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Jacobs Carter Burgess
Planning and Design for the New Chinese Hospital
May 7, 2008
Jacobs Carter Burgesswith
ARUPMazzetti Associates
FW EngineersSJ Engineers
Herman Miller for HealthcareDavis Langdon Associates
Treadwell RolloWeAreSure
KCADPR
Chinese Hospital Progress Update
Jacobs Carter Burgess
Born November 27,1940at Chinese Hospital
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.”
Jacobs Carter Burgess Health in Chinatown
1900 City Officials were reluctant to finance any health services for the Chinese population even though viewed as a “laboratory infection.”
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.
Jacobs Carter Burgess 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
Jacobs Carter Burgess Chinese Hospital History
Chinese Hospital opened on April 18, 1925 at 835 Jackson Street with sixty patient beds.
Jacobs Carter Burgess Chinese Hospital
Jacobs Carter Burgess Integrated Delivery System
Chinese Hospital
Chinese CommunityHealth Plan
Chinese CommunityHealth Care Assn.
CCHCA
CH
CCHPIDS
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
Jacobs Carter Burgess
“The trouble with the future is that it usually
arrives before we're ready for it.”
Arnold H Glasgow
Jacobs Carter Burgess Our Approach
• An Integrated Design Approach• Process Mapping• Target Costing• Systems Integration and Optimization• Decision Management
Jacobs Carter Burgess Goals
To Provide Affordable New State Of The Art
Facilities From Which Chinese Hospital Can
Efficiently Meet It’s Role And Mission In The
Community
Jacobs Carter Burgess Goals
To Recognize Site
Limitations and
Optimize Site Use
Jacobs Carter Burgess Goals
To Optimize Construction Value Through
Optimization of Engineering Systems, and the
Building Envelope
Jacobs Carter Burgess Goals
To Develop the Smallest Code Conforming
Workable Spaces and Use Modular and
Movable Systems Where Appropriate
Jacobs Carter Burgess Goals
To Use Proven and OSHPD Approved
Materials, Assemblies and Systems Without Frills
Jacobs Carter Burgess Goals
To Minimize Cost Escalation by Using
Integrated Project Delivery and Lean
Practices to Reduce Time and Wasted Efforts
Jacobs Carter Burgess Goals
To Respect the Unique Nature of Chinese
Hospital and Its Relationship to the Community
and Between the Hospital, Health Plan and
Physicians
Chinese Hospital
Chinese CommunityHealth Plan
Chinese CommunityHealth Care Assn.
Chinese Hospital’s net operating margin has defied the odds.
Chinese Hospital
All California Hospitals
1995 1.06% -1.20%
2000 4.35% -5.20%
2003 5.60% 3.35%
2006 10.24% 2.02%
Jacobs Carter BurgessThe Planning and Design Process
– Integrated Planning and Design
– “Inside Out and Upside Down”
– Over 280 Meetings and Work Sessions with hospital staff, nurses, and physicians
Jacobs Carter BurgessThe Planning and Design Process
– Integrated Planning and Design
– “A Mixture” vs “A Solution”
Jacobs Carter Burgess
To Choose Optimal Solutions
and Maximize Value
Establish a Value for Each Decision
Choose the Sequence with the Highest Maximum Value
The Planning and Design Process
Jacobs Carter Burgess The Planning and Design Process
Jacobs Carter Burgess An Integrated Delivery Process
Jacobs Carter Burgess
Programs and Medical Systems
Architectural and Building
Systems
Civil and Structural Systems
MEP Systems Interiors / Modular Systems
An Integrated Delivery Process
Design Documentation
Finalize Preliminary Design
On Site Construction
Cost Model Reconciliation
Decision Point # 1: Confirm decision process, communications, protocols, meetings
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
Jacobs Carter Burgess The Planning and Design Process
– Integrated Planning and Design
– “Inside Out and Upside Down”
– Process Mapping
– Room Diagrams
– Equipment Lists
Patient is diagnosed/referred by Physician
Registeredpatient?
Patient arrives at MadronaMedical Center
Patient is directed toIntake for registration
(5-10 min)NO
YESPatient is registered
Patient directed toOncology departments
Patient arrives at Reception (45min prior to appointment if lab/x-
rays req’d)
Patient signs in withreceptionist
Patient directed to Labto get blood work done[done within Oncology]
(10 min)
New patient toOncology?
