6/24/2015. Learning Objectives. Preamble. The Long Push, Part IV: The Story of Memorial Hermann

Transcription

1 The Long Push, Part IV: The Story of Memorial Hermann Michael A. Hatton Larry Newlands Learning Objectives Learn the steps to develop a long-range strategic infrastructure plan and a sound business case (energy and maintenance cost savings) to secure funding for hospital infrastructure upgrades Learn how to implement phases of the plan within budget and on schedule to maintain credibility and administrative confidence in the plan. Understand the importance of developing and issuing regular status reports indicating actual costs and schedules as compared to budgets and deadlines. Learn how to measure and verify actual results (energy consumption and cost savings, maintenance savings, etc.) achieved by implementation of the plan. Preamble Memorial Hermann has evolved from a fix when fails capital process to a pro-active planning process that seeks to methodically replace capital equipment and infrastructure in a more timely fashion. Our efforts over the prior 7 years have improved reliability, improved survivability during a natural disaster, and greatly reduced the deferred maintenance/capital project backlog. 1

2 Results This approach has also resulted in better planning and implementation of Best Practices for life cycle replacements and energy efficiency; both of which have improved Memorial Hermann s bottom line. Persistence, marketing, planning and benchmarking pays off It did Not happen overnight. Feedback and Results Must be shared with the C-Suite to continue the focus. BAS > Time Clock BAS is Often Under-Utilized BAS can aid in achieving energy reduction and improving tenant comfort with strategies such as: Minimizing Area Run Times Central Plant Operations AHU Discharge Temperature Reset Schedules (Seasonal) Static Pressure Reset Schedules Implementing Additional Strategies for Humidity Control Air Reductions to Code Minimums including After-Hour Operations and Weekends Lighting Controls Data Collection & Processing (Dashboards) Fault Detection (Effective) is the Next Frontier Capital Planning Marketing Effort Required to Sell Initiative Planning Means > Next Year (5-10 Year Capital Plan) Benchmark to Anchor Your Datum Today Initiate Immediate ROI Projects (i.e., HVAC Scheduling) Plan/Push Market Results of Efforts OPM Still Exists Use It (i.e., Utility Rebates/Grants) Plot Your Success Market/Sell to the C-Suite Year-End is Always a Great Time for Funding A Memorial Hermann Year Used to Start in June (Prd 12) Have Proposals Ready when C-Suite Approves Funding 2

3 Funding Sources Force it into that New OR Project (Get a Seat at the Table) Year-End R&M $ (Relationship w/c-suite) OPM > Most Utilities have Grants or Incentives Include Rapid Payback Tasks into BAS PM Contract - Structure Helps BAS PM Outcomes Build it into the New Bed Tower Project (Ask!) You are the Infrastructure Sales Team It is Said to Be Pro-Active Today s FM Needs a 5-Year Capital Infrastructure Plan Refer to it Often when C-Suite Budgets Next Renovation Educate (Market) Your A&E Team on Day 1 During Project Planning FM Must Stay Involved with Renovations Commissioning is Not a 4-Letter Word - Use It Keep it Collaborative Yes, the PM Really does Not Know How an AHU should Function Project Manager vs Facility Manager Project Manager Well-Defined Focus/Scope A Shiny New Widget Finite Schedule Finite Funding The Next Project Awaits Well-Trained to Say NO (Scope Creep) Tom Sawyer Approach to Project Closeout Facility Manager Broad Focus Finite Funding Needs a Partner Owns Project Outcomes when PM Moves On Scope Creep is Their Friend Goal is to Get Project to Also Replace AHU 3

4 Project Manager vs Facility Manager Partnership Required Observation that FM & PM May Not Get Along Must Collaborate Make PM Your Best Friend (or - Have Pictures!) Stay Involved w/ PM s Project Show Up at the V/E Meeting Spend $1, Save $2 Building Operational Performance Degrades Over Time Building Systems have Finite Life Cycles Some New Technologies are Both Reliable and Energy Efficient Led Lighting Condensing Boilers Variable Pumping Systems Heat Recovery Chiller (if Sized Correctly) ASHRAE 90.1 Resets Work; Set Them Up (BAS) Spend $1, Save $2 Invest in Building Systems New Facilities (Push Best BAS Practices) Life Cycle Replacement/Retrofits Utility Hardening (Natural Disasters) Building Envelope Must be Corresponding Investment in People (Training Tool Kit) Your Staff May Not Understand the Basics Your Consultants May Not Understand Current BAS Practices 4

