General contractor delivers project nearly three months ahead of schedule and $3 million under budget
SAN FRANCISCO, CA – Skanska, a leading global construction and development firm, recently completed Sutter Health’s Samaritan Court Ambulatory Care and Surgery Center (Samaritan Court), a three-story, 69,000-square-foot medical office building that allows the client, Sutter Health, to offer patient access to more convenient, affordable and connected care across the region. The project’s completion continues Skanska and Sutter Health’s enduring working relationship and further cements the construction firm as a leading provider of healthcare projects throughout the region, and beyond. In addition to leveraging several innovative construction tactics, Samaritan Court marks the first instance in which a general contractor collaborated with all trade partners (mechanical, electrical, plumbing, framing and drywall) on layout strategy and responsibilities simultaneously, done via the use of Dusty Robotics, delivering the project nearly three months ahead of schedule at a cost savings of approximately $3 million for the client.
“The completion of Sutter Health’s Samaritan Court Ambulatory Care and Surgery Center exemplifies how Skanska worked efficiently across teams to prioritize our client’s needs and bring their vision to reality,” said Jeremy Cortesio, Project Executive at Skanska. “In the face of a pandemic and supply chain challenges, our team completed this project ahead of schedule and under budget to deliver a best-in-class healthcare facility to the region and its residents.”
Located near the border of San Jose and Los Gatos in Santa Clara County, Samaritan Court brings together 34 physicians within Palo Alto Medical Foundation from 12 medical specialties, along with a clinical lab, imaging suite and an ambulatory surgery center, designed to make care more convenient and affordable for patients and providers. The completion of Samaritan Court is a key part of the client’s broader plan to build more than two dozen ambulatory care centers across Northern California over the next four years.
Efficiencies and innovative processes
Despite significant project challenges including the COVID-19 pandemic and supply chain delays, Skanska leveraged innovative construction technologies such as the use of Dusty Robotics, virtual punch list, and Takt Planning, to relay efficiencies to all project partners, including the architect/designers, owner, trade partners, and equipment specialists, delivering the project nearly three months ahead of schedule at a cost savings of nearly $3 million for the client. The team used an integrated form of agreement (IFOA), which, throughout the pandemic, helped stimulate creative ideas and planning remotely.
To ensure the project was delivered ahead of schedule, the team focused on rework to determine where improvements could be made to cut rework in half in comparison to projects of similar size and complexity, implementing major changes to the traditional project delivery process. In the goal-setting stage, the project team determined the average number of punch list items on similar projects that could be used as a baseline for measuring rework. The team analyzed historical data from comparative healthcare projects and found the typical project averaged 250 punch list items per 10,000 square feet. Using this metric, the Samaritan Court team altered the process by starting punch list activities during the design and preconstruction phases rather than in the closeout phase when work has been put in place.
Over three hundred conditions were resolved in two months, not counting the many conditions that would have been repeated multiple times. Based on historical data, these items would have caused a delay of up to 30 days and cost more than $100,000 to resolve.
The virtual punch list allowed each stakeholder to review final conditions—furniture, casework and equipment placement, ADA clearances, device and outlet alignment, utility connections and item placements that would require unique finish details—in the building model, ultimately allowing the team to achieve its goal of cutting rework by 50 percent on the project.
Skanska worked extensively with all trade partners specializing in mechanical, electrical, plumbing, framing and drywall, to facilitate a combined layout plan in a first-of-its-kind collaboration and implementation of Dusty Robotics, which offers robot-powered tools to save time and improve results through BIM-driven layouts. Once layout work was complete, a single file was uploaded to Dusty Robotics where a 2-D draft is processed and printed onto the floor. Skanska’s work provided a faster, more accurate and clearer layout that all trade teams could utilize, working together simultaneously to further reduce field errors and relaying an added benefit of time and cost savings to the client team.
Additionally, the project team leveraged the use of Takt Planning, and set an aggressive goal to learn and implement related strategies to have a single schedule for all project partners, including the architecture/design team, owner, trade partners and equipment specialists.
Designing for better patient outcomes
The design team, Boulder Associates, brought the client’s vision to life for a warm, timeless, easy-to-maintain, and inviting space by incorporating warm woods, recessed modern lighting, natural stone and visually stimulating wayfinding graphics into the project’s interior design.
Samaritan Court boasts strong wayfinding throughout the building with local flora and fauna elemental themes assigned to each floor, such as water, pebbles and trees. In collaboration with signage and art consultants, the team added a breakdown of natural elements to assign to each medical practice in the form of graphics, aimed to create an intuitive and self-sufficient overall feeling and orientation in the building for both patients and staff.
Key operational and planning considerations for the design focus on providing patient-centered care by aligning the care model and technology with the built and natural environments to achieve the best outcomes for end users. Elemental design highlights include:
- Designing the building to have a single entry/exit for patients, promoting clear wayfinding.
- Centralizing reception areas for upper floors at the patient entry points.
- Centralizing waiting spaces on upper floors to allow a variety of clinical services to share seating and maximize efficiency for staff movement.
- Localizing departments to achieve the greatest operational efficiency for the best patient care with ease of access to core modalities including Diagnostic Imaging and Laboratory Services.
- Allowing departmental adjacencies to share point-of-care rooms and support spaces between clinic modules and services.
- Locating the surgery center on the first floor for ease of patient access and discharge.
- Orienting patient care and recovery rooms toward pleasant views of the natural environment to encourage patient recovery.