YESPatient waits in
Waiting area (1-5 min)
Patient is called in by Receptionistand directed to _____________ tohave vitals signs taken by Nurse (5
min)
Patient taken to Exam room byNurse and waits for Physician
Physician arrives at providesinitial consultation (1 hr)
Nurse/receptionist doesscheduling/educating patient[in exam room] (30-45 min)
Patient directedto Imaging
Patient directed toExam room
NO
Patient (de-gowns and )returnsto Oncology waiting area [interimwaiting area that is separate fromgeneral waiting for those waitingfor lab results or infusion station]
to wait for results (5-45 min)
Patient gowns for x-ray,x-ray taken (5 min)
Lab results/x-rays comeback
Patient directed to Exam roomwhere Physician/Nurse review
results
Is patient readyfor treatment?
YES
Infusion stationavailable
YES
Patient assigned tostation and is treated (5
min - 8 hrs)
NO
NO
Requiresfluids
Blood counttoo low
NO
Patient checks out atReception (5-20 min)
Patient goes home (andis called back next day)
After hours?
NO
YES
Jacobs Carter Burgess The Planning and Design Process
ICU Single Patient Room
Jacobs Carter Burgess The Planning and Design Process
Exam Room
Operating Room
R/F Room
Office CubiclesOffices
Jacobs Carter Burgess The Planning and Design Process
– Integrated Planning and Design
– Systems Optimization
– Structural Systems
– Mechanical Systems
– Electrical Systems
– Plumbing Systems
– Building Envelope
Jacobs Carter Burgess Mechanical Systems
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.
Jacobs Carter Burgess Relatively Short Floor to Floor Heights
Careful Coordination with Structural Systems
13’6” and one floor at 12’0”
Jacobs Carter Burgess Area = Cost
Jacobs Carter Burgess Desire Meeting Affordability
Jacobs Carter Burgess Building Cost Comparisons
Jacobs Carter BurgessThe Planning and Design Process
– Decision Management
– Target, Scale and Value
Jacobs Carter Burgess Cost Comparisons
– 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
Jacobs Carter Burgess Current and Future Space
Jacobs Carter Burgess The Planning and Design Process
– Integrated Planning and Design
– Architectural Image
– Context
– Community
– Sustainability
Jacobs Carter Burgess Development of Exterior Design
Jacobs Carter Burgess Development of Exterior Design
Jacobs Carter Burgess Development of Exterior Design
Jacobs Carter Burgess
The Work Continues
Dependent Decision Logic
Criteria
Calculation
“Component”
Anchorage
DPR Added To Team
Jacobs Carter Burgess
A Demonstration Project
Steps and Incremental Packages Which Include Criteria, Calculations, Drawings and Related Specifications for Review and Approval
Step 1 CompletedDevelopment and Confirmation of Required Essential Program Elements
Step 2 CompletedDevelopment and Confirmation of Essential Building Systems Approach
Step 3 CompletedDevelopment and Confirmation of a Basic Life Safety and Exiting Approach
Preliminary Submission
Dec-07 Preliminary Plan Set
Jacobs Carter Burgess
The Increments and Packages
Jacobs Carter Burgess
The Increments and Packages
Est. Date
Steps and Incremental Packages Which Include Criteria, Calculations, Drawings and Related Specifications for Review and Approval
Increment / Package 1
Jun-08Development, Submission and Confirmation of Site, Accessibility and Life Safety Plans Including Partition Types and All Life Safety Related Building Systems
Increment / Package 2
Jun-08Development, Submission and Confirmation of Underpinning/Shoring Systems
Increment / Package 3
Jul-08Development, Submission and Confirmation of Foundation, Structure and Envelope
Jacobs Carter Burgess
The Increments and Packages
Est. Date
Steps and Incremental Packages Which Include Criteria,Calculations, Drawings and Related Specifications for Review and Approval
Increment /Package 4
Sep-08Development, Submission and Confirmation of Mechanical, Plumbing and Electrical Components and Anchorage
Increment / Package 5
Oct-08Development, Submission and Confirmation of All Other Architectural and Interior Elements
Increment / Package 6
Dec-08 Compilation and Submission of Composite Documents
Jacobs Carter Burgess Status
– 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
Jacobs Carter Burgess Activities
– Acquire and Integrate
– Sub-contractors
– Vendors
– BIM models
– Decision management
– C-VSM (continuous VSM)
Jacobs Carter Burgess LEED
2 points to Gold!
Jacobs Carter Burgess Activities
– Other Important Owner Decision Related Initiatives
– Mock-up Rooms
– Equipment Analysis and Selection
– Transitional Space
Jacobs Carter Burgess Considerations
– 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
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
The Planning Continues
Jacobs Carter Burgess
Born November 27,1940at Chinese Hospital
Chinese Hospital?
Jacobs Carter Burgess
Thank You
Jacobs Carter Burgesswith
ARUPMazzetti Associates
FW EngineersSJ Engineers
Herman Miller for HealthcareDavis Langdon Associates
Treadwell RolloWeAreSure
KCADPR
Chinese Hospital Progress Update