Linbeck Group LLC

Owner:

Texas Heart Institute Denton Cooley Building

Architect:

Morris Architects

General Contractor:

Linbeck Group, LLC

Scope Of Work

Linbeck was responsible for implementing a construction plan that would require significant and continuous organization. Managing the Linbeck team and 107 subcontractors, suppliers, and equipment vendors would be challenging enough. However, consider that the location is in the heart of the huge Texas Medical Center. The building was constructed on three acres at the corner of a busy intersection, attached on one side to the existing St. Luke's Episcopal Hospital, and provided construction parking for only four vehicles. In addition, a tower crane was required to raise the formwork for the 10-story structure.

One way   dealt with the tight site conditions was to create a double-deck construction trailer, cutting ground office space in half. Another successful approach was the implementation of a just-in-time delivery system for construction materials to keep on-site inventories and waiting time to a minimum.

We also managed the complexities by developing a Construction Planning Manual that provided contractors and consultants with a clear and comprehensive framework for dealing with the subcontractors' and owners' issues that could arise during construction. The manual provided information ranging from where contractors should park to how to access the project's change management system. Typical items included:

• Assuring patient access to the existing hospital
• Coordinating helicopter activity with tower crane movements
• Maintaining fire egress pathways from the adjacent hospital
• Providing a construction environment that did not adversely impact hospital operations.

Preconstruction Planning Impacts Costs

Our TeamBuild development approach provided the Texas Heart Institute and St. Luke's with the information, analytical tools, and development/construction knowledge to make informed decisions during both the project planning and implementation phases. The process nurtured an environment where all team members contributed their individual expertise through co-active participation. The approach helped the architects and engineers to understand project issues from a constructability point of view prior to and during design, which minimized plan revisions. Scheduling was also a crucial component of cost containment. Conscientious adherence to subcontractor schedule commitments reduced waste and inefficiency and increased productivity. A comparative cost analysis shows that THI's $185/square-foot cost is at least 10% less than comparable facilities.


Creating a Cohesive Team

This massive, care-intensive effort required the support and cooperation of many players throughout the building process. From the onset, the entire design and construction team met with the two owners to set goals, outline each party's needs, expectations and roles, and create a collaborative environment. This level of communication and cooperation would prove essential as the team worked through the effort of obtaining nine separate building permits and applying the same collaborative approach with the City of Houston building officials.

The subcontractors were chosen early in the design phase so that they could participate in the efforts to develop comparative cost analyses and coordinate precision scheduling. The core subcontractors were chosen due to their previously proven ability to work cooperatively and cost-effectively with Linbeck on very difficult and complex building projects. The early involvement of these contractors played a significant role in keeping the project on budget and on schedule. 

For example, part of the challenge was managing the cost environment with its average materials price escalations of over 6% throughout the three-year construction process. Of particular concern was the drywall material, which increased in cost by 25 percent. To address this, the team deferred their purchase of drywall, predicting that the market price would come down over time. They also invited the drywall contractor to participate in their collaboration and offered an incentive for cost-saving initiatives. As a result, Linbeck's team saved the owner over $100,000 in material costs.

Another value from the collaborate approach was the development of an e-mail based billing system. Linbeck would e-mail each pay application to the architect, who would review the costs, attach an electronic signature, and forward it on to the owner's representative. The invoice would then be paid electronically by direct deposit to Linbeck's account. This system vastly reduced days outstanding, providing payment in twenty days or less, and allowed subcontractor payments in under 30 days. This was a great boost for subcontractors who are often faced with carrying labor and material expenses for at least 90 days. The e-mail billing system also proved successful in expediting change orders and dramatically reducing the typical approval time periods.


Safety: A Paramount Consideration

At the beginning of the project, we established safety goals with the owners, design team, and subcontractors. These goals were posted and measured each week. Preconstruction planning efforts addressed the safety needs of each activity and each major process underwent a preliminary hazard analysis.

Each week, our team met with subcontractors to discuss schedule, quality, and safety challenges for the upcoming week. An example was the erection and dismantling of the tower crane. The entire plan was discussed, defined on paper, and shared with the local community partners (other hospitals, the Texas Medical Center, and public services), subcontractors, and employees. The team elected to remove the crane on a weekend to limit the number of pedestrians, employees and subcontractors and used police escorts to optimize street closures and traffic flow.