5 Project Continuum Visual Finding Success Benchmark Current Energy Consumption and Costs Establish Energy Cost Reduction Goal Develop the Strategic Energy Plan Finance the Program Implement Supply-Side ECRM s Implement Demand-Side ECRM s Sustain the Savings Capital Investment and Savings 5

6 Actual Energy Costs Memorial Hermann Portfolio Improvement 15 Million Square feet Real Estate Assets Energy Cost Reduction Mandate Reduce Cost Structure Mandate Staffing Levels are too Low Higher Material Costs Higher Service Contract Costs Energy 51% Staffing 27% 8% Materials 14% Service Contracts Slide provided by TME 6

7 Cost for Electricity and Gas per Sq.Ft. Retail Energy 20% of Portfolio! Comparing Facilities 7

8 Observations on Commissioning Is there Value Added with Commissioning? It Depends Observations TAB is an Important Quality Tool in Healthcare that is Often Low Bid Commissioning and the TAB Process are Unfortunately Still Underutilized in the Healthcare Construction and Renovation Business Memorial Hermann has Proven that Improving the Commissioning Process Means Huge Cost Savings for the Future Commissioning (A Tool) Done Correctly Blends the Micro Look with Macro System Performance Matches the Field Expert with the Textbook Design Standards Has Firm Predecessors on a Schedule that Cannot be Compromised (TAB, Controls, F/A, E-power has to be Finished Prior to Commissioning Effort) Commissioning Needs to be Included Early in a Healthcare Project (in Order to Add Value) Is a Waste of $ and Time if Rushed Before System Completion May be Better Completed Post-Occupancy? Idea. 8

9 Road Blocks to Successful Peer Review Has Commissioning Provided Value to Your Project? Is Commissioning Simply a Budget Line Item? Is Commissioning Something You Wait and See if You have Money Left for? Does Our Industry Truly Understand the Goal, Cost and Opportunities of Commissioning?" (Definition) Commissioning has Very Favorable ROI Done Correctly Commissioning is Not a Simple Checklist! (Technical vs. Process) Results A Satisfied Owner and Successful Healthcare Project Fabulous Appearance Terrible Energy & IAQ Performance Commissioning Late to the Dance Project Constraints Budget Schedule Undefined Owners Project Requirements Key Stakeholders Insulated from Big Picture Shifting/Loosely Defined Scope Key Players Change Project Delivery Method (SS, GMP, CMR ) Value Engineering Focus on the Visible Elements 9

10 Results Schedule Compression; End of Job (Waste of Effort) TAB, Commissioning, and Training Quality Lacking Move in Before TAB and Commissioning Completed Never-Ending Punch List Systems that Do Not Talk (BAC Net, Modbus, etc ) Oversized Capacities (from V/E, Vague OPR s, Lack of Coordination, ) Excessive Construction and Operational Costs Grossly Over/Under Appropriate Square Feet for Program HAI s, Quality Concerns, Infection Prevention Memorial Hermann s Experience 2006 Expansion Project >50% More Energy (Btu s/sq. ft.) at Opening Commissioning Funds Wasted (Schedule Compression) TAB Incomplete Design & Construction Defects (Many) from Fast Pace Many Environmental Challenges However: Still Opened On-Time Still Opened On-Budget GMP/CMR/Stipulated Sum; Similar Results Success; At a Price Building Looked Finished Memorial Hermann s Experience (Previous State) Reality! How do we know a project is complete?" (a) Regulator Signs Off (b) PM = Out of $ (c) Schedule says Complete (d) Patients Move In (e) Architect Signs Certificate of Substantial Completion (f) Consultants Out of Hours (Fee vs. Focus) 10

