Howard Brown Health is a not-for-profit organization serving the healthcare needs of the LGBTQ community in Chicago. The new 91,000 sf, 5-level structure includes street-level retail, pharmacy, phlebotomy lab, and generous clinical space. It also provides underground parking and expansive rooftop terraces for events, functions, and community gatherings. The new facility is also a good neighbor as its architecture compliments Halsted Street with projecting bay sections, various tones of articulated brick, and large windows in all public areas.

The building construction is high quality. The structural frame is cast-in-place post-tension concrete, while the skin combines articulated brick and insulated glass curtain wall. Interior finishes are colorful, maintainable, and durable, essential characteristics for healthcare environments.

HBH is the largest, most significant healthcare supplier to the LGBTQ community, and this building has become the focus of these efforts in Chicago. During the project, the design team arranged bi-monthly community outreach meetings in local business owners’ restaurants with the neighbors, Alderman Cappleman and Alderman Tunney, as well as project milestone events that were attended by Senator Feigenholtz, Congressman Quigley, and the North Halsted Business Alliance to articulate the various stages of the project and to explain the ensuing and anticipated stages of the work on-site as it progressed month to month. The general contractor, McHugh Construction, engaged in minority participation, which realized approximately 10% overall company participation. There was MBE/WBE/LGBTQ and DBE inclusion as part of the project’s design, permit expediting, and vendor procurement and installation phases.

Zero incidents were reported.

The iconic Joan and Paul Rubschlager Building completes a campus transformation on eleven acres in the nation’s largest urban medical district to a hub for leading edge patient care, research, and education. The overarching mission is a belief that cancer and neurosciences patients deserve services designed to meet their needs and complex problems, in a streamlined, supportive, and highly effective way. The vision was to create a facility that embodies this evolution of care and enables Rush to deliver a closely coordinated, unmatched outpatient experience to more patients than ever before. The central goal was to improve health by applying the Rush values of innovation, collaboration, accountability, respect, and excellence.

Tenets of Target Value Delivery principles were used and resulted in a streamlined construction solution that coexists with exemplary design. A rigorous set-based design process was used for selecting a high-quality exterior brick material, noted as reminiscent in a warm and familiar way, but pivotal in meeting our target cost. In addition, the local subcontracting community was more adept at managing the quality of brick, over terra cotta or synthetic materials. 

The design and construction team were in a co-located studio in addition to partnering with the owner’s equipment consultant, systems furniture designer and technology consultant. BIM models were hosted on the cloud, and we integrated all consultants’ work into the implementation documents for clarity of design and permitting. It was a collaborative process as we selected and onboarded trade partners for design assist including elevators, MEP trades, curtainwall, and framing. Our excavation contractor proposed a utility tunnel jack and bore system, a first for Chicago. The innovative boring pit and utility sleeve installation was half the cost of a traditional tunnel excavation solution, and it was safer than an open pit. We created as-built conditions for the Board of Underground and the final installation was implemented with pinpoint accuracy. 

Lean construction evaluation was a project constant. During our mockup room evaluation, the builder was able to review constructability fabrication workflow. Concurrently, we conducted integrated team milestone and phase pull plan sessions that subdivided our workstream into Utility Tunnel, Shell & Core, Fit Out, and Site/Parking Garage. A regulatory workflow was also established due to the complexity of approvals needed by multiple agencies in Chicago. 

54 Bid Packages and five Permit Packages were issued, plus two Zoning and Planned Development Applications. A micro-schedule was developed just for the Planned Development and Zoning Variance permitting. Difficult constraints were commonly overcome by our component teams holding a regular cadence of coordination workshops. Real time decisions were essential to our success. A Project Execution Plan was developed that addressed document control (e- Builder) and quality (Finishline). 35,170 items in total were entered in Finishline, checked, and resolved.  

Quality meetings were conducted every Thursday through the entire construction process. The design team employed an envelope consultant, and the Owner held a contract with a testing and quality control consultant. Together they coordinated reviews of drawings, specifications mockup tests and field inspections. When significant issues arose, we would swarm the item with a SWIFT (Specific Work in Focused Time) team and develop a path to meet the Owners Project Requirements. 

While the near westside community is diverse, Rush had never established mandatory MBE/WBE/DBE targets for all parties. Every goal exceeded target except for one while 930,949 total manhours were expended on constructing the project: 

Community Business Spend 9.82% met versus 3% goal.

Minority Female 44.12% met versus 32% goal.

WBE 7% met versus 6% goal.

MBE 30% met versus 26% goal.

City Residency 36.5% met versus 50% goal.

