1. Palomar Medical Center West: Segmented Review Process

2. Discussion Points Project Overview Why This Process? Details of What Was Done Ingredients Successes Lessons Learned

3. Building Stats 725,000 BGSF 360 Beds Project Cost $690 million Construction Schedule Start: July 2007 Finish: December 2010

4. 360 Bed Hospital (288 Beds + 72 shelled rooms) 192 Acute Care Beds 168 ICU Beds 56 Emergency Positions (Level 1 Trauma) 12 Operating Rooms 6 Cath Lab/Interventional Radiology Rooms 18 Imaging Rooms H O S P I T A L P L A N N I N G

5. 5 Design Bid Coordination Fabrication Construction Bid Design progresses over the same time with assistance from contractors Early OSHPD “Preliminary” reviews begin before documents are “finalized” Select contractors are chosenOther contractors bid when Permit is awarded Early contractors assist in design and begin their coordination efforts. Fabrication can begin earlier and all work is coordinated in 3D BIM and Design-Assist Strategy Plan Check - OSHPD I N T E G R A T E D P R O J E C T D E L I V E R Y Integrated Team & Process / BIM & Design Assist Contracts

6. Courtesy of the Office of Statewide Health Planning & Development I N T E G R A T E D P R O J E C T D E L I V E R Y OSHPD Pilot Permit Process

7. Why This Process? Innovation stems from problem solving Start dates often move, but end dates usually do not Ongoing Collaborative Discussion with OSHPD Blend of communication, desire to improve the process, and needs of the project

8. The Segments Segment 1: Detailed Approach –“Rules of Engagement” –Design Methodology, Modeling Assumptions, Code Interpretations. –Using Past Experience, Address Every “Rock in the Road” that has occurred on past reviews from both sides.

9. The Segments Segment 2: Building Configuration and Loading Criteria –Building Configuration and Layout of Lateral Force Resisting System –All Loading Assumptions –All Special Loading and Vibration Sensitive Areas –Matching Architectural and Structural

10. The Segments Segment 3A: Lateral Model and Frame Sizes –Complete Lateral Design Model and Accompanying Frame Elevations –Substantial Work Effort For Design and Review –Most Subsequent Design Activities are Dependent on Output From This Model

11. The Segments Segment 3B: Gravity Design and Model –Beams, Girders, Columns, Slabs –Both Model and Drawings –Most Subsequent Detailing is Impacted By This Sizing.

12. The Segments Segment 4: General Notes, Specifications, Typical Details –Specific Details Are Derived From Typical Details –“Floater” in the Process For Continuity of Review

13. The Segments Segment 5A: Foundations –Heavily Dependent on All Information in 3A and 3B Segment 5B: Diaphragms, Drags, and Chords –Heavily Dependent on All Information in 3A and 3B

14. Final Submittal Incorporates all Information From Segments All Detailing Now Introduced Unique Design Features That Develop Late Introduced

15. Schedule

16. Necessary Ingredients Owner and Architect That Can Commit To The Structure and Not Look Back Collaborative Team Cooperative Review Team Frequent Face to Face Interaction Sufficient Manpower and Fee

17. Extremely Helpful Ingredients Design Assist: Subs on Board 3D Coordination: BIM

18. What Worked Best “Rules of Engagement” Segment Model Segments Designer and Reviewer Both Impact The Design: Better Experience For All Saved Time

19. Lessons Learned Minimize Overlapping of Segments Focus More On Process, Less On Dates Recognize and Address Continuous Deadline Pressure For Team Obtain Clarity on What is Being “Conditionally Approved” Control Bookkeeping Address Long Lead Items: AMC, Soils, Ground Motion Do Not Limit To Structural Review

24. Q U E S T I O N S ?