Maximize the Potential of an IPD Team for a Replacement Hospital with Lean Coaching and Innovative Tools

Maximize the Potential of an IPD Team for a Replacement Hospital with Lean Coaching and Innovative Tools


Sutter Health/CPMC developed the St. Luke’s Replacement Hospital as a seismically compliant facility as part of their master plan for the City of San Francisco, California. Boulder Associates was teamed with SmithGroupJJR expressly to provide expertise in lean thinking and integrated design practices. With SmithGroupJJR as the architect of record and medical planner for the project, Boulder Associates focused on integrating the design team with the design assist trade partners and general contractor, as well as developing and deploying integrated methods of project management, BIM development and model management, and design production.

The Challenge

Entering 2011 as Sutter struggled to recover from the recession, the team was asked to achieve a difficult milestone: deliver the design documents early but maintain the current, modest staffing level of the team.

The Process

BA coached the team in the elements of the Last Planner™ system, including reliable promising, pull planning, and weekly work planning. The team implemented the BA Way design process, our design-based version of Last Planner™, including the following management and control components:

  • Milestone and phase planning – the team regularly planned phases as a stakeholder group, documented the plan, and then tied team and individual work planning to the milestones.
  • Individual Weekly Work Planning – each team member maintained a work plan of weekly activities and measured plan percent complete, tasks anticipated, and captured reasons for variance. Plans were updated daily and reported weekly.
  • Team Weekly Work Planning – The design team met weekly to plan their work and to confirm proper staffing. Team members reported on their individual work plans and discussed reasons for variance together.
  • Daily 5-minute stand-up meetings – The team leader met with individual team members at their desk for daily standup meetings. This allowed the leader to keep the pulse of the team as well as providing each team member with one-on-one time to ask questions and receive direction.

The Results

These project management methods allowed the integrated team to shorten a 16-month design schedule to 13 months, a 19% improvement in time to deliver the permit package. Furthermore, the team maintained level staffing throughout the design process and delivered even, steady work. During that period, the team reached a PPC average of 81%.

Lessons Learned

Overall, the Last Planner implementation was successful and produced valuable results for the owner.

Last Planner in design requires fluidity, particularly in early design phases. Designers move rapidly between design alternatives, which means that a plan made on Monday may complete or even obsolete by Tuesday, requiring a much shorter planning cycle than typically applied in construction.
RECOMMENDATION: Adjust planning frequency as needed to deliver best value to the team.

We also discovered that it was important to adjust the planning cycle duration when the team was crunching to finish work ahead of a major milestone. More frequent check-ins and robust re-planning kept the team aligned and prevented cycles of negative iteration.
RECOMMENDATION: utilize a Training Within Industry (TWI) approach focused on demonstrable small wins.