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Penn Medicine’s new 1.5-million-square-foot flagship hospital (known as “The Pavilion”) is making history in Philadelphia, PA as the largest capital project in Penn’s history and the most ambitious healthcare building in Philadelphia to date. 

The building is located in a very congested urban environment, with adjacent tenants including a museum, three hospitals, a stadium, and a public transportation station. Traffic is a major problem in the area, and as Philadelphia is experiencing a construction boom, the availability of skilled labor presents an added layer of difficulty. In addition to site and labor challenges, the world-class facility is also expected to serve as a “future-proof” hospital that can seamlessly evolve over the next 100 years of medical advancements. For a challenge of this size and scope, �ձ�����'s teammates needed to think outside of the box. 

To address the site complexities and maximize lean efficiencies, the PennFIRST team (comprised of Penn Medicine, BR+A, HDR, Foster+Partners & LF Driscoll / �ձ����� JV) implemented an off-site manufacturing (OSM) and construction strategy that follows Design for Manufacturing Assembly (DfMA) principles. In following this approach, the project designers were tasked with creating cellular, repeatable, and scalable elements. The team has also been challenged to reduce the total number of required parts by standardizing components, using intelligent materials, designing for ease of fabrication, and designing for ease of assembly and handling. 

The team identified numerous off-site opportunities including, but not limited to, precast concrete, bathroom pods, pre-manufactured headwalls, modular operating room components, unitized curtainwalls, multi-disciplinary MEP racks, and risers. These opportunities allowed the team to reduce the number of site deliveries, site trash, and on-site labor as well as improve construction quality, worker conditions, and safety. Schedule savings is one of OSM’s biggest advantages. Utilizing precast concrete is expected to save 40 working days, which equates to over 30% of the cast-in-place schedule. 

Below is a graphical representation of the team’s Initial Dissection Plan (IDP), which is an exercise used to identify the opportunities described above. The IDP aligns stakeholders early in the conceptual design of the project and helps to maintain repeatability as the design progresses to 100% Issued For Construction Documents (IFC).

Keeping it Local 

Although many of the required prefabricated elements could be purchased from established manufacturing facilities, the team pursued a strategy to prefabricate locally, cognizant that local work preservation was very important to the owner and the City of Philadelphia.

Initial research revealed that the majority of local prefabrication capabilities were single trade only. For instance, the local sheet metal contractors were experienced in building “ductwork only” racks. Similarly, the pipe fitters had built pump skids with installed piping. As a result, the team identified and developed a local Multi Trade Production Facility (MTPF) that could serve as a centralized hub for all key trade partners engaging in off-site work. 

By bringing the different trade partners together into one centralized MTPF, the PennFIRST team increased collaboration and helped streamline costs. This strategy effectively created testing grounds for other off-site innovations and simulations that can be used to enhance �ձ�����’s capabilities in this arena. Additionally, the team has leveraged the MTPF to simulate the installation of prefabricated elements such as multi-trade racks. This serves as the initial installation mockup that will help refine quality control, safety, and speed of installation that ultimately will be repeated in the field. 

�ձ����� understands the importance of collaborative design and construction, which further supports the Integrated Project Delivery (IPD) approach, including a diverse team with shared financial savings based on performance. The PennFIRST team is bringing on key trade subcontractors early into the design of the project, which gives a more diversified influence and capitalizes on our design-once philosophy. This delivery method captures more benefits beyond a traditional design/build delivery or CMR where contract barriers between trades raise the difficulty. Even the idea of including a carpentry/drywall key trade partner has presented an opportunity to stitch MEP and structure together in a more comprehensive effort

The Design Foundation

As the PennFIRST team has discovered, it is the pre-work effort that makes any off-site strategy a success. For this solution to be successful, the team needed a well-planned design that could support the effort. The PennFIRST team was in the unique position of being able to influence the design, and they have used this advantage wisely. The team engaged the engineers and MEP design team in DfMA workshops and discussions early in the project to ensure the design would best support the prefabrication elements. One example is utilizing prefabricated generator enclosures. Instead of stick-building the roof-mounted enclosures, pre-piped and pre-wired enclosures will be placed on top of the generators via hydraulic cranes. This was a decision made early enough that the supplemental roof steel could be designed and released along with the base building steel mill order. Early decisions can offer impactful time and schedule savings.

Additionally, as a direct result of our collaborative discussions, the construction team influenced the clinical function of the hospital. The design will feature 504 “acuity adaptable” patient rooms. This means that the rooms can easily be repurposed based on the hospital’s needs. Despite the different “Day 1” clinical functions of the rooms, each patient room will be identical in layout and dimensions. An indirect benefit is repeatability, which is ideal for prefabricated elements.

The mechanical and electrical layouts also play an equally important role in the successful use of prefabrication in healthcare projects, as clinical requirements can create complex layouts that are difficult to scale and construct off-site. To make sure they can deliver a hospital that meets the clinical needs of the hospital staff AND the schedule and budget requirements of the owner, the team ensured critical conversations and discussions were taking place between project engineers, architecture planners, and clinical consultants BEFORE the design was finalized.

Keys to Off-Site Success: 

• Collaboration is key: A successful off-site strategy can only work if you have a full agreement and constant collaboration with your owner, design team, engineers, and trade partners. 
• Evaluate the Initial Dissection Plan list in close detail: Identify and discuss the opportunities for off-site and prefabrication work and organize the elements by priority.
• Consider the benefits and constraints: Every project is different and will most likely need a custom strategy based on project requirements. Identify and estimate the potential benefits (cost, schedule, safety, quality, and sustainability) and then weigh them against any existing constraints (budget, schedule, site logistics, and other project requirements).
• Review against Target Cost Model: Off-site strategies are only successful if they can work within your budget. Quantify all schedule savings, on-site labor reductions, and sustainability benefits that you expect to gain through off-site efforts. Off-site manufacturing can sometimes be justified even if there are no apparent dollar savings. It may ultimately be beneficial for situations that involve less impact or disruptions to busy urban areas, etc. This should be considered in your discussions. 
• Adopt a pull plan schedule for design: Understanding the appropriate timing for design decisions is critical. If you are adopting an off-site strategy, you will need to make design decisions earlier than most traditional approaches. For instance, bathroom pods may require a local slab depression to accommodate the subfloor while maintaining ADA compliance. This depression will often require a steel design that can accommodate such. 
• Review procurement strategies: Identify and engage equipment manufacturers, integrators and trade partners as early as possible. Always make sure you are following the procurement policies relevant to your project and location. 
• Plan for safety: Design a production-focused safety program (as opposed to site construction) in support of work at the MTPF. 

In summary, an off-site strategy and the development of a Multi Trade Production Facility was a successful solution for this project, as it has given the team the necessary runway to execute the chosen delivery method and the client’s wishes as efficiently as possible. For the PennFIRST team, the Pavilion itself has become the “client” for the MTPF, which has justified the expenditure and investment. The decision to use off-site strategies should always be considered on a case-by-case basis and after careful consideration of the qualitative and quantitative benefits.