By Stephen Winikoff, AIA, EDAC
From the May/June 2016 Issue
Allegheny Health Network’s (AHN) Wexford Health + Wellness Pavilion is a transformative community resource. The facility serves as a one-stop shop that streamlines the continuity of care to support healthy lifestyles. The care center houses a full spectrum of outpatient services—ambulatory surgery, medical and radiation oncology, radiology, physical and occupational therapy, a women’s center, and family and specialty physician practices—and delivers a level of quality and sophistication not usually found in outpatient settings. Equipped with community oriented amenities, including a demonstration kitchen for cooking classes and wellness education spaces, the Wexford facility is a destination for those who are seeking preventive care or treatment.
Upon recognizing a need for diverse options focused on coordinated wellness in the western Pennsylvania marketplace, AHN sought to build this facility as efficiently as possible without sacrificing quality. In order to achieve this balance, this owner turned to the design-led construction team at CannonDesign to help lead the process.
Evolving Design And Construction Approach
AHN sought to create a first-of-its-kind, transformational healthcare facility that would raise the bar on patient convenience, care coordination, quality, and service excellence. CannonDesign responded with an integrated design-led construction approach that delivered the new AHN Wexford Health + Wellness Pavilion within a compressed schedule of 22 months. The 173,000 square foot building opened in October 2014.
This achievement would have been much more challenging under the traditional design-bid-build delivery model. As the customary delivery system that has been employed in the construction industry for much of the 20th century, design-bid-build is the three-party paradigm where the owner contracts separately with both a designer and a constructor. The process becomes very linear and prototypically fragmented with sequential design, procurement, and then construction. There is very little interaction among the contracted parties, usually resulting in increased errors, disputes, higher costs, and ultimately longer schedules.
The adverse results of this silo based approach has led owners to gravitate toward a more integrated project delivery (IPD) with a single point of responsibility and a more enhanced predictability of outcome. The process ensures the owner receives a well-designed project, on time and on budget with minimized risk. Its basis is collaboration—where design, construction, and budget decisions are made by a team of architects, engineers, estimators, construction managers, and trade subcontractors.
Digging Deep For Design Solutions
On the AHN Wexford Health + Wellness Pavilion, CannonDesign began the project by using a design research process that delved into the needs of the owner, tenant, staff, and others. This essential information was then passed along to the architects and engineers as they began the design process. The goal was to develop more than one solution and give the end-users the benefit of selecting a design concept that best suited their needs.
Once the design alternatives were developed, a meeting was held with the internal staff of architects, engineers, cost estimators, construction managers, and construction superintendents together with outside trade subcontractors, to begin the estimating process and develop construction alternatives. These alternatives were not just explored for the ability to reduce cost, but also for a consistency with the architectural and engineering design intent. Once the first estimate was completed, it was evaluated against the owner’s budget and then discussed with its representatives to identify ways in which the costs could be reduced, if needed.
Once it was determined that the project was within budget, a “not-to-exceed” guaranteed maximum price (GMP) contract was developed with the owner, which included the option of bidding the project with incomplete drawings and 100% scope narratives, enabling the firm to choose the apparent low bidders to work with the A/E staff and jointly complete the drawings before construction began. The contract also included a construction schedule and a surety bond.
Fast Track To Quality Care
The project was fast-tracked by beginning construction as the drawings progressed. This concurrent design and construction process was enhanced with the use of building information modeling (BIM). Using Revit modeling software, the project team was able to anticipate constructability problems before they became an issue.
Ron Dellaria, principal at CannonDesign and senior advisor to the firm’s design-led construction division has been involved in American Institute of Architects (AIA) and Associated General Contractors of America groups advocating for BIM-facilitated IPD for most of the past decade. With this AHN project, Dellaria encountered some initial reluctance for the owner, but he was able to demonstrate the value of adopting an integrated design-led construction delivery method in lieu of traditional low bid procurement.
“We convinced AHN that we could do 100 percent of design development documents—which are essentially 50 percent construction documents—and use the technology to allow the sub-trades to bid the job and then plan the details. We built a guaranteed maximum price that included a contingency. Once we released the documents and brought the trade contractors on board, we adjusted the GMP but kept the contingency,” says Dellaria.
