Accelerated design for new hospital – check out how it’s done.

In the run-up to Health Facilities Design and Development conference, I wanted to explore some of the new case studies on the agenda.

One topic that really stood out is Jeffrey Williams’ presentation in his role as Director of Nursing at St John of God Midland Public and Private Hospitals, in particular the short time it took to get the project off the ground.

I caught up with Jeffrey recently when he gave me a sneak preview on some of the features of the new hospitals, key design innovations and a breakdown of the user group consultation process:

Project overview

Construction of the new 367-bed co-located public and private hospitals has reached 70 per cent, and is on target for a November 2015 opening.

With 307 beds, the public hospital will offer a wide range of services to the communities of Perth’s northern and eastern suburbs and the inner Wheatbelt, while the 60-bed integrated private hospital will offer the choice of private health care.

State and Commonwealth Governments have jointly invested $360 million in the public hospital project that will be operated by St John of God Health Care under a public private partnership agreement. The WA-based private health care operator is investing $70 million in the private hospital.

Fast facts

  • First major hospital facilities to be built in the Midland area in more than 50 years.
  • HASSELL architects and Brookfield Multiplex are the design and construction partners.
  • The public hospital will treat approximately 29,000 inpatients, 55,000 emergency patients and 89,000 outpatients in its first full year of operation.
  • The public hospital will provide an expanded range of services from those provided by Swan District Hospital free of charge to public patients.
  • There will be 367 beds in total – 307 public beds and 60 private beds.
  • The public hospital will have 50 per cent more beds than the Swan District Hospital.
  • More than 1,000 staff will be employed at the hospitals.
  • Easy access will be provided for pedestrians, vehicles, and public transport.
  • On-site parking will include 725 staff bays and 221 visitor bays.
  • Easy drop off and access to the emergency department will be provided.
  • Patients, visitors and the community will enjoy landscaped gardens, courtyards, public art and plazas.
  • The hospitals are being built on an eight-hectare site, four times the size of the Midland Oval.

Accelerated design

The State Government released its expression of interest in September 2010 seeking responses within five weeks.

Post EOI submission, St John of God Health Care continued to work closely with its partners Brookfield Multiplex and HASSELL to develop a design within the allocated budget while awaiting confirmation of our selection to tender for the request for proposal.

Thankfully St John of God Health Care was selected and had a short 20-week window in which to prepare and submit a response.

On 1 December 2011, St John of God Health Care was announced as the preferred tenderer and, following negotiations, signed a contract with the Western Australian Government on 14 June 2012.

During the negotiation phase, St John of God Health Care, Brookfield Multiplex and HASSELL worked closely with the State Government’s consultants to ensure that any major design issues were dealt with at a high level so that construction could start as soon as possible after contractual completion.

This preparation allowed St John of God Health Care to achieve the State Government’s goal of starting work within one month of satisfying the conditions precedent, in August 2012

User group design

While we completed the design very quickly, we could only establish the design user groups after the contract was signed. This led to a concurrent construction and user consultation process that meant we had to focus on those areas where we needed to finalise the design and start building first.

We began a four-step user group process, with each group running between 16 and 20 weeks.

At the first meeting, we presented the users with a schematic design. The architects and builders then took the users’ advice and presented the modified design at the second meeting. The third stage was detailed design when we presented drawings showing room elevations and the position of furniture and equipment. The fourth meeting was a presentation of the final detailed design and allowing the users a last opportunity to highlight any remaining issues.  The detailed design was then signed off ready for construction drawings to begin.

Taking the Emergency Department User Group as an example, the users told us that the waiting room was too small and so we adapted the design accordingly. This process allowed us to drill down into the operational detail by asking them their opinion on matters such as the number of cubicles and the department’s layout.

Accelerated construction

While the user group consultations were taking place, preparatory construction work, such as piling and pouring concrete for the floors got underway. We also made decisions such as the location of wet areas to enable holes to be drilled for the later installation of pipes and drainage.

In those early days, we included around 130 square metres of expansion space on each floor. This built-in flexibility meant that we were well prepared for short-and long term expansion and design changes.

Managing expectations

From the word go, we made it clear to the user groups that the construction budgets were fixed.

The WA Health Clinical Services Planning Framework was a useful tool as some things were a given and did not need to be included in the design discussion.

For example, we had already made sure that we had the right number of beds and could explain to the users that we were working with a 30-bed medical ward, a 24-bed short stay surgical unit, or a 12-bed intensive care unit.  We also knew that St John of God Midland Public Hospital was a Level 4 hospital for cardiology and a Level 1 hospital for intensive care.

