Dartmouth Hitchcock Medical Center (DHMC) is the only Level 1 trauma hospital in New Hampshire, providing primary and specialty care to patients throughout New Hampshire and Vermont. Despite DHMC’s technical staff having the ability to support the area’s most complex cases, their facilities could not meet patient base demand and often exceeded 能力, 迫使DHMC每月拒绝数百名患者.
In 2018, DHMC董事会批准了一个新的, 六层240,000平方英尺的住院楼, expanding services and 能力 by adding 64 state-of-the-art inpatient beds and shell space for future flexible expansion.
The facility was designed with an interdisciplinary and “future-proof” approach. 病房提供灵活的医疗/外科服务, 降压, 甚至是重症监护方案, 视需要而定. Each room is private and offers space for visitors to be with their loved ones during their stay. 和, 技术是最前沿的, 集成病人仪表板, MyChart床边, 遥测装置, allowing patients to interact with their provider teams at their fingertips.
挑战:基于地理位置的劳动力短缺
上山谷是一个小的集合, 佛蒙特州和新罕布什尔州边界上典型的新英格兰城镇. 面积很大, 但是人口很少, DHMC是方圆几英里内唯一一家为这些居民服务的医院.
DHMC’s priorities and obligation to Upper Valley residents extended beyond the care they were providing. It was important to the hospital to put the Upper Valley to work through this significant construction project, 在某种程度上，这是可能的, 保持本地劳动力和供应商基础.
百家乐软件’s knowledge of the New Hampshire subcontractor market and capabilities informed a thoughtful strategy to do just that, 最终将超过50%的项目支出留给当地公司.
解决方案:深思熟虑的采购 & 有意的
预制构件
保持工作本地化: The 百家乐软件 team took a holistic view of the planning and buyout for this project: identify which scope areas could be supported by local subcontractors and vendors, and then determine where there were opportunities to introduce creative solutions—like 预制构件 and material pre-purchasing—that would infuse greater efficiencies into the project.
开始, 团队把当地所有分包商的规模都标出来了, 能力, 以及承担如此规模和复杂项目的经验. The subcontractors were invited to an open house event where they could learn more about the project, 见见百家乐软件团队, 并了解竞标的期望和时机.
“我们的计划是尽可能使用当地劳动力, 当我们把那条路开到极限的时候, we explored creative solutions that could enhance the overall delivery of the project,里基·加拉说, 高级项目经理.
计划确定性预购设备: 在2020年2月的设计开发期间, 百家乐软件 and designer HDR proactively mapped out decision deadlines for material purchasing, 在任何可能的情况下建议变通办法. This is a risk management strategy that 百家乐软件 employs on all projects, 但事实证明，随着COVID的到来，这对DHMC至关重要和及时.
2020年初，世界面临着前所未有的不确定性, 百家乐软件’s DHMC team was preparing to break ground on the long-awaited (and much needed) Inpatient Tower. 而不是, 他们的重点转向了预测迫在眉睫的材料短缺, 供应链问题, 边境的关闭, 以及天文数字般的价格上涨.
“从项目一开始, 早在听说COVID之前, we planned this project to be as schedule and labor-resilient as possible…and then the pandemic really stress-tested that approach,百家乐软件预制总监Bill Seery说.
百家乐软件 secured steel prices before costs skyrocketed and bought from a New Hampshire-based steel mill to avoid potential U.S./加拿大边境问题. 所有M/E/P设备均为预购, locking in early pricing to avoid escalation and circumnavigating long equipment lead times, 在新罕布夏需要物资之前就将物资运抵.
它还提供了其他好处, 比如允许M/E/P设备被设计到建筑中, and all structural slab requirements and electrical could be fully coordinated in advance, 消除冲突和现场返工.
这种积极主动的方法也延伸到了商品项目上. 管道, 绝缘, 屋面, and drywall were prioritized; subcontractor onboarding was expedited, 提交和审查都是快速进行的, 材料都订购好了. 纳舒厄的仓库, 恩菲尔德, 和西布鲁克, NH和温莎, VT were used to store the materials until they were needed much later in the project. This fast-tracked procurement approach proved critical as lead times increased nearly 500% on many commodity items during the pandemic.
到2020年4月, 百家乐软件团队锁定了其分包商和供应商基础, 预购的材料, 他有一个扎实的计划，要为住院病人大楼奠基, 定于2020年7月.
“If we weren’t proactive about the way we approached procurement and 预制构件 on this project, 当COVID来袭时，我们就会措手不及,加拉说。. “我们没有对问题做出反应，也没有试图改变方向. 我们以最有效的方式规划了这个项目, 当大流行来袭时, 我们处在最好的情况下，可以正面应对.”
See how 百家乐软件’s equipment and commodity pre-purchase strategy safeguarded the project when COVID hit, 交货时间也直线上升.
加强交付的预制: “我们进行预制的方式……是非常系统化的. 我们从场地开始思考，一直到M/E/ p和完成,布莱恩·汉密尔顿解释道。, 百家乐软件的医疗保健副总裁 & 生命科学. “当你把预制过程看作是在工地上减少劳动力时, it opens up people’s minds; they aren’t just thinking about the standard 预制构件 elements.”
DHMC预制方法的每个方面都是经过深思熟虑的. The selected scopes needed to add value to the finished project or the way it was delivered. 从最小的解决方案，比如在门上预装硬件, to large-scale improvements like a structural shift to bolted connections, 或驱动外部设计进行预制, 决策必须提高质量, 提高交货速度, 省钱, or remove on-site labor to mitigate campus disturbances and make the jobsite safer.
“百家乐软件 went into this project knowing the value and advantages that 预制构件 would bring. 当HDR勾勒出一个概念性的体量图时, the entire DHMC project team started collectively digging into the elements of the job that we wanted to pre-fab,汉密尔顿继续说道。. “我们一开始就做这件事真的很重要, 因为在某些情况下, 它改变了我们接近大楼的方式.”
By pre-fabricating systems that directly impacted care delivery and the patient experience, 比如头墙, 医用气体架, 湿墙, 百家乐软件和客户团队能够尽早且经常地进行检查, ensuring the assemblies met DHMC’s exact specifications and standards of care. It also helped keep the schedule in-line by reducing the risk of defects and non-compliance that would need to be repaired or replaced during punchlist.
“By going into the Inpatient Tower project aware of these potential delay ‘traps,的前期规划, pre-procuring, and pre-fabricating were all applied to mitigate and diminish these risks,西瑞说。. “Our goal on every project is to eliminate risk through intensive pre-planning, DHMC的结果展示了这一努力的成果.”
Check out the video below to see what was pre-fabricated and the value it added to the DHMC Patient Tower project.
翻倒塔
Three years after COVID called into question the feasibility of DHMC’s long-awaited project, 住院病人塔将向上山谷社区敞开大门, providing close-to-home care and a patient experience that rivals its neighbors in Boston and Portland.
Dartmouth Hitchcock Medical Center’s state-of-the-art tower has increased the hospital’s ICU 能力 by 228%, with an additional two floors of shell space for a flexible expansion and space for 64 beds which could increase 能力 by 356% when fit-out. 医院的正门很受欢迎, 有舒适的大堂, 美丽的教堂, 便利的设施和服务，如食品和饮料站, 哺乳室, 以及为DHMC患者扩建的出院休息室.
The once too-small hospital is now a landmark for primary and specialty care in the Upper Valley.