In 2018, the DHMC board approved the construction of a new, six-story 240,000 square foot Inpatient Tower, expanding services and capacity 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. Patient rooms provide flexibility to serve as med/surg, step-down, or even critical care options, depending on need. Each room is private and offers space for visitors to be with their loved ones during their stay. And, technology is at the forefront, with integrated patient dashboards, MyChart Bedside, and telemetry units, allowing patients to interact with their provider teams at their fingertips.

The Challenge: Location-based Labor Shortages

The Upper Valley is a collection of small, quintessential New England towns along the Vermont/New Hampshire border. The area is large, but the population is low, and DHMC is the only hospital within many miles for these residents.

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, and to the extent it was possible, keep the labor and vendor base local.

Consigli’s knowledge of the New Hampshire subcontractor market and capabilities informed a thoughtful strategy to do just that, ultimately keeping over 50% of the project spend with local firms.

The Solution: Thoughtful Procurement & Intentional
Pre-fabrication

Keeping the Work Local: The Consigli 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 pre-fabrication and material pre-purchasing—that would infuse greater efficiencies into the project.

To start, the team mapped out all local subcontractors with the size, capacity, and experience to take on a project of this scale and complexity. The subcontractors were invited to an open house event where they could learn more about the project, meet the Consigli team, and get a sense of the expectations and timing for bidding.

“Our plan was to use local labor whenever we could, and when we maxed out that avenue, we explored creative solutions that could enhance the overall delivery of the project,” said Ricky Gala, Senior Project Manager.

Pre-purchasing Equipment for Schedule Certainty: During Design Development in February 2020, Consigli and designer HDR proactively mapped out decision deadlines for material purchasing, advising on workarounds wherever possible. This is a risk management strategy that Consigli employs on all projects, but it proved critically important and timely at DHMC as COVID hit.

As the world was facing unprecedented uncertainty in early 2020, Consigli’s DHMC team was preparing to break ground on the long-awaited (and much needed) Inpatient Tower. Instead, their focus shifted toward forecasting looming material shortages, supply chain issues, border shutdowns, and astronomical price increases.

“From the beginning of the project, well before COVID was ever heard of, we planned this project to be as schedule and labor-resilient as possible…and then the pandemic really stress-tested that approach,” said Consigli Director of Pre-fabrication Bill Seery.

Consigli secured steel prices before costs skyrocketed and bought from a New Hampshire-based steel mill to avoid potential U.S./Canada border issues. All M/E/P equipment was pre-purchased, locking in early pricing to avoid escalation and circumnavigating long equipment lead times, getting materials to New Hampshire well before they were needed.

It also provided other benefits, like allowing the M/E/P equipment to be designed into the building, and all structural slab requirements and electrical could be fully coordinated in advance, eliminating clashes and field re-work.

This proactive approach extended to commodity items, too. Piping, insulation, roofing, and drywall were prioritized; subcontractor onboarding was expedited, submittals and reviews were fast-tracked, and materials were ordered. Warehouse spaces in Nashua, Enfield, and Seabrook, NH as well as Windsor, 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.

By April 2020, the Consigli team had locked in its subcontractor and vendor base, pre-purchased materials, and had a solid plan going into the Inpatient Tower groundbreaking, set for July 2020.

“If we weren’t proactive about the way we approached procurement and pre-fabrication on this project, we would’ve been caught on our heels when COVID hit,” said Gala. “We weren’t reacting to a problem and trying to change course. We planned the project in the most efficient way possible, and when the pandemic hit, we were in the best possible situation to take it head-on.”

See how Consigli’s equipment and commodity pre-purchase strategy safeguarded the project when COVID hit, and lead times skyrocketed.

Pre-fabrication for Enhanced Delivery: “The way we go about pre-fab…it’s very systematic. We think from the site all the way through the M/E/Ps and finishes,” explains Brian Hamilton, Consigli’s Vice President of Healthcare & Life Sciences. “When you approach pre-fab as removing labor from a jobsite, it opens up people’s minds; they aren’t just thinking about the standard pre-fabrication elements.”

Every aspect of the DHMC pre-fabrication approach was deliberate. The selected scopes needed to add value to the finished project or the way it was delivered. From the smallest solutions like pre-installing hardware on doors, to large-scale improvements like a structural shift to bolted connections, or driving the exterior design for pre-fabrication, the decisions had to improve quality, increase speed of delivery, save money, or remove on-site labor to mitigate campus disturbances and make the jobsite safer.

“Consigli went into this project knowing the value and advantages that pre-fabrication would bring. When HDR had roughed out a conceptual massing diagram, the entire DHMC project team started collectively digging into the elements of the job that we wanted to pre-fab,” continues Hamilton. “It was really important that we started this out of the gate, because in some cases, it changed the way we approached the building.”