Name of Facility: Allegheny Health Network, Wexford Health & Wellness Pavilion. Square footage: 173,000. Budget: $57.4 million. Construction Timetable: 22 month design and construction schedule (construction completed on time in 18 months). Facility Owner: Allegheny Health Network. In-House Project Manager/Facility Manager: Allegheny Health Network. Architect/Construction Manager: CannonDesign. Electrical Engineer/Mechanical Engineer/Structural Engineer: CannonDesign.
Furnishings: Herman Miller. Flooring: Forbo; Itec. Carpet: Shaw. Ceilings: USG. Movable Walls/Wall Surfacing: Modernfold. Restroom Fixtures: Bobrick. Lighting Products: EdgewoodSargent. HVAC: Limbach. Roofing: Massaro. Doors: Massaro/Wyatt. Elevators/Escalators: Otis.
The team was confident enough of the GMP after working with the key trade contractors that it convinced AHN to split the contingency with them, essentially ensuring the owner could keep half the contingency, while CannonDesign would use 50% of its portion to incentivize the trade contractors as construction proceeded. When construction was completed, half of the contingency was sufficient, even though the project as originally designed could have been accomplished within the original bids. When the owner added scope, it wasn’t necessary to extend the schedule to complete the work. The team was able to tap into the contingency to accelerate the schedule so the additional scope would not delay completion. This also encouraged the team to collaboratively see where to push to get things done.
Owners, architects, engineers, contractors, and consultants worked in co-location spaces and generated the creative feedback that led to informed decisions. The arrangement allowed for team members to always be current on the project. For instance, fabricators could begin tasks off-site immediately after the modeling of the details was complete because the collaborative environment permitted immediate consensus. And trade contractors were on board with the process because the collaborative environment permitted immediate consensus.
Patient Centered Care
The AHN Wexford Health + Wellness Pavilion brings a range of outpatient services into the community, on a level of quality and sophistication normally found only in a hospital. Not only convenient, but because this is a “one-stop shop” with all of the services under one roof, the continuity of care across specialties is far more seamless and integrated than when patients need to transition between physically separate facilities. Embodying patient-centered care, a few key features of the facility are:
- State-of-the-art cancer institute with advanced radiation oncology and medical oncology facilities, including a 16 chair chemotherapy infusion center
- Outpatient surgery center with four operating rooms and three procedure rooms
- Comprehensive orthopedic surgery, sports medicine, and follow-up care, including physical, occupational, and rehabilitation therapy
- Comprehensive women’s health center that provides a full spectrum of gynecologic and breast healthcare services
- Cardiovascular institute complete with access to medical and surgical specialists, cardiac rehabilitation, and advanced diagnostic care such as EKG, echocardiography, and nuclear cardiology
- On-site laboratory testing and a retail pharmacy
- Visionworks store complete with optometry care and an on-site durable medical equipment supplier
“[CannonDesign] totally understood what our vision was and they were very involved with us the whole way through. As we were designing the building, they took the time to meet with our subject matter experts and understand what was important to our clinicians,” says Bonnie Irvin, vice president of patient experience at Allegheny Health Network.
“We were able to get the building up in 18 months and I think one of the reasons was the fact that [CannonDesign] was both the architect and the contractor for this project. Working in that way, they were able to coordinate things in a much different way than your traditional construction model,” Irvin continues.
Ultimately, leveraging the design-led construction delivery model allowed AHN to bring a transformative health facility to market efficiently and effectively. This model helped AHN achieve an architecturally significant facility with world-class care on an accelerated construction timeline with limited risk and guaranteed cost. The success of AHN’s efforts with its Wexford Health + Wellness Pavilion demonstrate a new construction delivery model for other organizations to follow in healthcare and other market sectors moving forward.
Winikoff is vice president at CannonDesign in Pittsburgh, PA. He has more than 15 years of project management and architectural design experience in healthcare, and his technical experience makes him adept at understanding project priorities and proactively resolving issues.
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