Opening to the community in January, the Inova Women's Hospital and Inova Children's Hospital is the centerpiece of Inova Health System's capital improvement program in Northern Virginia. The project's delivery was a true team effort with all partners unified by a singular goal: to open the hospital for patient care at the earliest possible date. Despite relentless winter weather and the default of a prime subcontractor, the facility will open six weeks earlier than anticipated.

The two hospitals, located on Inova's Fairfax campus, share a 665,000 square-foot, 10-story building that includes 192 patient rooms, as well as 118 private pediatric rooms, a 108-bed neonatal ICU, 33 labor and delivery rooms, six C-section suites, and eight operating rooms. From the project's earliest stages, Clark Construction's personnel collaborated with Inova's construction and design personnel and architects from Wilmot Sanz to identify and focus on specific aspects of the project in order to meet their demanding expectations. The path to early activation began three years ago.

Safety and Schedule Performance

From the start, the team was committed to meeting Inova's activation date, no matter the obstacle; little did they know how this commitment would be tested over the course of construction.

A healthcare project of this size and complexity has so many different components. To make it more manageable, Clark got lean. Using the principles of Lean Construction, most notably pull planning, the team created Short Interval Production (SIP) schedules. The planning process included representatives from every subcontractor, who freely shared schedules, manpower, and quantities. This resulted in the team planning 20 months of construction on a single (albeit very large) sheet of paper. This effort allowed the team to know precisely what was occurring on every facet of the project at any given moment.

This planning session was invaluable when, at the peak of their scope of work, the original electrical subcontractor defaulted and went out of business. On Friday, the project had 125 electricians on-site. On Monday, none showed up for work. Because of the detailed schedule, and the ability to track work down to individual tasks on each floor, the subcontractor's sureties were able to view the project, validate the work through a third party, and bring on a replacement - Dynalectric - to join the team in one week's time. The master schedule allowed Dynalectric's personnel to pick up where work halted, with minimal delay.

The focus on early activation also had a profound impact on jobsite safety. The team logged more than 2 million man-hours throughout the course of the project. With the SIP schedule, they were better able to plan and monitor the safety efforts. As a result, the project's recordable rate was 1.67, less than half the national average, and the lost time rate was 0.09, sixteen times lower than the national average.

Self-Performance Success

The team self-performed support of excavation, cast-in-place concrete, and healthcare technology systems on the hospital, which provided Inova with greater schedule and quality certainty. With a 14-month scope of work, Clark Concrete developed a schedule that was both accelerated and reliable. Their team used tables for deck formwork to expedite the typical floor cycle and improve overall quality. They also developed a custom plan to keep concrete work on track despite a winter of historic snowfalls and "polar vortex" cold. To maximize productivity during the winter months, Clark Concrete and its ready-mix supplier developed a mix that performed better in cold temperatures; in the field, they used embedded logging devices to monitor differential temperature in placed concrete. This data informed a heating plan to ensure the concrete would properly cure and maintain full structural integrity, even as temperatures fell to record lows.

S2N Technology Group also worked hand-in-hand with Inova to design and install a full suite of technology systems, including electronic security, telephone and data infrastructure, overhead paging, audio-video, distributed antenna, and clinical technologies, including nurse call, real time location system, physiological monitoring, fetal monitoring, and telemetry. Working with the client early in the project schedule, S2N helped Inova correctly plan the hospital's technology systems before construction began. The group's on-site management ensured the installation process was properly sequenced and in accordance with industry standards and best practices.

Comprehensive Quality Control

To ensure the hospital was built to precise specifications, quality control efforts began well before groundbreaking. Clark followed a comprehensive quality control program, based on the U.S. Army Corps of Engineers' model that focused on early planning for all construction activities and involved all project partners at all phases.

In the preparatory phase, the team held meetings for every definable feature of work. Together with Inova, the design team, and appropriate subcontractors, Clark conducted a detailed review of the specifications, drawings, submittals, and installation plan for each facet of work in the hospital.

As construction began, the initial installation of every component was reviewed by the same team from the preparatory meetings. This quality team conducted ongoing inspections as production work continued, digitally compiling, tracking, and sharing any issues before taking corrective action.

The process was meticulous and proved a significant asset when potential issues arose. For example, in an initial meeting, it was noted that a deflection in the concrete slabs would affect uniform installation of door frames. Building the frames directly on the slab would make the hospital's corridors uneven. The underlayment subcontractor joined the next meeting to develop a plan to coordinate door frame and underlayment to ensure a level surface, and to control cost, limit the amount of material used. Before construction, the team surveyed the slabs, set an elevation benchmark, installed the frames, and then poured the underlayment to the bottom of each frame for a smooth and level surface. Clark's proactive solution ensured a quality product without impact to the schedule or budget.

Total Team Effort

Healthcare projects are among the most challenging to plan, design, and build. The path to early activation on the Inova Women's Hospital and Inova Children's Hospital required a full team effort, from the client to the subcontractors. With everyone on-site working with clear expectations toward a common goal, an integrated project team can exceed its expectations and overcome the most unexpected challenges.