Design Team 33.79% met versus 32% goal.

Specific IDE facility design accommodations included: All-Gender Multi-Stall Restrooms for equity, people with disabilities, and granting safe spaces for transgender and gender nonconforming patients, visitors, and staff; Adult Changing Tables to allow caregivers and patients the opportunity for privacy and comfort; and Pet Relief Areas for patients who have therapy and emotional support animals.

Social relevancy was accomplished through a granular ethnography study that included patient interviews, provider workshops, and human centered research. The future state analysis was particularly insightful for the cancer service line patients and validated the tenets of collaboration, community, and connectivity and, in turn, the Pillars of Success for people, growth and reach, quality and safety.

Prior to construction Rush led the implementation of forming a Safety Charter and Committee. Safety Talks were conducted routinely. The Safety Committee was another standing meeting that monitoring jobsite safety and any field observations and documenting any incidents Safety was a hot topic and Safety Moments were the first agenda item in the weekly OAC (Owner/Architect/Contractor) meetings. A total of 8,751 safety observations were recorded during this mega-project. The Owner was instrumental in developing a root cause analysis process when a non-compliant observation was reported. Like a SWIFT team these observations were swarmed immediately, and work could be halted depending on severity of incident. 

This project was early into construction at the outset of the pandemic in early 2020. While all other Rush projects were halted, this facility was designated a critical project by the Governor of Illinois and construction was permitted to continue. An additional level of precautions was implemented for the safety of our respective team members and Rush issued a zero-tolerance policy on PPE, social distancing, and temperature testing upon entry to the jobsite. Due to the severity prior to immunizations, members of the construction team were removed from the project for not adhering to safety guidelines.

Cook County Health’s Belmont Cragin Health Center is a new two-story, 25,000 SF healthcare clinic designed to provide a range of services under one roof for medically under-served populations throughout Cook County. With 30 exam rooms, the Clinic provides pediatric and adult primary care, women’s health, and dental care, as well as specialty services including cardiology and endocrinology. The Women, Infants and Children (WIC) food assistance program is also located on site. In addition to exam rooms, the program also includes ultrasound, private staff offices, provider workstations, and medical support spaces. Creating a welcoming community resource that is transparent and accessible to all users was key to the design of the project. Construction included a steel frame with a glass exterior shell, a new parking lot, sidewalks, and new landscaping.  From a safety perspective, the project had an excellent safety record with over 40,000 trade hours worked and zero lost time and OSHA recordable incidents.

F.H. Paschen used its established, three-phase quality control program that is modeled after the US Army Corps of Engineers program and includes preparatory, initial, and follow-up inspections for each definable feature of work. F.H. Paschen encouraged full transparency and collaboration with all stakeholders and held numerous prefabrication and pre-pour meetings with the subcontractors and Owner’s representatives to discuss and confirm procedures, schedule, impacts on the community, and construction of mockups to ensure that all parties agreed on the products prior to fabrication and installation. As with all F.H. Paschen projects, quality control was addressed in detail at weekly project meetings to review the previous week and prepare for the week ahead.

The new Belmont Cragin Health Center is double the size of the existing clinic it replaced, bringing modern healthcare capabilities to the Belmont Cragin neighborhood.  The primary initiative in creating this new Health Center was to provide appropriate care at the right time, in the right place, and under one roof to decrease the amount of preventable hospitalizations.  The 30 exam rooms included in the program can accommodate more than 50,000 visits annually, ultimately increasing the capacity of healthcare services while simultaneously decreasing wait time for patients.  Constructed during the COVID-19 pandemic, the larger clinic allowed Health Center staff to administer COVID-19 vaccinations to community residents.  Additionally, the Women, Infants and Children (WIC) food assistance program is also located on site.  The patient care team includes bilingual Spanish-speaking staff to better serve the patients coming for treatment.  Both Holabird & Root and F.H. Paschen are committed to diversity and inclusion in all projects.  For the design phase, the Holabird & Root team utilized subcontractors to meet Cook County Health’s established 35% MBE/WBE participation goal.  For the construction phase, the established diversity goals were 24% MBE + 10% WBE participation.  The team exceeded these goals by achieving 26.7% MBE + 13.82% WBE participation.  Overall, the project had 48.36% minority and women workforce hours with over 11% being local to the Belmont Cragin neighborhood and surrounding community. 