We were therefore clear about what we were trying to achieve and this allowed the users to understand the clinical scope so they could focus on how the unit might work and how we could make workflow more efficient.

Innovation in design

We standardised all of the rooms that are common across multiple areas of the hospital. For example, a dirty utility and a clean utility have the same layout in all areas.

We will be using swipe access widely throughout the hospitals for security, including to high traffic areas such as emergency department and restricted areas such as drug rooms.

All patient bedroom ensuite rooms were manufactured offsite as ‘pods’ to a standard, including a standard bedroom pod and a mental health pod, and installed within a short timeframe. While this was cost neutral from a construction perspective, cost and time savings were achieved in the installation.

We decentralised our staff stations, meaning that most ward areas have two or three staff stations instead of one centralised staff station and so clinicians will be closer to their patients.

Finally, we designed to accommodate future expansion. When the State Government issued its proposal for a 307-bed public hospital, they said that the hospital must have the capability to expand to 464-beds by 2021.

The design accommodates expansion in several ways:

1. Intensive Care Unit and Coronary Care Unit

This 12-bed shared unit has six rooms configured for intensive care patients and six rooms configured for coronary care patients. The six coronary care rooms can quickly be converted to intensive care rooms as the required services are already in place and space exists in the adjacent area for 12 coronary care beds to be installed with minimal disruption.

2. Operating theatres suite

The operating theatres suite is designed to cater for the maximum 464-bed capacity with nine theatres and three procedure rooms. These are all of equal size and configuration meaning that the three procedure rooms can easily be converted into theatres, while the procedure rooms can be re-located to a nearby area of the hospital.

3. Private beds

The two 30-bed private wards have been integrated in such a way that when the State Government wants to expand the public hospital from 307 to 367 beds, these can easily be converted into public hospital beds and St John of God Health Care will build a stand-alone private hospital on a nearby site.

4. Additional wing

The expansion to 464-beds can be achieved by adding a new wing extending out from the existing ward block on the northern side of the hospital. Again, this is designed to be achieved with minimal disruption to existing hospital operations.

Lessons learnt

I have two roles and two sets of responsibilities on this project: the first is clinical design and the second is transition and operational readiness. I have learnt lessons across both of these areas.

It was challenging in terms of the limitations on which people within WA Health that we and the other tenderers were allowed not access during the bid preparations. If we were to go through the same process in the future, we would request earlier and wider access to key players in the public sector.

Secondly, we would focus on operational preparedness earlier. While we had a firm view of how we would run the hospital, we did not start working through this in earnest until after the building program started. If we had begun earlier, we would have benefited from additional preparation time.

However, all aspects of the project, including the partnership with WA Health and the North Metropolitan Health Service, in particular, have worked really well. In terms of construction and commissioning, everything is on budget and on track for opening in November 2015

Working in partnership

The traditional public private partnership means the State saves on design, construction and facility management, but continues to deliver the service. As our model also includes clinical services delivery, the State Government can achieve further efficiencies.

Overall, it has been a very positive process, with the focus now firmly on completing construction, operationalising our commissioning program and finalising the details of the patient transfer from the existing Swan District Hospital that will close when the new hospital opens.

Hear more from Jeffrey during his presentation at Health Facilities Design and Development Victoria.

8 lessons learnt from dredging projects

There’s no shortage of hold-ups when it comes to dredging projects, with such a big industry, Australia is full of them. Ahead of Dredging and Reclamation 2014, I caught up with a few project leaders to see where mistakes have been made. Some key areas stood out that I wanted to share with you:

Mapping is key

Financial considerations are hard to overestimate in any project. Developers can often be unwilling to spend money on mapping and monitoring, instead opting for the simplest possible technique. Unfortunately, as you go down the line with this approach, there’s still some surprise when the approvals get rejected. Without the right equipment, the operation tends to go over thresholds or other similar measurements. In the field, the simplest technique doesn’t give you the answer all the time. You’ll only end up having to spend your money on fines and delays instead. Be one step ahead of the regulators and the public.

Transferring risk can end up costing big bucks

Dredging project owners are always looking to reduce their risk, trying to create contracts that transfer risk to the dredging contractor and it doesn’t work. A contractor can decide at some point that they haven’t made enough money, pick an area of AS 2124 and attack it and make a claim. If multiple contractors operate within a wharf or similar structure at the same time, this can cause access issues and lead to further claims.

