Critical care

by Clair D. Urbain

Tackling a complex hospital construction project can be one of the most demanding and challenging undertakings for any contractor. Tying new systems in with old ones, containing construction dust and disturbances, while allowing the hospital to operate smoothly, and handling evolving customer requests can take even the best laid plans and turn them upside down.

Messer Construction Co., a Cincinnati-based general contractor and construction manager, thrives on this type of business. Focusing on healthcare construction and related projects, this $700 million in annual revenue company finds these projects can be completed on time and on budget by using Lean techniques borrowed and modified from industry, says Mark Luegering, Messer Construction vice president.

Its most recent project, the 13-story, 416,434 sq. ft. Cincinnati Children’s Hospital Medical Center Location S Research Tower, challenged Messer from the beginning of the project through building occupancy.

“First, we’re working on a tight location and tying into existing operational hospital facilities, both physically and mechanically. The project’s design started out as a facility where the research and office areas were designed very similar from floor to floor, but during construction, that turned into something very different as researchers modified lab and office floor designs to meet the requirements of each department’s cutting-edge research,” says Todd Sadler, Messer Construction’s senior project manager on the site.

“This facility is different from other research facilities,” says Sadler. The complexity of the building led to design changes and schedule adjustments throughout construction. “We used process control and the Last Planner, a Lean scheduling approach, to manage through these changes,” says Sadler.

“This 13-story building is really 14 floors. The 11th floor is the height of two floors because its interstitial mechanical space contains independent and redundant mechanical systems needed to handle biohazards in the laboratory. Plus, there’s a roof penthouse with redundant air handling and electrical equipment,” Sadler says.

“While work was in progress and the designers were meeting with the department heads to finalize the space planning, Messer led the schedule tracking and communication between parties to ensure informed decisions were made about potential re-work, cost and schedule implications. We re-sequenced work to stay on target if progress on certain floors needed to be placed on hold or modified. Because of Lean planning and our ability to lead communication between the client, designers and Messer, we met the occupancy date of November 12, 2007,” says Sadler.

Messer’s process control system starts with using the Last Planner concept developed by the Lean Construction Institute. Simply put, it gets all parties working on the project to talk through the building process and find out how it can be completed with minimal downtime and conflicts between trades.

“A successful example of the Last Planner system was integrating the concrete frame pour schedule with the exterior façade schedule. We used it to get the building enclosed as quickly as possible. The trades worked together and used a Fraco mast climbing system, which was installed as soon as the first three floors were poured, so exterior framing and masonry could begin. This process saved us months in the schedule, released interior construction sooner and reduced our heating and cooling costs during construction,” says Sadler.

Preassembly saves
During the floor design modifications, 509 doors were added to the building and had to be worked into the construction schedule sequence. Dusty Russell, carpenter foreman on the project, led an initiative to pre-install the door hardware. Dusty really embraced Lean concepts and personally led several of the project’s Lean initiatives,” Sadler says.

“What worked best was to preassemble the door hardware onto pre-finished doors at the supplier’s shop and then install the door onto the frame upon delivery. This eliminated the need to sort, store and install more than 152 hardware sets. The downside: we could ship only up to eight assembled doors vs. 10 to 15 unassembled doors per skid. This increased material handling costs, but we were able to get door installation time down to minutes, and the finished product was higher in quality. This worked so well that we are adapting this process on our other projects,” says Sadler.

With more than 4,100 baseline schedule activities identified in order to stay on schedule, the Messer team identified the schedule milestones and constraints.

The construction issues, furniture deliveries and the pending move-in of more than 1,300 occupants required weekly schedule updates which needed to paint a picture that everyone could understand and follow. “The facility’s furniture needed to be ordered eight weeks ahead of delivery for each of the occupied 12 floors. As we better understood the furniture contractor’s fabrication, delivery and installation process, we realized the above-ceiling inspection was our real constraint. Other work couldn’t continue until the inspection was complete, which could set back furniture delivery. When we used the above-ceiling inspection milestone to drive other milestones, we were able to better handle the workflow. Even though we built complete recovery schedules for five of the floors, identifying the correct milestones made delivering complete floors on or ahead of deadline possible. We could predict furniture delivery dates for each floor almost four months prior and made each delivery date within a week of the established dates,” says Sadler.