Another activity for this project was the erection of eight stories of scaffold for plaster wall installation. The safety of all workers for over seven subcontractor operations was analyzed. As a result, we stopped all work on the scaffold and removed all unnecessary employees when materials were being stocked. Linbeck also stopped work when one trade was working above another, putting the lower workers at risk. This operation was completed with no incidents and set a safety standard that became a guideline for all future project scaffold installations.


Bringing Healers on Board

Planning the THI facility absolutely required regular input from the surgical and research teams. Meeting their needs would prove paramount to the success of the project. So, physicians, nurses, and medical professionals met regularly with the design and construction team throughout the planning, preconstruction, and construction phases. Dozens of three-dimensional computer renderings were created of various facility spaces and shared with the employees, who then provided detailed feedback in focus-group settings. Full-scale mock-ups of the operating rooms, ICUs and the patient rooms were constructed to facilitate hands-on input into the design process.

Their ideas and opinions helped produce a truly unique facility. For example, they were the ones who brought up the issue that surgical suites are typically too small to effectively accommodate the large team of doctors and nurses that is required in surgical heart procedures. They also commented that it is difficult to work around the barrage of equipment in a surgical suite and that it was easy to trip on electrical cords. Because of their input, the design team assembled a group of people that would represent a surgical team. Then a bed and all surgical equipment were brought in. 

From this exercise, the team was able to determine the optimum size for the surgical suite, analyze equipment, and determine ways to reduce mechanical clutter. Because of the medical staff input, most chords were moved to the ceilings and most equipment to exterior walls or the ceilings. The same process took place in designing the elevators. Staff said that typical hospital elevators are too small to accommodate the teams and equipment required for surgical heart procedures. Once again, a group of people and equipment was assembled and an elevator was designed that could accommodate the need. A mock-up was constructed to confirm the final dimensions needed to serve the patients.

Staff input not only impacted major design decisions, but helped shape even small details. For example, our staff suggested that electrical outlets are typically located inconveniently close to the floor. As a result, outlets were designed at a height that was more functional for everyday use.

Participation of the client's employees was not only crucial in developing a facility that would truly meet their needs, but it also reduced the potential for change orders, since renderings and mock-ups could be reviewed, revised, and approved before creating construction plans and documents.

Fast-Track Construction

All utility relocation and foundation pours and a majority of the structure were completed well before the final construction documents were completed. Fast-tracking is uncommon in highly complex healthcare facilities, but was necessary for this project. This approach saved the owners approximately nine months of development time for a project where the facilities are critical for life-saving cardiovascular treatments and research.

Challenging Utility Relocation

Utility relocation was a crucial component of the project. Existing critical systems for chilled water, steam, and emergency power to serve the hospital, were buried on the THI site and would need to be relocated before excavation could begin. Thirty-inch chilled water lines, high-pressure steam lines, emergency power service, and stormwater and sanitary systems were all crisscrossed across the site. Lines had to be located and removed, temporary replacement lines installed, and new tie-ins planned – all without disrupting power and service to the hospital. St. Luke's is a high and critical care facility with world-renowned services that provide for the needs of 900 patients daily. Loss of operation was not an option. 

We planned the relocation work a year in advance, intentionally scheduling the work for February when the need for chilled water would be down 30 percent from its summer peak usage. Despite this careful planning, the team could not have anticipated that February would be unseasonably mild. Using every temporary cooling system unit available from their supplier, the team provided 2,200 tons of temporary cooling. The main system was shut down on a Friday, crews worked around the clock for three days, and the system was brought back on line by that Sunday. This level of vigilant planning allowed the team to relocate all pipes and power without incident.

Designing for a Healthy Building

St. Luke's was awarded the National Air Filtration Association's Clean Air Award for far exceeding government guidelines in their efforts to create a healthy building. The owners wanted to maintain this high standard in the new facility and even take it to a higher level. To accommodate such responsible attitudes the design team built a variety of decisions into the interior design. These included: 

• determining the best positions for air intake units to reduce the potential for bringing in exhaust or contaminated air;
• incorporating tile and vinyl flooring for the majority of the facility, rather than carpet, to reduce the potential build up of mold, dust, or odor;
• using painted or non-porous wall finishes, rather than wallpaper since the glue could act as a catalyst for mold and the wallpaper would also keep the walls from breathing;
• performing wind testing before finalizing the locations of air intakes and exhaust to ensure patient safety and to be a good neighbor; and
• installing high-efficiency filtration on air handling equipment, which provides a 99.997% filtration.