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AUGUST 2015 | 97 Moose Jaw New Regional Hospital RENDERING COURTESY STANTEC Moose Jaw New Regional Hospital by ROBIN BRUNET D ave Shoemaker, director, construc- tion management for The Boldt Company, says, "I like to say it's the hardest and simplest thing you'll ever do. And it's worth doing." Shoemaker's words couldn't appear more contradic- tory, but for anyone who has ever fol- lowed Lean principles – which is what he is referring to – they make perfect sense, and Lean was key to the develop- ment of the new Five Hills Health Region (FHHR) new regional hospital in Moose Jaw, Saskatchewan. With 72 beds and 43 treatment rooms, the $103.8-million, 206,667-square-foot replacement for the Moose Jaw Union Hospital is organized into different clini- cal zones. The rapid throughput zone or Universal Care Unit provides standard environments for same day services such as exam/patient assessment activi- ties, phlebotomy and observation. Second is the Fixed-Technology Zone housing major procedural processes such as surgeries and advanced diag- nostics. Finally, the Collaborative Care Unit accommodates same-day outpa- tients requiring phlebotomy, dialysis, patient education and therapies. The wide degree of adaptability of these zones is unique in a hospital set- ting that is traditionally designed to be zone specific – often right down to indi- vidual rooms. They're the result of the FHHR using Lean principles to not only avoid design and construction repeti- tion and maximize efficiency, but also to ensure the optimal flow of patients. In 2011, FHHR est ablished an Integrated Project Delivery (IPD) team that included FHHR, the Ministry of Health, Stantec, Devenney Group Ltd. (which specializes in hospital design), Graham Group Ltd. and The Boldt Company to develop the new hospi- tal. "Essentially, we and Devenney had the Lean experience, and our col- leagues underwent a learning curve that ultimately allowed us to deliver the facility in 42 months instead of 60 months," says Shoemaker. The designers and builders agreed to put all, or a significant portion, of their profit at risk and be rewarded by shar- ing any cost savings with the owners – which spurred them to come up with cost-effective solutions. The project components were decom- posed into a detailed pricing estimate, which was value analyzed as the design prog ressed. Building Infor mat ion Modelling (BIM) protocols were estab- lished to aid in design co-ordination, trade co-ordination and clash detection in systems integration, constructability planning and scheduling. Nearly 200 people (including health- care professionals and communit y representatives as well as the design/ construction team) were involved in the design, and scaled table top models and full-size mock ups of rooms or areas were built to test ideas. Tom Atkins, VP, Stantec, notes, "Flexibilit y and adaptabilit y was a key objective: for example, 18 stan- dard rooms were designed to be eas- ily adapted to provide more ICU care if needed, and department zones were developed to be able to take more patients by expanding into neighbour- ing zones as needed. "We looked for flexibility everywhere and came up with interesting solutions, for example: instead of built-in millwork we opted for movable furniture, which would allow for interiors to be adapted more easily as required. The mechani- cal and electrical systems we chose are highly adaptable, and we selected a GPON system as the data backbone for the hospital because of its higher use of fibre optics instead of copper – meaning, less ripping out of walls to upgrade the system down the road. We standardized systems, wherever possible." As for maximizing the hospital's energy efficiency, the IPD team did not so much focus on new technology as it did on reduction – again, according to Lean. "We focused on reducing loads, which is key," says Atkins. "We simpli- fied the systems and reduced the num- bers of everything wherever possible. And we selected equipment that had minimal maintenance characteristics." Sequencing of work and supply chain was also a key component of the project. During the construction stage, which commenced in the spring of 2013, the trade foreman, superintendents and suppliers used a rolling six-week look ahead and a weekly work plan to check the previous day's production against the plan and assign the coming day's tasks. "In achieving our timelines not everything was Lean driven," says Shoemaker. "For example, we started construction while the drawings were still being worked on. However, the intention was the same: not to waste time or money." Colin Olfert, operations manager for Graham Group Ltd., says, "We didn't exactly drink the kool-aid and sit around singing songs; there were some significant disputes arising from such intense and constant collaboration. But with everyone focused on trying to find the best solutions for the hospital, the disputes led to productive outcomes." Kyle Matthies, director of commu- nication for FHHR, agrees: "Even just the process of coming up with ideas as a group and either voting them down or refining them was mentally exhaust- ing. And figuring out the size and con- figuration of the different departments was like trying to assemble a giant jig- saw puzzle." Construction solutions included 40-foot-tall and eight-foot-wide exterior wall assembly panels manufactured off site and tilted up on location in order to enclose the facility as soon as pos- sible. "This was vital since it enabled duct work and other systems to be installed over the winter months," says Shoemaker. The prefabrication is esti- mated to have cut labour costs by over 60 per cent. Other construction solutions devel- oped by Stantec, Graham and other team members include preassembled steel stud headwalls complete with mechani- cal and electrical integration, which facilitated the fast-track work schedule. With the hospital being prepped for a grand opening later this year, all parties agree that Lean can be a game- changer for the design and construction processes. "It's easy to overcomplicate things in our fields of discipline, and Lean is the remedy," says Atkins. Olfert adds: "Now we have the tools and skills to carry on to other projects." As far as Matthies is concerned, the new hospital is testimony of what can be achieved under Lean. "As health-care needs change, so can the hospital, both inside and out," he says. "We're really excited with the end result." A LOCATION 55 Diefenbaker Drive, Moose Jaw, Saskatchewan OWNER/DEVELOPER Five Hills Health Region ARCHITECT/INTERIOR DESIGN/ STRUCTURAL/MECHANICAL/ ELECTRICAL/CIVIL Stantec GENERAL CONTRACTOR Graham Group Ltd. CONTRACTING/LEAN CONSULTANT The Boldt Company MEDICAL PLANNING/DESIGN Devenney Group Ltd. TOTAL SIZE 206,667 square feet TOTAL COST $103.8 million

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