Jacobs Carter Burgess Chinese Hospital Progress Update

Planning and Design for the

New Chinese Hospital

May 7, 2008

Jacobs Carter Burgess

with ARUP Mazzetti Associates FW Engineers SJ Engineers Herman Miller for Healthcare Davis Langdon Associates Treadwell Rollo WeAreSure KCA DPR

Jacobs Carter Burgess

Chinese Hospital?

Born November 27,1940 at Chinese Hospital

Jacobs Carter Burgess

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.”

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Health in Chinatown

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

Jacobs Carter Burgess 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.

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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

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Chinese Hospital History

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

Jacobs Carter Burgess

Chinese Hospital

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Integrated Delivery System

Chinese Hospital CH Chinese Community CCHCA Health Care Assn .

IDS CCHP Chinese Community Health Plan

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

Jacobs Carter Burgess

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

Graeme Edwards

”Plans are nothing; planning is everything.”

Dwight D. Eisenhower

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“The trouble with the future is that it usually arrives before we're ready for it.” Arnold H Glasgow

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• • • • •

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

Our Approach

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To Provide Affordable New State Of The Art Facilities From Which Chinese Hospital Can

Efficiently

Meet It’s Role And Mission In The Community

Goals

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To Recognize Site Limitations and

Optimize

Site Use

Goals

Goals

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To Optimize Construction Value Through

Optimization of Engineering Systems

, and the

Building Envelope

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Goals

To Develop the

Smallest Code Conforming Workable Spaces

and Use

Modular and Movable Systems

Where Appropriate

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To Use

Proven

and

OSHPD Approved

Materials, Assemblies and Systems Without Frills

Goals

Goals

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To Minimize Cost Escalation by Using

Integrated Project Delivery and Lean Practices

to Reduce Time and Wasted Efforts

Goals

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To Respect the Unique Nature of Chinese Hospital and Its Relationship to the Community and Between the Hospital, Health Plan and Physicians

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

Chinese Hospital

All California Hospitals 1995 2000

1.06% 4.35% -1.20% -5.20%

2003 2006

5.60% 10.24%

3.35% 2.02%

Chinese Community Health Care Assn .

Chinese Hospital Chinese Community Health Plan

The Planning and Design Process

Jacobs Carter Burgess

– Integrated Planning and Design – “Inside Out and Upside Down” – Over 280 Meetings and Work Sessions with hospital staff, nurses, and physicians

The Planning and Design Process

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– Integrated Planning and Design – “A Mixture” vs “A Solution”

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The Planning and Design Process

To Choose Optimal Solutions and Maximize Value

Establish a Value for Each Decision Choose the Sequence with the Highest Maximum Value

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The Planning and Design Process

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An Integrated Delivery Process

An Integrated Delivery Process

Jacobs Carter Burgess Programs and Medical Systems Architectural and Building Systems Civil and Structural Systems

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

MEP Systems Interiors / Modular Systems

Cost Model Reconciliation 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 Finalize Preliminary Design Design Documentation On Site Construction

The Planning and Design Process

Jacobs Carter Burgess

– Integrated Planning and Design – “Inside Out and Upside Down” – Process Mapping – Room Diagrams – Equipment Lists Patient is directed to Intake for registration (5-10 min) Patient is registered NO Patient is diagnosed/ referred by Physician Patient arrives at Madrona Medical Center Registered patient?

YES Patient directed to Oncology departments Patient arrives at Reception (45 min prior to appointment if lab/x rays req’d) Patient signs in with receptionist Patient waits in Waiting area (1-5 min) Patient is called in by Receptionist and directed to _____________ to have vitals signs taken by Nurse (5 min) Patient taken to Exam room by Nurse and waits for Physician Physician arrives at provides initial consultation (1 hr) Nurse/receptionist does scheduling/educating patient [in exam room] (30-45 min) YES Patient directed to Lab to get blood work done [done within Oncology] (10 min) New patient to Oncology?

NO Patient directed to Imaging Patient gowns for x-ray, x-ray taken (5 min) Patient (de-gowns and )returns to Oncology waiting area [interim waiting area that is separate from general waiting for those waiting for lab results or infusion station] to wait for results (5-45 min) Lab results/x-rays come back Patient directed to Exam room where Physician/Nurse review results Is patient ready for treatment?

Patient directed to Exam room NO Requires fluids Blood count too low YES NO NO Infusion station available YES Patient assigned to station and is treated (5 min - 8 hrs) After hours?

NO Patient checks out at Reception (5-20 min) YES Patient goes home (and is called back next day)

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The Planning and Design Process

ICU Single Patient Room

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The Planning and Design Process

Exam Room Operating Room Offices R/F Room Office Cubicles

The Planning and Design Process

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– Integrated Planning and Design – Systems Optimization – Structural Systems – Mechanical Systems – Electrical Systems – Plumbing Systems – Building Envelope

Mechanical Systems

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•

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

.

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Relatively Short Floor to Floor Heights

Careful Coordination with Structural Systems 13’6” and one floor at 12’0”

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Area = Cost

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Desire Meeting Affordability

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Building Cost Comparisons

The Planning and Design Process

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– Decision Management – Target, Scale and Value

Cost Comparisons

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– 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

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Current and Future Space

The Planning and Design Process

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– Integrated Planning and Design – Architectural Image – Context – Community – Sustainability

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Development of Exterior Design

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Development of Exterior Design

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Development of Exterior Design

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The Work Continues

Dependent Decision Logic Criteria Calculation “Component” Anchorage

DPR Added To Team

A Demonstration Project

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

Step 1 Step 2 Completed Development and Confirmation of Required Essential Program Elements Completed Development and Confirmation of Essential Building Systems Approach Step 3 Completed Development and Confirmation of a Basic Life Safety and Exiting Approach Preliminary Submission Dec-07 Preliminary Plan Set

Jacobs Carter Burgess

The Increments and Packages

The Increments and Packages

Jacobs Carter Burgess Est. Date

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

Increment / Package 1 Jun-08 Development, Submission and Confirmation of Site, Accessibility and Life Safety Plans Including Partition Types and All Life Safety Related Building Systems Increment / Package 2 Jun-08 Development, Submission and Confirmation of Underpinning/Shoring Systems Increment / Package 3 Jul-08 Development, Submission and Confirmation of Foundation, Structure and Envelope

The Increments and Packages

Jacobs Carter Burgess Est. Date

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

Increment / Package 4 Sep-08 Development, Submission and Confirmation of Mechanical, Plumbing and Electrical Components and Anchorage Increment / Package 5 Oct-08 Development, Submission and Confirmation of All Other Architectural and Interior Elements Increment / Package 6 Dec-08 Compilation and Submission of Composite Documents

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– 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

Status

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– Acquire and Integrate – Sub-contractors – Vendors – BIM models – Decision management – C-VSM (continuous VSM)

Activities

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2 points to Gold!

LEED

Activities

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– Other Important Owner Decision Related Initiatives

– Mock-up Rooms – Equipment Analysis and Selection – Transitional Space

Considerations

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– 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?”

Jacobs Carter Burgess

The Planning Continues

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

Jacobs Carter Burgess

Chinese Hospital?

Born November 27,1940 at Chinese Hospital

Jacobs Carter Burgess Chinese Hospital Progress Update

Thank You

Jacobs Carter Burgess

with ARUP Mazzetti Associates FW Engineers SJ Engineers Herman Miller for Healthcare Davis Langdon Associates Treadwell Rollo WeAreSure KCA DPR