There’s an illusion in the current way contracts are done that risk can be transferred from the project owner. Whilst this may save short term costs, it can lead to substantial cost and time delays down the line.

Owners still have a lack of experience in terms of practical dredging knowledge. Most teams have a procurement unit working in isolation and independently of everyone else, which leads to a single vision. Risk becomes points on a paper inside a contract that becomes transferred rather than dealt with from a practical view.

Communication is top priority

It seems obvious, but it’s still an area that leads to many issues throughout the dredging process. This is crucial both for contract relationships and to avoid delays and disputes from stakeholders.

Collaboration, partnership, and being able to see another person’s perspective is key. Building a rapport builds confidence and trust that the contract and project is being handled responsibly – work together early and often, both at the project level and more broadly.

Good planning up front and a robust assessment of baseline environmental conditions needs to be locked in. Have a very well defined project description early on and don’t change it. All of those things will help approvals, stakeholder communication and consultation.

The ‘unforeseen’ can be avoided

If you’re acting for the Principal, start thinking about the likelihood of unexpected conditions at the early feasibility stage of a project right up to when you select a tenderer. After selecting a tenderer and the Contractor is working on site, you lose much of the power to influence. Take steps to identify possible latent conditions at any early stage, before you’re confronted with them during project execution.

Latent conditions need to be managed

If a Principal is faced with a more complex project with varying soil and rock types, then it is well advised to carry out a more thorough investigation to lower the risk of not detecting a latent condition. Obviously there is a cut off; a Principal can’t investigate every cubic meter for the planned Project.

Any site investigation can only be a representation of anticipated subsurface conditions. Principals should always aim to reduce the risk to an acceptable degree. Consider Early Contractor Involvement with the scope of the planned site investigation.

Geotechnical modelling has huge potential

 

Both the Principal and the Contractor should formulate a robust 3D geotechnical model of the likely subsurface conditions. The model can determine what materials you are likely to encounter in different types and categories.

The Principal’s consultant and the Contractor’s production estimator can then calculate the derived productions fairly accurately. If a latent condition is encountered, a geotechnical model can provide the parties with a benchmark to calculate where the differences are. Be wary of interpretation – different biases can lead to issues.

Take proactive measures

A proactive way of dealing with disputes as they arise is needed. A dispute board can be selected for their knowledge and expertise before any dispute has arisen. By undertaking an on-going relationship and regular site visits, the dispute board will acquire a good working knowledge of the project. When a dispute arises, the dispute board will have a much better understanding than a court or arbitral tribunal, which will only be appointed after a dispute has arisen.

Keep learning and evolving

The fundamental of dredging is that you dig the stuff up out of the ground and put it somewhere – that hasn’t changed. What has changed is the way that you do it, and that’s driven from environmental approvals.

The management of reclamation areas has improved enormously, and understanding how to minimise the amount of turbidity or sediments that get back into the environment. That’s going to become much more important as work is done in the Great Barrier Reef Marine Park. Innovation will be dealing with the conditions and coming up with the best outcome using all of your knowledge and resources available to come up with a solution.

The Dredging and Reclamation conference has been developed as a value creation forum where knowledge, new ideas, best practice and real world learning experiences can be shared amongst other dredging professionals. Providing key case studies from leading practitioners, the conference will share insight into Australia’s most exciting dredging projects in the planning, design or development stages.

Find out more by visiting www.dredgingandreclamation.com.au or call 02 9229 1090.

Old Aussie buildings… Don’t write them off just yet

The spotlight is well and truly on retro & refurb as Australia is poised to reduce energy emissions, operational costs and get smarter with space. But why is it so important now? How can technology help? Where do we keep making mistakes? And what can be done to make sure our older buildings stand out? We sought the expert’s insight from Caimin McCabe, Director, Cundall Australia ahead of his presentation at Retrfit & Refurb 2014

What would you say are the key drivers prompting property owners and investors to start thinking about retrofitting their own buildings?

There are a few key areas here:

  • In the building owner’s mind is asset repositioning or increasing asset value. They want to create a better asset and establish a point of difference from the competition.
  • The asset valuation might be done as a direct result of current operational costs to try and reduce the running costs of those buildings.
  • Retention is an increasing driver for retrofitting. Particularly in Grade B, C and D buildings where there’s a lot more competition for tenants. When their leases come up for renewal, they start to reflect upon whether they want to stay or if they’ll get a better deal elsewhere.
  • Flexibility is another area we’re seeing as a driver. There are increasing numbers of smaller entities who want smaller space in good locations, leading to a need to accommodate multiple (small) tenancies on each floor – particularly within Grade B, C & D buildings.
  • In the back of people’s mind whilst doing this are issues like NABERS Energy performance to see if it can be improved.

