Lean construction and design benefit local projects of all kinds


In a pull planning session for Kadlec Regional Medical Center’s Free-Standing Emergency Department, sticky notes – color-coded by trade and listing critical task information – are placed on a wall and continually repositioned to refine the sequence and timing of all construction-related activities until the ideal schedule is achieved. Photo contributed by Bouten Construction.


By Kathy McNelis for TCAJOB

In 2010 – as the faltering economy continued to wreak havoc in the construction industry – Bouten Construction recognized that in order to remain competitive it was imperative to increase its efficiency.  The firm decided to research the possibility of integrating lean methods in its operations, ultimately implementing a program that is transforming every facet of its business – both on job sites and in its Tri-Cities and Spokane offices.

The focus of lean construction – based on production management principles developed by Toyota – is attaining maximum value for the client by minimizing waste in time and scope so that projects are completed faster, more cost efficiently and with a higher level of quality.

Lean construction encourages input at each phase of the project from all participants – including the owner, design team, trade partners, and city or county building officials – to address vital issues early in the process.

Bouten’s research included staff attending a two-day seminar conducted by the Lean Construction Institute in Boulder, Colo., in late 2010 and spending two days with a San Francisco general contractor who had adopted lean practices five years previously to learn how lean methods enabled the firm to streamline the construction process, completing projects early, within or under budget, and with enhanced quality.

Bouten hired Lean Project Consulting of Louisville, Colo., to educate its staff in the philosophy, principles, tools – primarily the Last Planner® System – and implementation of lean construction.  Lean Project Consulting conducted two-day boot camps for employees – including leadership, construction crews and administrative staff – in Bouten’s Tri-Cities and Spokane offices.

Last Planner® System tools include master scheduling, phase scheduling, look-ahead scheduling, weekly work plans, constraint analysis, weekly plan percent complete, and learning/action plans.  By the end of 2012, Bouten plans to implement Last Planner® System on all of its construction projects.

Some of the first projects on which Bouten is implementing LPS are Kadlec Regional Medical Center’s Free-Standing Emergency Department in Kennewick and three elementary schools for Kennewick School District.  The $16.2 million, 20,700-square-foot emergency department will be complete in spring 2013.  Each of the elementary schools features 42,353 square feet of renovated existing space, with Sunset View and Cascade, which will be complete in June at a cost of $9.35 million, containing 8,627 square feet of new space and Lincoln (anticipated completion in June 2014 at a project cost of $9.48 million) containing 10,944 square feet of new space.

“(Last Planner® System) dictates a more intense level of coordination and communication among the design and construction team members for a smoother-running project with less waste.  Our goal is to shave 10 percent off the schedule of each successive school,” said Earl Eastman, Bouten Construction regional manager, who serves as project manager for the Kennewick School District projects. The projects were designed by Madsen Mitchell Evenson & Conrad’s Spokane office.

“Creating an optimal flow in schedule and activities allows for better planning of manpower and materials, which promotes an increased focus on quality,” Eastman said.

For each school, a series of preconstruction meetings precedes pull planning.  The pull planning sessions – which address the schedule one milestone at a time within each major project phase – involve the trade partners and incorporate their critical input in the schedule so that each trade is able to execute its work at the most advantageous time and in the correct sequence.

Doug Carl, director of capital projects for Kennewick School District, said lean construction techniques are expediting the completion schedule of the schools.  Carl, who attended Bouten’s boot camp, said the teaming aspect of pull planning enables trade partners to let the general contractor know their needs up front in the construction process, which allows issues to be resolved more easily and builds extra certainty into the schedule.

“From Sunset View to Cascade, we’ve informed the school district’s purchasing manager that the furniture schedule needs to be moved up,” Carl says.  “This relieves pressure on the district because there isn’t a rush to get everything into place immediately prior to the first day of class.”

He said the lean construction’s cost-saving, quality-boosting results have far-reaching benefits.

“Good schools are an asset to the region and help promote its growth and prosperity,” Carl said.  “I want to build schools that look good and that are comfortable and functional.  I also want to be effective and careful with the citizens’ money.”

The Last PlannerSystem also is being employed on Kadlec Regional Medical Center’s Free-Standing Emergency Department as is another lean tool – 3P (Production Preparation Process).  Utilized primarily on medical facilities, 3P is a design method that has end-users – including physicians, nurses, lab technicians and support staff – formulate the most efficient processes for the delivery of healthcare services and then develop a floor plan to support those processes.

