Tackling North America’s Largest Healthcare Project in Seven Steps
This article is about the $1.5 billion University of Montreal Health Centre BIM project. This is a good study case on how to innovate and manage such a complex project as well as learn the best practices.
Montreal is in the midst of a healthcare building boom. Last year saw the opening of the city’s first mega-hospital, the 2 million-square-foot McGill University Health Centre. This year, an even larger project will be substantially complete. The $1.5 billion, 3.6 million-square-foot University of Montreal Health Centre (CHUM, for Centre Hospitalier de l’Université de Montréal) will consolidate three hospitals—Hôtel-Dieu, Hôpital St.-Luc, and Hôpital Notre-Dame—into three interconnected towers on two downtown city blocks.
Designed by global firm CannonDesign and local firm NEUF Architect(e)s, CHUM is currently the largest healthcare project under construction in North America. The first phase wraps up this year and includes the main portion of the hospital complex, the clinical ambulatory center, logistics center, pharmacy, laboratories, and underground parking. Phase two, scheduled for completion in 2021, will feature a learning center and library, auditorium, and finalization of the clinical offices.
The project is structured as a public–private partnership. Construction management and general contracting services were awarded to a joint venture between Obrascón Huarte Lain, in Madrid, and Laing O’Rourke, in London. CannonDesign and NEUF were contracted directly to the joint venture but also receive input directly from the CHUM user groups.
Executing this massive project—one of the largest ever to be modeled in Autodesk Revit—required CannonDesign to redefine its approach to BIM, project workflow and delivery, and staffing. Many of the protocols developed for CHUM have since been implemented elsewhere in the firm.
Below are seven lessons CannonDesign shared from the project, starting from day one.
1. Upend the project RFP
CHUM’s original RFP called for 55 percent of the program to be built in a series of mid-rise buildings in phase one. CannonDesign and NEUF quickly recognized an opportunity for improvement and proposed a high-rise solution that would build 85 percent of the program up front, incurring more costs earlier in the project and reducing the risk of significant escalation. The team won the project contract in 2011.
2. Get everyone on the same page, in the same office
Nearly 180 architects across 15 offices worldwide have worked on CHUM. To ensure consistency, the team set strict protocols. “It wasn’t going to be enough to just design the building,” says Christie Cavataio, a senior vice president for CannonDesign and the senior project manager for CHUM. “We needed to design the workflow as well.”
In late 2011, CannonDesign and NEUF hosted a project delivery meeting, which included each firm’s quality control and BIM leaders and the project’s BIM consultant, Boston-based CDV Systems, to establish a road map for the design and documentation process. These protocols applied to both routine and BIM-specific tasks, from email correspondence and transmittals to building equipment content and reference details in the Revit model.
The owner team's complex nature also required a different organizational structure. Unlike the typical workflow, in which the design architect hands off the project to a local architect-of-record following design development, CannonDesign and NEUF have worked together throughout the entire project, even co-locating into an office in Montreal alongside the client, key consultants, and contractors performing major design/build scope.
3. Leverage your IT infrastructure
The project's scope—the largest in CannonDesign’s history—combined with the distributed team and joint-venture client in two European countries presented infrastructure challenges. With the project model comprising 100-plus Revit files, sharing BIM data was one of them. CannonDesign leased space from a data center to host all project data and to run all project software (it purchased its own servers and workstations). Users from each of the 15 different offices ran their software remotely, on the same network as the workstations located at the data center, to minimize latency when loading project files and to avoid complicated file transfers between the various offices.
As a result, CannonDesign’s IT department could complete the frequent updates to software and hardware at only one location. A centralized platform also allowed CannonDesign and NEUF to benefit from a 24-hour work cycle: As teams in North America were ending their workday, teams on the other side of the globe, in cities such as Shanghai and Mumbai, India, would be starting their day and could use the same hardware and software licenses.
4. Treat BIM like a centralized database
Healthcare projects deal in repetition, with corridor after corridor of identical patient and exam rooms, surgical suites, and offices. The design team leveraged technology to automate the repetitive aspects of the project and to facilitate collaboration and coordination.
Though the client required the designers to use Autodesk Revit, CannonDesign and NEUF took a data-focused approach that maximized the value of the BIM data, rather than thinking only in terms of 2D drawings and schedules. For this to work, team members had to input the data with extreme precision. For example, room names had to be standardized across the project: Naming exam rooms “EX. RM.” in some instances and “EXAM ROOM” in others could be disastrous, messing up search results in the BIM model as well as batch design updates.
In addition to Revit, the team made extensive use of CodeBook, a database application tailored to capture and manage healthcare room and equipment requirements. In CodeBook, users can identify key or “exemplar” rooms, like exam, operating, and patient rooms, that then become templates, allowing the designers and medical planners to work out the requirements of each room type with the specific CHUM user group, and then apply these requirements to all corresponding rooms. CannonDesign estimates that Codebook cut the time needed to populate the model by half, as compared to manual input. Likewise, because healthcare technologies are rapidly evolving, an upgrade in room equipment can be pushed to all 442 exam rooms, 39 operating rooms, and 772 single-bed patient rooms with a single click.
5. Use the right tool at the right time
While Revit and CodeBook provided most of the horsepower, not every task required such advanced tools. The design team and owner group used PDFs for internal communications, editing shared documents with Bluebeam Studio. Matthew Forman, AIA, a vice president in CannonDesign’s St. Louis office, says he would often markup PDFs in Bluebeam Studio and see in real-time another designer, in another office, pick up the changes in the Revit model.
Bluebeam Studio also facilitated the language barrier during user-group meetings. Whenever the English-speaking architects and their French-speaking end users struggled to communicate, they could sketch room and equipment configurations directly in Bluebeam.
Microsoft Excel also proved invaluable. While the CodeBook database was guarded by the design team’s power users, everyone else used Excel to input their equipment or room data, which could then be imported into CodeBook.
To illustrate design and coordination issues with CHUM and hospital staff, the team used Autodesk Navisworks. For example, the 3D-model coordination tool allowed the design team to walk user groups virtually through the center’s dialysis department in first-person perspective, much like a video game, to show that sight lines to patients would be maintained.
6. Keep on training
Consistent training is essential for maintaining the integrity of project protocols, Cavataio says. Designers joining the team received a full week of training before they were allowed to touch the Revit model. They also had to shadow existing team members to see the project’s protocols in action.
Even project managers, who don’t typically handle the model, received the same overview training. Though the process was time consuming, Cavataio says, it was essential for maintaining project standards.
7. Don’t forget face time
While technology was essential for the different offices and firms to communicate, it doesn’t supplant face time. CannonDesign regularly rotated staff members from the 14 remote locations through its Montreal office and scheduled in-person training sessions. “Don’t discount the value of technology,” Forman says, “but nothing beats a face-to-face conversation.”
CHUM Project Stats
Budget: $2 billion CAD ($1.5 billion USD)
Size: 3,597,000 square feet (334,172 square meters) across three towers, each 21 stories tall
Room count: 442 examination rooms, 39 operating rooms and 772 single-bed patient rooms
Staff: 10,000-plus employees and 6,000 students and interns
Annual patients served: 345,000 ambulatory patients, 22,000 inpatients, and 65,000 emergency patients
Equipment count: 185,000-plus
CHUM BIM Stats
Model size: 159 total model files (41 architectural, 9 data, 6 logistics, 77 M/E/P, 26 structural)
Number of base drawing sheets: 6,756
Number of base drawing sheets with revisions: 29,572
Autodesk Revit software versions upgrades: Three, with the fourth planned in 2017