This project had an excellent safety record with over 40,000 trade hours worked and zero lost time and OSHA recordable incidents.  To achieve these numbers, F.H. Paschen implemented a robust training program, requiring all supervisors to be 30-hour OSHA certified, first aid certified, and AED trained.  F.H. Paschen requires mandatory Job Hazard Analysis on all self-performed work and implemented a Construction Safety Phasing Plan.  Safety stand down meetings were held throughout the project on a variety of topics to reinforce the safety-first mentality.

The Advocate Christ Medical Center (ACMC) Adult Emergency Department Expansion is the first interior renovation completed under an Integrated Project Delivery (IPD) contract for Advocate Health Care.

The project transformed the existing 17,600 SF Level I trauma and resuscitation center into a new 43,000 SF state-of-the-art Emergency Department (ED) across 6 phases. The new ED boasts 45 private exam rooms, 10 resuscitation exam rooms, 6 behavioral health exam rooms, 8 fast-track and 2 new X-ray rooms, along with numerous other staff support spaces focusing on improving patient outcomes and reducing wait times in support of the community.   

The Integrated Project Delivery team included Advocate Health Care, HDR Inc, Pepper Construction, Grumman Butkus, Dickerson Engineering, Thorne Associates, Hill Mechanical,  and Jamerson & Bauwens as collaborative partners focused on delivering this first-in-class project safely, on time, and within the Owners allowable maximum price for the project.

Quality was the priority in our collaboration to design and deliver an informed, flexible and value-driven critical care environment that patients can trust for first-in-class care for years to come. With proactive attention to planning and safety, the team completed multiple phases and sub-phases of renovation work throughout the facility, while keeping patient services fully operational. A critical success factor was early and consistent communication across the entire project team, as well as the hospital’s key personnel and support staff. 

During design, the entire team was involved from user meetings through document development, frequently checking in and comparing the design progress and development with the anticipated construction costs, constructability concerns and material procurement impacts. The team managed a list of opportunities and risks throughout this phase to help inform early decision-making efforts.

The project team collaborated using virtual tools such as Revit, Bluebeam, Touchplan and StructionSite to increase value by reducing silos traditionally found in construction and improving communications across all team members.

Revit was used by the Architectural and Engineering partners during the Design Phase and continued through MEP coordination, which reduced some of the rework/rebuilding of models that would occur with a more traditional delivery approach. 

Once demolition was completed, the project team scanned the existing conditions, including existing utilities that had to remain, to make final edits to the Revit model ahead of fabrication. This reduced the amount of waste and required rework that often occurs during renovation work, while also increasing the confidence of the project planning team to push the schedule toward completion.

A Bluebeam Studio session was created so all project partners could view and easily access the most critical documents, including plans and specifications, approved submittals, vendor equipment and furniture coordination drawings, etc. This approach to paperless documentation significantly increased the speed in which changes reached the field and, as a result, reduced waste from rework that traditionally occurs when changes are delayed. 

Touchplan was also used for project planning. This web-based software takes the Last Planner System for project planning (scheduling) virtually, making the detailed project plans more transparent, collaborative and accessible to the tradespeople who are tasked to complete the work. The team used this software to develop finely tuned schedules that informed the project teams, hospital departments and staff that may be affected by the work. For example, the team was challenged with replacing all the finishes in a few of the primary corridors of the hospital. Reducing the shutdown of these corridors was a top priority for the hospital. Through close coordination within the project team and the use of Touchplan, the team developed a detailed schedule, including three consecutive shifts per day across seven different sub-phases, that reduced the overall shutdown duration by more than 40% compared to what was initially planned. This schedule was used to communicate with the hospital staff. It was completed with zero incidents, no unanticipated impacts to the hospital and within the exact timeframes that were initially promised.

Structionsite is an online software that allows for 360 photo-capture, which was used during this project for preconstruction and progress photos as well as pre-drywall and pre-ceiling photos. These photos were shared with the hospital facilities at the completion of the project as a means of as-building the installed conditions that are no longer visible upon regular inspection. Additionally, using this software, the team developed a fully equipped “virtual” typical-exam and resuscitation-exam rooms for stakeholder input prior to construction, ensuring outcomes matched expectations. Through this proactive process, the team identified priorities that were then standardized across the different types of rooms, which resulted in zero requests for modifications after occupancy. These virtual rooms were ultimately adopted as the standard for emergency rooms at Advocate’s other hospitals. 

Improved communication continued in the field by using daily morning huddles with the project’s lead foreman. These meetings were held onsite every morning at the day’s work location. They established a rallying point for the project each day, where the foremen would describe their team’s tasks, identify questions or concerns that needed immediate attention, and establish the overall team goals for that day. These meetings helped ensure that all tradespeople had important, firsthand information to optimize productivity, reduce unintended conflicts, minimize risks and focus on what was most important for that day’s work. Staying informed and in sync, the team could design, coordinate and install new system infrastructure while allowing critical infrastructure to remain active, ensuring that patient care remained uninterrupted.  

