Planning and Design for the New Chinese Hospital May 7, 2008

1. Chinese Hospital Progress Update Planning and Design for theNew Chinese HospitalMay 7, 2008 Jacobs Carter Burgess with ARUP Mazzetti Associates FW Engineers SJ Engineers Herman Miller for Healthcare Davis Langdon Associates Treadwell Rollo WeAreSure KCA DPR

2. Chinese Hospital? • Born November 27,1940 • at Chinese Hospital

3. 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.

4. 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.”

5. 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.

6. 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.

7. 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

8. Chinese Hospital History • Chinese Hospital opened on April 18, 1925 at 835 Jackson Street with sixty patient beds.

9. Chinese Hospital

10. Integrated Delivery System CH IDS CCHCA CCHP Three partners form a “fourth” enterprise and jointly share in its success independent of individual operations

11. “It's not the plan that is important, it's the planning. “Graeme Edwards”Plans are nothing; planning is everything.”Dwight D. Eisenhower

12. “The trouble with the future is that it usually arrives before we're ready for it.” Arnold H Glasgow

13. Our Approach • An Integrated Design Approach • Process Mapping • Target Costing • Systems Integration and Optimization • Decision Management

14. 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

15. Goals To Recognize Site Limitations and Optimize Site Use

16. Goals To Optimize Construction Value Through Optimization of Engineering Systems, and the Building Envelope

17. Goals To Develop the Smallest Code ConformingWorkable Spaces and Use Modular and Movable Systems Where Appropriate

18. Goals To Use Proven and OSHPD Approved Materials, Assemblies and Systems Without Frills

19. Goals To Minimize Cost Escalation by Using Integrated Project Delivery and Lean Practices to Reduce Time and Wasted Efforts

20. Goals To Respect the Unique Nature of Chinese Hospital and Its Relationship to the Community and Between the Hospital, Health Plan and Physicians

21. The 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

22. The Planning and Design Process • Integrated Planning and Design • “A Mixture” vs “A Solution”

23. The Planning and Design Process To Choose Optimal Solutions and Maximize Value Establish a Value for Each Decision Choose the Sequence with the Highest Maximum Value

24. The Planning and Design Process

25. An Integrated Delivery Process

26. An Integrated Delivery Process Programs and Medical Systems Architectural and Building Systems Civil and Structural Systems MEP Systems Interiors / Modular Systems 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 Finalize Preliminary Design Design Documentation On Site Construction

27. The Planning and Design Process • Integrated Planning and Design • “Inside Out and Upside Down” • Process Mapping • Room Diagrams • Equipment Lists

28. The Planning and Design Process ICU Single Patient Room

29. The Planning and Design Process Exam Room Operating Room R/F Room Offices Office Cubicles

30. The Planning and Design Process • Integrated Planning and Design • Systems Optimization • Structural Systems • Mechanical Systems • Electrical Systems • Plumbing Systems • Building Envelope

31. 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.

32. Relatively Short Floor to Floor Heights Careful Coordination with Structural Systems 13’6” and one floor at 12’0”

33. Area = Cost

34. Desire Meeting Affordability

35. Building Cost Comparisons

36. The Planning and Design Process • Decision Management • Target, Scale and Value

37. 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

38. Current and Future Space

39. The Planning and Design Process • Integrated Planning and Design • Architectural Image • Context • Community • Sustainability

40. Development of Exterior Design

41. Development of Exterior Design

42. Development of Exterior Design

43. The Work Continues Dependent Decision Logic Criteria Calculation “Component” Anchorage DPR Added To Team

44. A Demonstration Project

45. The Increments and Packages

46. The Increments and Packages

47. The Increments and Packages

48. 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

49. Activities • Acquire and Integrate • Sub-contractors • Vendors • BIM models • Decision management • C-VSM (continuous VSM)

50. LEED 2 points to Gold!