hospital for Parkland Hospital and Health System, Dallas, Texas. With a vision in hand, we crafted a welcoming, state-of-the-art facility that is patient-centred and promotes excellence in critical care. All this was possible because of our highly collaborative, co-located team of dedicated professionals.

As the largest healthcare construction project in the country at the time, it needed a special team and approach to deliver the project. We used an integrated project delivery (IPD) approach but without a formal IPD contract. The team members — HDR, Corgan and BARA — adopted a Collaborative Project Delivery (CPD) model of execution with several key elements:

• Primary consultants were to be engaged simultaneously, with a construction manager-at-risk (CMAR) in a design assist mode
• A 40,000 SF co-located office was established for all key consultant team members and for mock-ups of key rooms
• Aligned/coordinated contracts between the key consultants ensured that we captured the scope of early involvement
• Use of an integrated project management system for document control, accounting, BIM, scheduling, cost control and team communication
• Use of an owner-controlled insurance program (OCIP) to help alleviate and mitigate lost time and cost from potential claims between individual firms and the owner

Establishing Design Intent

With a project the size of Parkland and the number of team members that participated in the project, it was paramount to have a process for maintaining the design intent throughout the life of the project. The critical care tower project had an added level of complexity with the design vision being established at the beginning of the project, but with the risk it could take many years to design and build all components of the project. Therefore, it was critical for Parkland to maintain and document both the design intent and the program intent, creating a clear path for the success of the project and keeping everyone on the same page. Based on jointly established goals, we established the Basis of Design, which acted as a compass, guiding decision making along the way.

High-Performance Teamwork

High-performance teamwork is all about collaborative decision making and jointly developed goals. For Parkland, more than 900 stakeholders were involved in influencing, making, evaluating, or confirming decisions needed for the monumental project. The project was completed on time and $30 million under budget. The following factors outline what made our decision making successful.

Co-location: An important component in unifying the new Parkland project team was creating a co-located work space. Key team members from the design team and owner and construction team worked in this space adjacent to the new hospital site from project initiation to completion. Having everyone in one place provides the opportunity to experiment, exchange and test theories in a collaborative and inspiring space, together.

Collaboration: Bringing diverse minds together is the backbone to CPD/IPD. To ensure productive collaboration, at the start of the Parkland project, the team wrote a covenant that established the ground rules for how the team would work together. The covenant covered everything from conflict resolution strategies to communication protocols and required response times.

Concurrency: Because of the team structure and the ability to solve problems immediately, the project team could go from concept to design to construction in an abbreviated timeframe. With Parkland, this process helped us design two large-scale projects simultaneously — a master plan of the 64-acre medical campus and the schematic design for the hospital. This is unusual because typically, master planning and schematic design are produced in sequence. The master plan was approved by the client in December 2009, and the schematic design for the hospital was finished and approved in March of 2010. CPD/IPD allowed the team to work on multiple overlapping projects without compromising quality.

Research & Perspective

A key part of CPD/IPD is seeking perspectives from multiple users and peer groups. A number of factors contributed to collaborative decision making at Parkland.

Clinical Liaisons: Clinical liaisons were embedded in the team from programming through design. These individuals provided an active, timely link for communicating between the owners’ senior leadership and user groups, providing insight into how the individual buildings would ultimately function separately and together as well as with the overall campus.

Peer Reviews: As part of the CPD/IPD process, we invited industry experts, including other hospital owners and academia, to review design concepts. This industry review strengthened the design process by adding another layer of perspective. The Parkland peer review team provided a plethora of ideas and critical thinking on behalf of the entire project and the community Parkland serves.

Patient and Family Advisory Council: To harness the power of the patient perspective, the team established The Patient and Family Advisory Council, whose members consisted of patients and family members who had been at Parkland frequently throughout the years. They provided input on program and design decisions, and many of their comments and ideas were incorporated into the design process.

Construction Phase Efficiency

Parkland Health and Hospital System, working with the team, employed a number of lean construction methodologies on the project.

Pull Planning: Based on the size of the project and complexity of the schedule, the team used “pull planning” for scheduling. During two weekly pull planning sessions, crew foremen and the CM updated the schedule by trade and re-sequenced work according to the “real time” information provided by the workers. While efficiencies in the schedule are achieved as a result of re-sequencing work, the greatest benefit the team has experienced has been behavioral where we are all in this together and opinions matter.

Procurement Strategy: Timing is everything when it comes to procurement. Careful planning and collaboration with the design and subcontracting teams and swift execution allowed the team to adhere to the original budget and timeline. Procurement strategies implemented included:

• Early bid packages that gave the team an advantage over competing projects in the area with similar timing
• MEP and curtain wall, both design-heavy trades, were engaged early on in a design-assist role
• The sub market was primed early with information about what would be included in specific packages and when they would be released

Prefabrication: Through IPD and collaboration, the team identified repeating elements in the building that offered opportunities for off-site prefabrication. At the Off-Site Fabrication and Logistics (OFL) Facility, 750 patient bathroom pods, three miles of overhead MEP racks, and 850 headwalls were pre-assembled only two blocks away from the New Parkland Hospital. Prefabrication enhanced the project schedule, maximised the quality of the finished product and enhanced safety by allowing several trades to work at waist-to-shoulder height instead of using ladders in congested construction zones.

Mockups: Valuable clinical input was given to the design and construction teams as a result of the feedback users gave the team after experiencing the true-to-size models of patient care areas including an operating room, intensive care room, trauma room, labor and delivery suite, visitor elevator, neonatal intensive care room and emergency exam room. Once clinical and patient input was integrated into the rooms, nursing staff returned to practice mock medical codes and procedures in the mockup rooms to assure the design functioned at its highest level. The process also reassured Parkland nurses and clinical staff that the design team is looking out for their patient care needs. Tours of the mock-ups also supported the Parkland Foundation’s fundraising efforts.