The Integrated Project Delivery (IPD) Team also had monthly communications meetings, known in Lean circles as Big Room meetings, that provided a “check-in” opportunity for the entire group, which helped ACMC to optimize decision-making during the project and increase the return-on-investment (ROI) of the renovation. The team developed and monitored an IPD dashboard that improved transparency on the project’s health, including financial, schedule and safety metrics, as well as risks and opportunities to be considered for the team’s leaders. Information was updated monthly, allowing the team and ACMC to understand cost trends and track the project against incentive thresholds. Additional beneficial outcomes of this approach include being able to identify potential issues before they become challenges. 

As a result of these efforts, the team delivered the project two months ahead of schedule. It returned approximately $1M to the Owner, reinforcing that quality healthcare projects can be successfully executed using an IPD method.

The ACMC Adult Emergency Department expansion in Oak Lawn, Illinois, ensures that all patients who turn to ACMC for immediate access to critical, life-saving medical treatment can receive the highest quality care when needed. The renovation is designed to meet the need for emergency services in the Southland, the South and Southeast sides of Chicago, and Northwest Indiana. Originally built for an estimated 50,000-55,000 patient visits annually, the facilities needed to be more equipped to serve the actual number of visits, which exceed 100,000 annually. As the only Level I trauma center serving these areas, the busiest Level I trauma center in Illinois and a resource hospital for Region VII of the state of Illinois during times of disaster, the expanded ACMC Emergency Department is vital to providing high-acuity patients with timely, adequate medical attention, and efficiently moving patients with life-threatening injuries through triage and treatment. 

This renovation modernized and expanded the Level I trauma and resuscitation center from eight to 12 rooms, upgraded and increased the number of adult and pediatric emergency stations from 42 to 70 and enhanced clinical areas that support the emergency department, such as general radiology, inpatient endoscopy, heart catheterization laboratories, recovery areas, triage, cast room and transesophageal echo. In addition to ancillary support space, the renovation included trauma, non-trauma, fast track, imaging rooms, relocation of the patient access and Endoscopy and Heart Procedure Center prep and recovery areas, and establishment of a distinct Advocate Children’s Hospital Pediatric Emergency Department.

The upgraded and expanded facilities are transformational for the ACMC’s ability to fulfill its mission of providing quality healthcare for all people in the region. The expanded space will improve patient access to emergency services, help reduce the need to divert patients to other facilities, enhance patient privacy and provide dedicated space to address the emergent needs of specific patient populations. With new and added space, ACMC has an opportunity to improve patient health with state-of-the-art equipment and attract and retain additional quality staff. Overflow patients no longer need to wait for or receive care in the department hallways but can receive the care they need to heal in private rooms. The early delivery of the final project meant ACMC could apply the cost savings resulting from eliminating five phases of construction to achieve its vision for the new patient-care space. 

Commitment to maintaining a diverse workforce is demonstrated in achieving 28.3 percent of the 30 percent MBE/WBE participation goal. The project incorporated connections with smaller firms capable of the work as a valuable part of meeting project goals. The fact that minority firms selected for this project successfully advanced to work on additional jobs demonstrates that these efforts affect the community and industry in lasting, positive ways. 

The project employed sustainable waste management practices as part of the commitment to environmental stewardship. Efforts to save energy and decrease waste resulted in 87 percent of the 90 percent recycling goal achieved. Prioritizing responsible construction practices through collaboration across stakeholders, the project reduced financial and environmental costs associated with disposing of waste material, ensured the safety and well-being of the team, the hospital and its surrounding communities, and promoted a culture in the industry focused on contributing to a more sustainable future for all.

With patient, staff and team safety a priority, the IPD team focused on tracking both safety incidents at the job level, as well as “unplanned” shutdowns that would affect the hospital’s daily operations and ability to ensure a safe environment for their patients, visitors and staff.  

Through the IPD method and Integrated Form of Agreement (IFOA), this project required an extremely collaborative environment. All trades were in constant communication about upcoming activities and any potential risks to which other trades could be exposed. Through weekly meetings, activities that required additional safety measures were discussed and coordinated with all trades. This mentality of sharing information and collaborating created a safe environment where trades felt empowered to speak up and plan accordingly. 

Throughout this three-year project, the Team had three cut/laceration incidents (tradesperson safety), one unplanned impact on the facility, and zero unplanned impacts on patient care.