How are technologies and new approaches being used to improve environmental and operational performance of existing buildings?

I’d say the best bang for buck is actually looking at control upgrades and getting the building management system to actually do what it should be doing. Look at sub-metering to actually monitor where energy is being used; target reduction rather than assumptions.

The market is obviously seeing a lot of new technologies emerge, as well as enhancements to existing buildings including classic co-generation and tri-generation. In reality though, existing buildings can often find this difficult to accommodate as they don’t tend to have plant rooms available…

What’s quite important to us is it’s not just doing it for the environmental sake; the economics of decision making is equally important. Greater equipment efficiency and operation need to be considered..

Engaging the ‘right’ technical advisor or engineer to work alongside building or facility management in terms of the operational tuning is also key. The trick is to ensure this happens on an on-going basis in lieu of a one-off assessment.

We’re also seeing consultants and facility managers use big data analytics software to assess controls and trend log profiles in real-time to identify ‘rogue’ systems and control issues.

We’ve also found (and this is probably part of the whole-of-life approach) that there’s a tendency to ignore the façade. We’ve had some really good success on buildings where we’ve taken a step back and looked at the building as a whole and said: ‘Rather than just going in there and doing the engineering, we’ll check the whole façade.

We recently took this approach in a project that was focused on the chiller, in which we made many changes to the façade. This resulted in no need for a replacement chiller.

We re-commissioned and put in some new technology components, like diffusers to improve the air quality – we moved the pot of money around. In the end we got the building from its one star NABERS to a four star NABERS. We also significantly improved the indoor environmental quality of the building, so now the building is actually liked, not hated.

You might have an efficient building, but if you don’t want to work there, it doesn’t really matter.

Property owners of B, C and D grade buildings are under pressure to evaluate cost benefits. What are the key areas that need to be addressed during business case development to ensure ROI?

The interesting thing is, embarrassingly to some of the newer buildings, some of the older buildings actually have better performance. Just because they’re old doesn’t mean they’re bad. There is a trend in industry generally that new is good and actually sometimes old is better.

A lot of the old buildings are designed more with passive design in mind. The level of glazing, for example, in an existing building is generally a lot lower than on a new building. Our own office here has only 25 per cent glass, but we’ve got more daylight in our office than we would have if we were actually in a new building. This is because of how it’s introduced and how it’s used. The are a lot of advantages to those buildings which are not traditionally marketed or sold, which is why I talk about the whole building approach. It’s stepping back and asking: ‘What are the attributes? What are the benefits? How do I enhance them and connect the tenant to those benefits relative to other buildings?’

It’s important to realise there’s no silver bullet – if somebody’s trying to tell you that there is, don’t believe them. Every building is unique – there isn’t one size fits all. You have to judge each building on its own in terms of what’s there, but the approach needs to reflect the energy efficiency, indoor environmental quality and the attributes that the building actually has.

Depending on the asset location and target market, the argument isn’t about ROI, but more towards differentiation from competing Grade B, C & D buildings.

Building owners are typically looking only at rent; they’re not considering the quality of the environment they’re in. That’s where I suppose our role is, along with other colleagues, to try and highlight what the building could be for them.

The real risk is what happens if the landlord decides on doing nothing. The danger for the landlord is that they are then left with looking at costly incentives for tenant’s attraction or attention. They’ve potentially got higher vacancy and operating costs weighing down the asset value. They could even be breaching bank covenants as they’re not actually getting the returns. In our mind, doing nothing for an asset owner of a B, C or D grade building in the marketplace is not really an option any more – they just need to sit back and determine how they want to do this and how to reposition the asset.

A major retrofitting and refurbishment project will encounter many challenges across the design and delivery phases. From your experience, what would you say are the main barriers that prevent people from achieving their aspirations on a re-lifting project?