To accelerate completion, the emergency department is being designed and built on a fast-track schedule, in which construction is initiated before the full construction documents are finalized.

“The fundamental idea of lean is to increase value and efficiency by identifying and eliminating waste in processes,” said architect Kent Gregory, principal-in-charge of the project for Edmonds-based Taylor Gregory Broadway Architects.  “3P is a major strategic event that provided Kadlec Regional Medical Center a golden opportunity to put new processes in place for the FSED.”

Approximately 30 people took part in the three-day 3P event, which was facilitated by TGBA.  Participants included physicians, nurses, mid-level medical staff, radiological and lab technicians, support staff and administrative personnel – as well as the design team and representatives of Bouten Construction.

After collecting data on their current processes, Kadlec Regional Medical Center Emergency Department staff created diagrams of the service lines to be housed in the department, which they used in designing multiple floor plans.  Using an outline of the emergency department and pieces of colored paper denoting areas such as the exam rooms, staff tested their diagram data to determine the ideal flow of information, medication, equipment, physicians, nurses, patients and support staff throughout the facility.

Details of the preferred floor plan were worked out on paper.  Participants then took an actual emergency department patient-visit schedule and used game pieces to simulate the visit and all of its related activities.  They also built a full-scale, fully-equipped exam room, in which they performed mock, real-time medical procedures to determine where flow-obstructing impediments occur.  A full-scale patient bathroom also was built.  The architects developed a design from the resulting floor plan and models.

The emergency department was initially programmed at 22,000-25,000 square feet with 18 exam rooms.  Data generated by the 3P event demonstrated that the average patient visit could be reduced from 221 minutes (at the existing ER) to 90 minutes, the department could support 20,000 patient visits per year initially with a future capacity upward of 40,000 annual visits, and this could be accomplished with 15 – instead of 18 – exam rooms and in 20,700 square feet rather than the original range.  These became the principal goals for the new emergency department.

“The primary advantages of 3P are that the facility staff – not the architects – are designing the processes and the space, it creates a bonded team of people who are developing the processes they will use instead of adhering to ones generated by others, and it flattens the sense of hierarchy in any medical group so that the technicians’ input is just as important as that of the physicians,” Gregory explains.

“3P is a team-driven process with the architect’s leadership and input.  I’ve never seen this level of engagement of staff in the design of a project in traditional design,” says Jason Rose, KRMC director of plant operations.  “The key advantage to having frontline staff design the facility is that they help make decisions on process improvements they know better than anyone else and then take the concept of the building and put it into action.  The staff came up with great ideas and it was very rewarding for them to be able to design a facility in which they will treat patients.”

Rose said the process wasn’t without its challenges.

“When the goal to reduce the average (emergency room) visit from 221 minutes to 90 minutes was first announced, it created a lot of stress,” he explains.  “Then we jumped into the details and built feasible processes around the goals.  The central question became, ‘How do we pull waste out of the processes?’  One example is what we call ‘swarm.’  Immediately upon arrival at the (emergency room), the patient will be taken to an exam room where a doctor, nurse and lab technician will swarm the patient all at once so that the patient doesn’t have to repeat information to a series of caregivers and a plan for care can be started immediately.  The (new emergency department) was designed around new processes like this one.”

Rose said he was impressed with the results generated by the Last Planner System in the construction of the new free-standing emergency department.  There hasn’t been a single deviation from the construction schedule, which was established in January 2012.

“I want to learn more about Bouten’s Last Planner scheduling and apply it to hospital projects,” he said.

Nick Naccarato, co-owner of Garrett Electric of Richland, the electrical contractor on the Kadlec project, said the pull planning sessions are particularly beneficial for construction partners.

“As a trade partner you’re a bigger part of putting together the schedule – rather than having the schedule dictated to you,” he says.  “Contributing input enables development of a schedule that is realistic and achievable.”

Naccarato said that in electrical work, lead times are critical, particularly on medical projects since they incorporate specialty equipment.

“On a fast-track project such as the FSED, additional emphasis is placed on long-lead items,” he said.  “LPS ensures that none of the long-lead items are stumbling blocks in the schedule.”

Eastman said implementation of lean methods requires immense focus and dedication throughout the company.

“We are determined to stay ahead of the learning curve in lean construction so that we can discover ways to eliminate waste and reduce cost while continuing to deliver the same high quality we always have,” he said.




by By Kathy McNelis for TCAJOB
Tri-Cities Area Journal of Business

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