11 Memorial Hermann s PDC Experience What Really Happened 4-5 Years Worth of Effort to Test/Tune and Resolve Defects Wasted $30+ Million in Excessive Utilities Used Operating Funds to Resolve Re-Work! There is a better way Current $2+ Billion Expansion Project Goal to Reduce Defects, Reduce Cost, Reduce Future Operating Expenses, Increase Standardization of the Healthcare Building Project Improve Reliability of Systems and Their Results on Patient Care Outcomes Reduce the Test/Tune/Fix Duration from Previous 4-5 Year Time Frame Resolve Legacy Infrastructure Issues (Multiple Control Systems, etc.) Make Project Outcomes = Project Goals Utility Hardening Natural Disasters How? Ensure OPR are Defined Early Bring Key Team Members on Early (Including Commissioning) Implement New Peer Review process; Day 2 Pre-V/E the Job (Align Scope, Schedule, and Budget) Create Pauses to Force Budget, Scope and Design Critiques Spend $ Early to Challenge OPR/Goals/Systems (Owner s Dreams vs Wallet) Ensure Schedule and Budget can Handle the OSM Account for Aging Infrastructure Balance Technology/Efficiency/Budget 11

12 The Ideal Project Team Blends the Best from the A&E Disciplines Have P.M. s with Decision Authority Knows Budget, Schedule, Goals, Program (Clearly) Forces Collaboration (Aligns the Boxes ) Manages Egos to the Desired Outcomes and Goals Will say No when Required Realizes that Project Constraints Matter Includes the Local FM Collaborative Project Team (One Approach) Ensure Systems that Often have Defects are Focused on Early (a) Roofing/Waterproofing/Glazing (b) Building Controls (c) TAB (d) Equipment Capacities Find the Right Professional for Early Input Use Peer Review and Pauses to Eliminate V/E (a) Right Size Equipment and Redundancies (b) Eliminate Systems/Processes/Products that Do Not Perform (c) Listen to the Experts Often a Blend of Different Firms/Personalities Memorial Hermann s Goals (This Go Round ) Reduce Project Cost Keep in Compliance with Audit Best Practices Ensure Complete = Complete Standardize and Reduce Defects Standardize and Reduce O&M Learning Curve Test/Tune/Commission/Train; Reduce Operating $ while Ensuring Codes and Standards Met Erase the Need for V/E Build Relationships Successful Job; No Defects Finish the Post Substantial Completion Effort 12

13 Memorial Hermann Improved PDC Process Schedule Budget Program Double Check Budget/ Program SD DD Commissioning & OPR Peer Review Double Check Budget/ Program CD Peer Review Construction Commissioning Occupancy Selected Infrastructure Projects Utility Hardening Houston = Hurricanes Life Cycle Replacements New Technologies Building Controls Expansion Utility Hardening (Priority Matrix) 13

14 Reheat Boilers Condensing Boilers - Takes Advantage of Lower Operating Temperatures Emergency Generator Project (Replaces 1973 Vintage) Hurricane Utility Hardening Emergency Power 14

15 Infrastructure-A/C and Heating Systems Memorial City Water Well Sugar Land Hospital Tower Crane Erection 15

16 Sugar Land Hospital Expansion Katy Hospital Expansion Interior Steel Erection In Progress All Six Stories of Tilt Wall are erected Northwest Service Elevator Tower Windows have been installed on 3 levels of new Bed Tower Casting Beds have been removed East View towards Houston For additional project photographs and video, follow the link below: Katy Hospital Campus Expansion New Hospital Tower Expansion and Renovation Rendering 16

17 MHHS Cypress Hospital Campus MHHS Cypress Hospital Campus HP 2 PIB TMC Garage 4 G4 Pearland Campus CCC/Hospital MOB1 Far Left withnew Pearland CCC & Hospital in Foreground Hickory Slough Area F Central Plant Area C D&T Area D Bed Tower CCC Future Helipad FebruaryAerial Photograph 17

18 Texas Medical Center Campus HP I Digital Scan Conducted by Contractor for Site Logistics Planning MH-TMC Master Facility Plan Robertson Demo Haircut Phase I of PIB - Generator Building Demo line Bridge from G4 Note: All buildings in Red will be demolished Dock Central Plant MHHS TMC Campus Master Plan North Campus Elevation - Night 18

19 Just-in-Time Capital Budgeting Our First Infrastructure Project QUESTIONS AND ANSWERS 19