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Sutter Health’s Lessons from their First Lean Projects

by Hal on September 21, 2005

in construction, leadership, lean

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[Notes from LCI's 7th Annual Lean Construction Congress]

Sutter and two design and construction teams presented their learnings from their early projects.

  • Connected program planning with project management
  • Using Target Value Design approach
  • Using the lean principles as a common language among the project participants
  • Last Planner and the language of promising reliably
  • The group has struggled with leadership in the context of lean

The first project was done 60 days ahead of schedule and $100,000 under budget in spite of the client's instinct to spend every available dollar and starting the project over budget.

George Zettel, Turner Construction: Turner started on the side of "We're already doing this." Now we recognize that we were not. The superintendent says it was the smoothest project he ever ran.

Audience: What is your perspective on how you incorporate lean as a design team member?
Bonnie Walker, HGA: Lean has been really wonderful. It's a breath of fresh air to have true collaboration with the contractor. We are focusing on the whole rather than the pieces. Target Value Design (TVD) has allowed us to be proactive.
Romano Nickerson, Boulder Assocs: I can continue in the same line. The biggest thing comes in the construction administration portion. The camaraderie during construction was wonderful. I had personal relationships with all the trade superintendents. It had positive outcomes throughout.
Mike Mencarini, Unger Construction: We hold our phase schedules meetings at the jobsite. We invited nurses and doctors to our phase schedule meeting for remodeling an active emergency department. It set a context for the construction people to be sensitive to their needs.

Audience: Can the contractors cite a specific thing you thought you did well but when you implemented lean you discovered otherwise>
George: Our superintendent got things done with intimidation. He saw during the first four months subcontractor foremen helping each other without him needing to step in.

Audience: Who made the final decision on value-based design elements using real-time site estimating?
Dan Conwell, Sutter Health: The entire team was involved in that process. The team was aided by an oversight group. Wherever possible it was a consensus.
George: The architect needs to be sainted. The Davis site had three on site customers. There was a collaborative mechanism to flush out needs and wants. Turner would aid the architect with pricing of various options. Eventually the right answer would bubble up. The trust that developed in the first phase helped throughout.
Dave L: Ultimately, the client is the affiliate. Those clients are at the table with us while we are in a conflict-based dialog to reach a solution.

Audience: Can you expand on connecting planning with project management?
Dan: Planning never stops. It is not realistic to think we can finish planning before design begins. We see the value of letting planning continue through the design and construction document preparation.
Dave L: With planning available throughout the design process we can make a timely response. Our success is based on bringing the lean tools to the whole of the process.

Audience: How was it like with all the change in the environment?
Dave Jansen, Unger: It's one of the advantages of lean. LPS forces the subcontractors to do their planning. We've become more adaptable as a result. We're able to adapt to the operations of the hospital and shave time off the schedule along the way.
Mike: Getting back to Messer's comments. These tools are changing our culture. We are communicating much more with subcontractors.

Audience: Has lean affected the way you've dealt with OSHPD?
Bonnie: We've become very creative. We've change ordered out part of our building to provide beneficial occupancy. We met with OSHPD and was able to keep things moving forward.
Dan: We've been able to delete elements along the way that opened spaces to patient beds.
George: OSHPD is the approval organization for health facilities in CA. Lean has helped us improve the system allowing us to avoid deferred approvals. We see hope in the process.
Mike: We're also collaborating with the IOR.

Audience: Are you now able to say "No" more often or does the network of commitment allow you to say "Yes" more often?
George: The fear of saying no gets in the way of asking probing questions. Saying no surfaces the clients' concerns.
Romano: Openness among the project team has facilitated have better conversations. I now find myself doing things I wasn't doing before. It's now a more receptive environment with the owner.
Dan: I think it's a gradual process. It started out with people answering Yes and then transitioned to yes, but..' Now they are moving into the No. You can see the transition taking place and the trust building

Audience: Give us some examples of Target Value Design
Dave L: We modelled our initial effort on the work of Paul Reiser on the St Olaf project.
Mike: We start by telling the architect no curved walls. We have estimators and project managers present during design sessions. We had to produce a GMP before completion of the construction documents.

Glenn Ballard: What will this team decide to do next?
George: We'll be using modelling on the Davis project so we can make decisions on how we will remodel the hospital without impacting operations or incurring overtime and working 2 shifts.
Mike: Sutter has asked us to finish the bed tower project early. We are now doing some RPS to explore alternatives.
Dave L: Owners can be a key constraint. We seek to hold the owner accountable for staying out of the way. Some equipment decisions we need to defer. The next thing we are doing is an OAC workplan and measure PPC. We've been making things up only to find out later that there's a name for it.
Mike: While Sutter asked us to step up to lean. In turn they are tackling the payment cycle.
George: This is a step in the right direction.
Dan: Dave is providing the leadership. Then team is motivated. The next project we'll provide more value for the client while doing cheaper and faster.

Greg Howell: The superintendent on the Turner job expressed his opinions on doing projects lean, "I've never been on such good terms with an architect this late in a project."

{ 1 comment… read it below or add one }

1 Claude Emond September 22, 2005 at 10:20 am

Hi Hal,

it has been a while !

it is a superb testimony you present here. I am presenting some principles of lean construction management next week to a class of students doing their Construction Management Master degree (École de Technologie Supérieure) and would like, if it is OK with you, to distribute to them a copy of the PDF version of this testimony. I already mention in my presentation, your blog, your work with Greg, Lauri’s articles and the LCI. Actually the teacher in charge of this course, who asked me to do that, has just started his PhD studies in England with Lauri as his thesis supervisor and sponsor – the world is a small place; maybe, because, it is naturally «lean» for people who seek to be «agile» ;-)

Best regards


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