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How 3D Model Coordination Eliminates Risks from Challenging Healthcare Renovations

October 18, 2017

Shurid Rahman, Sutter Health

Brett Paloutzian, HED

Matthew Jogan, Ghafari Associates

Nicholas Grage, IntegraBIM

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What you will learn

2

• What are critical risks for a existing renovation

project in healthcare

• Early Design

• Permit

• Construction

• How model coordination can document,

manage and solve these risks

• Specific examples from our project Alta

Bates Summit Medical Center

• Things we would have liked to know earlier

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Project Context

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Alta Bates Summit Medical Center

4

• Campus in Oakland, CA

• Pill Hill Neighborhood

• 2015 SB90 Seismic Compliance and Master

Facility Plan

• Merritt Ground Floor Renovation

• Dietary Department

• MRI Suite

• Doctors Lounge

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Sutter ABSWR- Dietary, MRI, Doctor’s Lounge

5

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Site Advantages and Challenges

6

• Advantages

• Compliance

• Availability

• Proximity and connectivity

• Challenges in existing spaces

• Floor-to-floor heights

• Existing utilities to remain

• Non-conforming conditions

• Disruptions

• Unexpected/discovered conditions

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Critical Risk Assessment – Early Construction

7

ELEMENT RISKS

Issue you can solve now.

PROCESS RISKS

Issues that materialize with time, which

you cannot fully solve now.

+

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Critical Risk Assessment – Early Construction

8

• ELEMENT RISKS

• Incomplete Design Scope

• Cooking Hood Exhaust

• Grease Duct

• Walk-in Refrigerators/Freezers

• Lagging MRI Suite Design

• Cryogen Vent Routing

• Variable Existing Conditions

• Waterproofing

• Slab Levelness

• PROCESS RISKS

• Schedule Delays

• Design to field handoff

• Changing site conditions

• Unexpected Design Issues

• Hidden existing conditions not captured

• No trade partner input in the design

• Incomplete design scope going into

construction

• Late MRI selection

• Procurement Risks

• Restaurant equipment

• MRI

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What does Sutter want to achieve?

9

• Three goals

• Fast and reliable construction schedule

• Accuracy and customization of design

• Informed change management

• How can critical risks be eliminated to achieve

these goals?

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LCI CONGRESS PRESENTATION STYLE GUIDEModeling Culture and Workflows

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BIM Principles

11

BIM is a tool for Risk Management.

Focus on Workflow First, Model Creation Next.

Use BIM to Establish a Single Source of Truth.

Engage Trades and Vendors Early to create informed

models during Design.

Plan the Work to define the workflows that will

determine how 3D content needs to be developed.

Model the Build, then Build the Model.

Create processes that enable Design for Fabrication.

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BIM - Focus on Workflow First

12

Improve the Information Supply Chain via

Process Mapping.

Re-align Team Workflow to Optimize the Overall

Outcome.

Align the workflow to Leverage 3D.

Eliminate Waste within Information Production and

Exchange.

Process Mapping information handoffs for

Integrated Mechanical Design

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BIM - Establish a Single Source of Truth

13

Documentation as a direct output from fabrication informed 3D models

Create a culture where there is only One Source of

3D Information for each system.

Share Incomplete Information, often.

Team reviews the Design in 3D on a regular basis.

Use the 3D Model information to Inform all Outputs.

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BIM - Plan the Work

14

Early and detailed development of inflexible systems. Handoff Work Planning in Design using vPlanner

Define the Team Workflows that determine how

the 3D Content needs to be developed, not the

other way around.

Development of 3D models is directly related to

the Team’s Plan.

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BIM - Best Practices

15

Develop workflows to support a ‘Build the Model’ approach.

ALL work is in 3D.

Models are kept Updated & Accurate.

The team is Sharing Incomplete Information, often.

Team is Managing the Content via 3D models, and Managing the Work via collaborative visual planning.

Team members are modeling work with Direct Input from trades & vendors.

Model review outcomes include a set of Clearly Captured Action Items that resolve issues.

3D Model Design Review = Action Items are

captured as activities in the Team’s Plan and

managed via LPS using vPlanner.

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LCI CONGRESS PRESENTATION STYLE GUIDEExamples

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Accommodating Disparate Programs - MRI

17

• Challenges:

• Getting it to fit in the volume of space

available

• ADA clearances

• Magnetic Gauss fields that can kill people

• Imaging department above

• Sterile processing department below

• Dining seating on other side of the wall

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MRI Gauss Field Concerns

18

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MRI Gauss Field 2D to 3D

19

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MRI Gauss Field- Analyze the Impact

20

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Existing Conditions Complexity – Hoods and Exhaust

21

• Challenges:

• Floor to underside of beams = 10’-5”

• Fire sprinkler could not penetrate beams

• Grease ducts slope

• Long distance from hoods to exterior

• Solutions:

• Lowered ceilings from 9’ to 8’

• Changed light fixture type (low profile)

• Re-routed electrical racks

• Facilities Management included in the process

• Moved access doors

• Added valves to systems to improve maint’

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Design Intent vs. Constructability - Soffits

22

• “I am most comfortable with the state of details on this project than any other currently” Framer.

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Design Intent vs. Constructability - Soffits

23

• In coordination

we found that a

soffit just would

not work

• The above ceiling

conditions were

too congested

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Design Intent vs. Constructability - Soffits

24

• With a materials

change, the design

intent was

maintained and

constructability

achieved

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Weaving around existing conditions

25

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LCI CONGRESS PRESENTATION STYLE GUIDEWhat’s Next and Lessons Learned

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Critical Risk Assessment – Early Construction

27

• ELEMENT RISKS

• Incomplete Design Scope

• Cooking Hood Exhaust

• Grease Duct

• Walk-in Refrigerators/Freezers

• Lagging MRI Suite Design

• Cryogen Vent Routing

• Variable Existing Conditions

• Waterproofing

• Slab Levelness

• PROCESS RISKS

• Schedule Delays

• Design to field handoff

• Unexpected site conditions

• Post demolition scan and effort

• Design Variability

• Hidden existing conditions not captured

• No trade partner input in the design

• Incomplete design scope going into

construction

• Change Management Analysis

• Late MRI selection

• Procurement Risks

• Restaurant and MRI equipment

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What we would have liked to learn sooner

28

• Team understanding that design as an evolving

iterative process

• Sooner is better

• Modeling sooner creates better content to

inform design

• Having better existing information sooner

• Developing model based workflows sooner

• Alignment between Management and BIM

team

• Context of a small team and limited

resources

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