Front-line Lean efforts
In addition to using Last Planner and constraint analysis on this project, Luegering says Messer has adapted other Lean manufacturing techniques on the jobsite. Most have met with resounding success.

“Last Planner is just one tool in the Lean construction toolbox. Other Lean tools help in other aspects of the job,” he says.

“We have researched other tools as part of a study we conducted with the Lean Construction Institute. We looked at increased visualization on jobs, daily huddle meetings, first-run studies, establishing a visual workplace and developing fail-safe plans for quality,” says Luegering.

Improving visualization on jobs puts the status of the job front and center with workers. “The study found this works best when you assign values to certain levels, such as identifying productivity levels for workers. We use phrases such as ‘on schedule,’ ‘ahead of schedule,’ or ‘behind schedule.’ It also needs to be easy to understand visually and updated often. Also, making sure it’s posted in a prominent place is paramount because it’s a visual cue. It helps all workers appreciate the progress that’s taking place,” says Luegering.

“Daily huddle meetings are another effective tool,” says Luegering. “We encourage all of our subcontractors to participate. At the beginning of every shift, the crews talk about what needs to be done, the tools needed and how they will work so that it’s completed efficiently and safely.”

“First-run studies have proven to be the biggest time and money savers,” says Luegering. “For repetitive tasks, workers are videotaped completing their work, then they review the tape and develop ways to perform tasks more safely and efficiently. On one job, the concrete crew asked if they could have direct radio contact with the crane operator instead of searching for a supervisor with a radio to make the call for a pick. They also found a way to place horizontal rebar after the outside wall form was in place. Our ‘first run study’ projected this part of the job to be 50 percent over budget. After we implemented ideas from the videotape review, we were able to come in 25 percent under budget. This is classic ‘plan-do-check-act’ thinking, and it works,” says Luegering.

Sadler says a similar process was used to assemble coat hook frames needed in every office and many work areas of the Research Tower.

“Dusty Russell led two carpenters who focused on installing these items. While simple tasks, the work was repetitive and used several small pieces that had to be assembled. The carpenters used this exercise and they converted a potentially mundane task into an efficient one that produced a quality product every time,” he says.

The visual workplace tools from proven Lean processes include 5S (Sort, Simplify, Sweep, Standardize, Self-discipline) thinking. (See page 16 in the November-December 2007 issue of Contractor Tools and Supplies or click here for a detailed explanation.

“The Lean Process has also been very helpful in our equipment and material storage area. Each worker who needs a tool signs it out and checks it back in at the end of the day. If the tool needs repair, they tag it out so it can be sent back for repairs. Each type of tool is stored in an open, labeled bin that is easy to view. During the day, we can look in the bins to see which tools are being used. As the job progresses, the bins that have more tools in them during the day can be considered for return to Messer’s equipment supply facility. This process also reduces tool loss, damage and jobsite theft,” says Sadler.

Other Lean activities
Messer has had such success with Lean efforts on the jobsite that it is adapting the concepts of value-stream mapping, daily huddles and Last Planner processes in other departments. “We see many of our back-of-house activities as wasteful. From how we handle an RFP to how we improve our payment cycles to subcontractors, value-stream mapping is the best way to find bottlenecks,” says Luegering.

Value-stream mapping identifies the tasks that take place from beginning to end. Next, those closest to the process identify non-value adding activities and strive to eliminate them.

“Supply chain management is our next opportunity. We want to lead this effort with our suppliers, which will reduce everyone’s costs. We are looking for ways to better coordinate deliveries and product movement on jobsites to ultimately capture savings for everyone. Not enough contractors challenge themselves to do this. Self-discipline and motivation are required to do this successfully,” says Luegering.

Published in the January/February 2008 issue of Contractor Tools and Supplies magazine.

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