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Improving The Design and Permitting Process for Acute Care Facilities in California
Improving The Design and Permitting Process for Acute Care Facilities in California
Developing a Future State Map For California Healthcare Projects
June 2007 Update
Developing a Future State Map For California Healthcare Projects
June 2007 Update
Challenges to Design of California Healthcare
Projects
Challenges to Design of California Healthcare
Projects Very Complex
Projects Three or More
Years From Design Start to Permit
OSHPD Review Changes in
Technology Limited Resources Large Batch
Process
Very Complex Projects
Three or More Years From Design Start to Permit
OSHPD Review Changes in
Technology Limited Resources Large Batch
Process
Ineffective Cost Control During Design
Poor Integration of Design and Construction Technology
Loss of Team Members
Poor Construction Phasing
Ineffective Cost Control During Design
Poor Integration of Design and Construction Technology
Loss of Team Members
Poor Construction Phasing
The Current StateThe Current State
Significant Construction Cost Overruns
Multiple Permit Re-submittalsPoor Drawing Quality and
Coordination Between DisciplinesLoss of Team ContinuityDesigners Losing MoneyOwners FrustratedOSHPD DefensiveContractors Avoiding
Significant Construction Cost Overruns
Multiple Permit Re-submittalsPoor Drawing Quality and
Coordination Between DisciplinesLoss of Team ContinuityDesigners Losing MoneyOwners FrustratedOSHPD DefensiveContractors Avoiding
Time for A ChangeTime 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 ModelTried to Generate Current State VSMDetermined need for industry wide
visibility and participation
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 ModelTried to Generate Current State VSMDetermined need for industry wide
visibility and participation
Value to CustomersValue to Customers
Healthcare Provider Meets Functional
Program Requirements
Meets Cost Goals Completed On-Time Built-In Quality Meets Life Cycle
Requirements Satisfies Community
Served
Healthcare Provider Meets Functional
Program Requirements
Meets Cost Goals Completed On-Time Built-In Quality Meets Life Cycle
Requirements Satisfies Community
Served
OSHPD Code Compliant Submitted On
Schedule Coordinated
Design Complete Easily Interpreted
Plans and Specifications
High Quality Accurate
OSHPD Code Compliant Submitted On
Schedule Coordinated
Design Complete Easily Interpreted
Plans and Specifications
High Quality Accurate
What Are We Trying To Achieve?
What Are We Trying To Achieve?
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
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
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
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 DateProgress To Date
Created Format for Five all day Workshops Sponsored By Industry and Hosted by UCB/P2SL Group
Invited the Community to ParticipateOwnersOSHPDArchitects/Engineers/DesignersGC/Specialty Contractors/VendorsEducation
Created Format for Five all day Workshops Sponsored By Industry and Hosted by UCB/P2SL Group
Invited the Community to ParticipateOwnersOSHPDArchitects/Engineers/DesignersGC/Specialty Contractors/VendorsEducation
Progress To DateProgress To Date
Received Excellent Participation by Management from:OSHPD (5 People)CHW, St. Joseph's, UCSF Medical
Center, Kaiser, and Sutter HealthA&E CommunityCM/GC and Specialty Contractors
Between 60 and 88 participants throughout the 5 full day workshops.
Received Excellent Participation by Management from:OSHPD (5 People)CHW, St. Joseph's, UCSF Medical
Center, Kaiser, and Sutter HealthA&E CommunityCM/GC and Specialty Contractors
Between 60 and 88 participants throughout the 5 full day workshops.
Progress To DateProgress To Date
Workshop One - Focus and Results 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.
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
Workshop One - Focus and Results 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.
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 DateProgress To Date
Workshop Two - Focus and Results 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
Workshop Two - Focus and Results 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 DateProgress To Date
Workshop Three - Focus and ResultsDiscussion 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
Workshop Three - Focus and ResultsDiscussion 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
Progress To DateProgress To Date
Workshop Four - Focus and ResultsContinued 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
Workshop Four - Focus and ResultsContinued 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
Progress To DateProgress To Date
Workshop Five - Focus and ResultsIdentified 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
Workshop Five - Focus and ResultsIdentified 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
AccomplishmentsAccomplishments
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.
Created a current state map of the design and permitting process for four major health care organizations.
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.
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.
Began the creation of several future state maps including both near term innovation and long term ideal state opportunities.
Identified Five Actual Pilot projects where new processes will be implemented to reduce waste and increase value to the customer.
Initiated the actual mapping of four of the five pilot projects.
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.
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.
Created a current state map of the design and permitting process for four major health care organizations.
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.
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.
Began the creation of several future state maps including both near term innovation and long term ideal state opportunities.
Identified Five Actual Pilot projects where new processes will be implemented to reduce waste and increase value to the customer.
Initiated the actual mapping of four of the five pilot projects.
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.
BreakthroughsBreakthroughs
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.
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.
Pilot Project UpdatePalo Alto Medical Foundation (PAMF)
Pilot Project UpdatePalo Alto Medical Foundation (PAMF)
Sutter’s Palo Alto Medical Foundation, San Carlos Center ProjectCurrent primary focus points
Integrated OSHPD reviewElimination of waste in production of
designTarget Value Design
Sutter’s Palo Alto Medical Foundation, San Carlos Center ProjectCurrent primary focus points
Integrated OSHPD reviewElimination of waste in production of
designTarget Value Design
OSHPD Process Palo Alto Medical Foundation (PAMF)
OSHPD Process Palo Alto Medical Foundation (PAMF)
Reduce the design & permit cycle time.
Eliminate redesign Establish processes for acceptance. Identify the size of batches/packages
and to what disciplines. Establish clear and consistent
communication procedures. Interface protocol + Frequency Protocol for changes. Assigned staff stays on the job. What’s done is done.
Reduce the design & permit cycle time.
Eliminate redesign Establish processes for acceptance. Identify the size of batches/packages
and to what disciplines. Establish clear and consistent
communication procedures. Interface protocol + Frequency Protocol for changes. Assigned staff stays on the job. What’s done is done.
Developing a Standard Plan
Developing a Standard Plan
Three Sutter Teams 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
Three Sutter Teams 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 PlanDraft 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: 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.
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: 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)
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: 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.
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: 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
Additional Challenges and Ongoing Work
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 OSHPD Review/Use of BIM/VDC models Use of technology vs. capital limitations
Celebrating and Promoting Successes to OSHPD and Industry
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 OSHPD Review/Use of BIM/VDC models Use of technology vs. capital limitations
Celebrating and Promoting Successes to OSHPD and Industry