By pre-fabricating systems that directly impacted care delivery and the patient experience, items like headwalls, med gas racks, and wet walls, Consigli and the client team were able to inspect early and often, 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,’ pre-planning, pre-procuring, and pre-fabricating were all applied to mitigate and diminish these risks,” said Seery. “Our goal on every project is to eliminate risk through intensive pre-planning, and the results at DHMC showcase the fruits of that effort.”

Check out the video below to see what was pre-fabricated and the value it added to the DHMC Patient Tower project.

Turning Over the Tower

Three years after COVID called into question the feasibility of DHMC’s long-awaited project, the Inpatient Tower is opening its doors to the Upper Valley community, 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 capacity by 228%, with an additional two floors of shell space for a flexible expansion and space for 64 beds which could increase capacity by 356% when fit-out. The main entrance to the hospital is welcoming, with a comfortable lobby, beautiful chapel, easy-to-access amenities and services like food and beverage stations, a lactation room, and an expanded discharge lounge for DHMC patients.

The once too-small hospital is now a landmark for primary and specialty care in the Upper Valley.

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Design

When planning an aggressive project schedule, utilize repetitive design details to ensure quality and efficiency as multiple elements are built simultaneously off-site.

Pre-cast Concrete Foundations

The concrete foundations at Johnson Pond Houses were designed to eliminate on-site formwork and ease transportation to site. Consigli’s Virtual Design and Construction (VDC) team developed 35 concrete panel shop drawings to be repeated for each building. Each panel included every penetration, lifting device, reinforcing detail and finishing requirement, with concealing joints between panels. Foundations Engineer of Record Trillium Engineering reinforced details and accelerated drawing approvals.

To confirm there were no conflicts between the concrete, volumetric modular structural unit models, embeds and site work, each panel type was digitally modeled and clash-detected with the structural unit models. Drain lines, HVAC system louver openings, boiler vents, sprinkler drains and electrical conduits were modeled and sleeved in the panels based on the 3D model of Mechanical, Electrical, Plumbing and Fire Protection (M/E/P/FP) systems.

Volumetric Modular Structural Units

KBS Builders Inc. (KBS) pre-fabricated structural units that allowed in-factory framing, electrical, plumbing and fire protection installation. Consigli and the Kaplan Thompson Architects design team engaged M/E/P/FP design-build subcontractors for weekly coordination meetings to advance the design with KBS. With 18 structural units per building repeated across four houses, coordination and review of KBS shop drawings were required twelve weeks prior to on-site delivery.

The design-build delivery of the four repetitive buildings allowed the team to rapidly adjust design details and apply adjusted concepts from the first building to the last in real time for schedule and quality improvements. The structural units were designed to deliver nearly complete interiors for all spaces except the corridors and pre-cast basements.

Pre-fabrication

Traditional on-site construction limits simultaneous trades on site, due to its inherent sequential nature (first comes site work, then foundation, framing and so on). Pre-fabrication supports faster, higher-quality construction by simultaneously managing multiple trades and delivering materials to site only when installation-ready.

Pre-cast Concrete Foundations

Consigli Self-perform in Pre-casting Yard

With zero flexibility on structural unit delivery, the team had only four working days to set the foundation walls for each building. Consigli turned the parking lot adjacent to the project into a near-site pre-casting yard to construct foundations during sitework, allowing the team to pre-cast and pre-kit the panels on truck beds for just-in-time (JIT) delivery once the site was ready.

From the VDC group’s detailed drawings, Consigli’s self-perform team formed and pre-casted each of the 140 panels. A heated form structure supported rapid pre-cast at ground level, reducing jobsite hazards such as weather-caused slips and potential soil/excavation collapse in the foundation holes. The Consigli carpenters’ pre-casting system formed, reinforced, casted, cured and stripped panels on a five-day cycle.

Volumetric Modular Structural Units

Structural unit pre-fabrication occurred simultaneously with site preparation, foundation and steel fabrication, all of which converged on the date units were delivered to site. Each 18-unit building took 20 working days to pre-fabricate, including the installation of M/E/P systems, insulation, operable windows, an exterior air vapor barrier and a highly insulated exterior wall system to provide a Net Zero Ready structure. The interiors of the bedroom units, bathrooms and common area rooms included the installation of drywall, light fixtures, electrical outlets, flooring and finish paint.

Delivery & Installation

Pre-fabrication reduces on-site labor density, ensures manpower consistency and decreases safety incidents. To reap the benefits of off-site prefabrication against an aggressive project schedule, extensive coordination of trades is essential. 

Pre-cast Concrete Foundations

Concrete panels were delivered just-in-time and placed with a crane with structural steel support beams. Consigli’s self-perform installers set the entire foundation wall system in less than three days—from the first panel being set to the start of wood sill plate installation.