A few areas here also:

  • Existing site or services infrastructure might not be sufficient to achieve required outcomes – there could be limitations inherent within the building.
  • Working around existing tenants can also be problematic and might limit the extent or timing of works that can be done to retain a ‘live’ building.
  • Availability of financing will always be an issue. There’s also a lack of understanding on the alternative funding mechanisms, such as an Environmental Upgrades Agreement (EUA).
  • The return on investment could also be perceived to be too low to actually do the work. In terms of guaranteeing better rents, it’s impossible to do that. We find there’s a tendency to jump in legs first without spending enough time doing the upfront assessment and design stated. When you start to do the actual work, you expose issues you weren’t aware of because the due diligence wasn’t done at the beginning. This in turn might result in costly mistakes (affecting overall budget) and subsequent cut backs or reduction in scope as part of a value engineering response.

Regional Airports: The time for change has come…

It’s been nearly 20 years since the federal government distributed airports to local councils and local bodies to own and operate. In that time, the demand on regional airports has radically changed.

Just earlier this month Bundaberg Council released figures for 2013 showing a 17.4% increase in passenger numbers compared to 2012. The airport provides a gateway for tourism as well as providing hundreds of jobs and commercial opportunities for local residents.

So what’s the problem? Well, airports are ageing and starting to decay in some areas. If they are going to match demand for both services and tourism, some serious transformation is needed to turn airports into cash flow positive enterprises.

Airports are currently feeling the pressure from demands, operations, new regulations, safety, security and even changing aircraft types.

This has left many operators in search for knowledge, looking to uncover the real challenges facing the future operation of airports. It’s time start planning for the long term.

To gain some insight, I recently caught up with Bill Burke, CEO of Mildura Airports and  frequent sounding board for CEOs needing advice; he expressed the urgency for long term transformation planning:

Plan for the long term

“People often see airports as long-term assets that need little or no maintenance. All of a sudden, the day arrives when runways start to deteriorate and assets that had been considered indestructible suddenly start to fall apart. It then takes a lot of capital to fix them.

“It’s difficult to give specific time scales on when improvements are needed within the airport lifecycle. Just consider that every asset has a design life and once that benchmark is passed, the chances are some capital is going to be required for the repairs.”

Bill emphasised how it’s not just the runway that needs to be considered, terminals also decay and technology provides both new opportunities and new challenges:

“It’s about really understanding the needs of your airport as a whole and considering the wider vision beyond individual repairs and developments. Here at Mildura, we’ve recently completed the development of a new terminal building. When we presented it to the community, we received criticism over the size and direction the airport was taking. When we communicated the long term vision for the airport, exploring the logic of the layout, potential for expansion and how it fits the circulation of expected people, we managed to win the community round.”

“The terminal will allow the airport to operate for the next ten years, without any problems. Looking beyond that, I also built expansion opportunities into the plan, allowing the airport to evolve into the next phase. It will build on the facility that’s already here and be fairly simple and cost effective. The terminal will be able to double in size to accommodate growth.”

Be prepared to look for capital:

“Even with your long term plans in place, airports require large levels of capital to be sourced to adequately develop into an ‘airport of the future’. We can’t hide from that. I’m in the position currently where I need $20 million for a runway upgrade, without that capital the runway won’t be able to operate and provide the same level of service as it has before.”

Bill warns that too many people are just riding out the lifecycle and could land themselves in hot water:

“Too many airports – and I’ve seen too much of it in my career – have done little in the way of planning, they’ve never really looked far enough forward to think of where they might be right outside the square.”

Strive to achieve your potential

It’s not just asset management that will take regional airports to the next level, more has to be done to maximise existing revenue streams that could help secure larger capital and keep the day to day operations cash flow positive:

“Too few airports look at their operation in the bigger picture and put down a footprint and work to a blueprint that is expandable and can be developed in almost any direction to satisfy almost any requirement.”

“Regional airports need to look at everything they can. For some airports, there is opportunity for utilisation of the land resources – for industrial, commercial, maybe even sometimes retail activities”

“They need to also look at other commercial activities in terms of the facilities they have; in some cases they could lend themselves to aviation infrastructure uses.”

“You’ve got to identify what potential there is and what the market might be. There’s no point making a lot of noise and knocking on a lot of doors if you can’t deliver a product. I think every year an airport just has to evaluate its own potential.”

“Look at location and what’s happening in the wider community, try and work out where the airport fits in and where there’s potential to tap resources, do something bigger and better.”

“Airports that thrive in the future will be willing to embrace change, think long term and embrace knowledge.”

Bill will be joined by some of Australia’s leading airports during the 2014 Regional Airport Development Conference. The agenda has been designed to assist you on your journey of building and commercialising the airport of the future.