Threaded inserts allowed clean picks off the panels’ sides. Embedded cam rotational picks rotated the panels from their flat to vertical positions for installation. Temporary bracing held the panels in place while awaiting structural unit installation, and top embeds were set to lock in the units come time for installation.

Volumetric Modular Structural Units

Structural Unit Installation

Structural units were delivered in two stages per building (left and right side, two-floors high). In typical pre-fabricated structural unit assembly, units fit with no openings to the exterior. Unique to the Johnson Pound Houses, the structural units had openings for corridor connections when set in place. Keeping each building weathertight between setting units and getting the roof tilted required careful, multi-trade coordination.

Consigli reviewed punch list items throughout construction, catching deficiencies when work was first put in place. Every item delivered was immediately quality reviewed, further accelerating the completion of each building by taking early corrective action.

The post Pre-fabrication for Expedited Delivery: Colby College, Johnson Pond Houses appeared first on Consigli Construction.

Seery was a co-founder of the first U.S. company to integrate construction and manufacturing processes to produce custom, pre-fabricated bathroom units for commercial instruction. With more than 17 years of leadership experience, Seery will bolster Consigli’s efforts to improve scheduling, cost certainty, and safety for projects in healthcare, life science, hospitality, higher education, and multi-unit residential buildings using pre-fabrication approaches including exterior skins, volumetric multi-room modules, head walls, single and multi-trade small assembly systems, and much more.

In his new role, Seery will work with pre-construction teams, design teams, and clients to identify opportunities to pre-fabricate systems that will be beneficial to projects throughout the Northeast and Mid-Atlantic.

“Bill’s enthusiasm for pre-fabrication and his nearly two decades of proven leadership will help us implement innovative techniques for our clients across several markets,” said Brian Hamilton, Vice President of Healthcare & Life Sciences. “Bill has a builder’s mentality, and his hands-on approach throughout the entirety of the building process, from pre-construction to teams in the field, will ensure our clients get the highest level of quality and timely delivery on every project.”

Consigli has utilized pre-fabrication on more than 100 projects to date, offering customers a local leader in innovation with the ability to provide self-performance.

“I’m incredibly excited to join Consigli because the company recognizes the need to be at the forefront of pre-fabrication with all the benefits it can provide to our clients,” Seery said. “The use of pre-fabrication gives us more control of our projects, which leads to more predictable outcomes, creating better results.”

To learn more about Consigli’s experience in pre-fabrication, please visit: /approach/pre-fabrication/

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Managed on tight, urban sites, these projects feature unique solutions to construction challenges and the integration of modern finishes, high-end amenities, restaurants, and fine dining, which together, complement the continuous development of Boston into one of America’s strongest tourist destinations.

Pre-fabricated façade panels at the Hyatt Centric Hotel

At the Hyatt Centric Hotel in the Financial District, Consigli utilized its preservation expertise to plan and execute the complex connection of a new, 11-story high-rise into an historic 1920s-era building, while utilizing innovative off-site pre-fabrication strategies to fast-track the building’s multi-material façade installation.

Consigli’s resume extends to other notable projects including Eataly at the Prudential Center, which is a high-end international retail marketplace with multiple restaurants and support kitchens. Consigli procured Eataly’s signature pizza ovens from Italy, and their self-perform craftspeople installed the surrounding countertops and stone cladding on the bread ovens. Presently, Consigli is managing the transformation of The Taj Hotel into The Newbury, which will include 273 updated guestrooms and a new, four-season rooftop featuring a five-star restaurant.

Self-performed installation of pear-shaped pizza ovens at Eataly

Consigli’s hospitality specialization extends to other regions including New York City, where the firm has contributed to the skyline with the construction of the Hotel Indigo, The Bryant, and Essex Street Market.

To view Consigli’s hotel and hospitality portfolio, click here.

The post Consigli Recognized by GC Magazine as a Best Hotel & Hospitality Contractor in Boston appeared first on Consigli Construction.

Here at Consigli, we take pride in the craftsmanship that has come with years of experience and being hands-on builders.  With a team of dedicated tradespeople who have been with Consigli for many years, our carpenters, laborers and masons bring true expertise to our projects and provide us with a knowledge and understanding of construction means and methods that only a hands-on builder could have.

At the same time, we are constantly looking for ways to expedite our process…and projects for our clients.  With a strong construction market and an aging workforce, it can be challenging to find skilled labor to keep up with demand.  The more we can move prefabrication work to controlled environments, the more we’re able to reduce that pressure.

While nothing can replace the skills of our most qualified craftspeople, pairing their experience with today’s technological innovation is a powerful combination. Our staff calls upon an ever-evolving array of technology and techniques to provide clients with a customized approach to each project.

Our project partners at Autodesk recently spoke with Todd McCabe, vice president of project services here at Consigli, and profiled how our team is gradually transitioning towards a more industrialized construction process with an individualized approach:

https://www.autodesk.com/redshift/industrialized-construction/

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