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CHFM Planning, Design, Construction
Terms in this set (62)
Where do you find the most important design codes and standards information for your project?
• FGI Guidelines - 2014 version
• NFPA 99 - 2012 version
• NFPA 101® - 2012 version
• State Department of Health Licensing Regulation
• State Fire Marshal - local code AHJ
Referenced version by AHJ - varies by state
FGI - Guidelines for Design and Construction of Hospitals and Outpatient Facilities
NFPA 99, Health Care Facilities Code
NFPA 101°, Life Safety Code
AHJ - Authority Having Jurisdiction
These are the minimum requirements and versions change as the codes are updated and codified. The facilities team should also be aware of relevant countv and municipal codes which are stioulated locally.
What is the general composition of the PDC owner's team?
Individuals within each group should be identified prior to launching a project.
What is the general composition of the design team?
Others as identified by the A&E team
- Projects are generally led by an architectural design firm • The architect generally selects engineenng fim to join them - The engineering firm reports to the architect
What is the general composition of the construction team?
General Contractor - Construction Manager
Appropriate subcontractors - as required to complete the project scope
Reliable material suppliers
The composition of the delivery team is usually developed based on the construction delivery method to be used.
What are some of the critical factors to consider for a successful project outcome?
Developing the scope, budget, schedule and process
One of the first activities is to define the "Owner's Project Requirements."
What are the first critical steps to assure a successful project and best outcome for occupancy?
Planning and Programming
Consider these steps as transitions from beginning to end, some with overlap and some after the prerequisite is complete.
What does the programming phase establish?
Specific size, function and characteristics of various departments within the facility
There are always hierarchical organization structures within institutions that should be managed carefully during programming to assure it meets the demand rather than an individual's need.
What does the programming process require for successful outcome?
Open and honest interaction between the design team and the user group
The best model to establish the construction communication model is during the Owner's Project Requirement (OPR) session which kicks off the process.
What is a major concern when every project team meets with the user group during programming?
Political influences can be disruptive to both the creativity of the process and the final outcome.
It is important to identify issues as they might arise and discuss with the project's executive sponsor. Every project has both strong and weaker personalities involved in the process. It is important to hear all voices and not be stifled by the loudest.
What is the purpose of the schematic design phase?
Development of the floor plans, building elevations and a site plan.
This is where the space becomes more visible to the team, particularly how it relates to other structures on campus and how the adjacencies work.
What is the Basis of Design (BOD)?
The BOD is the architect's narrative describing the information received in the programming phase.
Best practice would have an Owner's Project Requirement (OPR) session at the outset of the project to kick off the programming phase This assures the owner can communicate non-negotiable requirements such as energy requirements, standards to comply with, etc., that can be developed within the project and reflected in the BOD.
What is one of the important outcomes of the schematic design phase from the owner's perspective?
First time the owner will see preliminary project budget numbers based on the work to date.
The project should be developed using realistic capital support based on relative cost/sq. ft. for similar work in the geographic region. The schematic design phase helps assure that the work is defined as originally perceived and has not had scope creep that will exceed the available funds. This is also the time for any budget issues to be resolved.
What budget contingencies should be included to assure the project can be successful?
Design Contingencies are usually consistent with their fee percentage. Construction Contingencies are often negotiated to assure the contractor does not have an incentive to do additional work by establishing a not to exceed value in the contract gross maximum price Both contingencies should be held in the owner's management and require significant rigor to achieve.
What occurs during the Design Development phase?
Progression from the Schematic Design phase to include final floor plans.
The floor plans are finalized to include size, characteristics, final adjacencies and connections for movement within the facility.
Which comes first, Schematic Design or Design Development?
Schematic Design (SD) precedes Design Development (DD), which is a continuation of the SD process.
In smaller projects, SD and DD phases might be more blended and harder to define. However, as the project kicks off, even in smaller scope projects, the design team needs to test their concepts with the the user group and the geography of the land.
What are Construction Documents (CDs) and how are they used?
The actual documents used for final pricing and construction. They are the basis of the general contractor's legal contract and are sometimes referred to as contract documents.
As with all projects, the process of construction is messy The construction process can handle the messiness as the project proceeds as long as all parties communicate within the team structure and are transparent in their activities
What disciplines are included in the construction documents?
All disciplines are included
These are the contract documents and represent the work to be completed. They include the project manual that properly describes the work in detail.
When is the right time to discuss medical equipment to be included in the project?
From the project onset
The best practice is to begin discussions and develop the medical equipment team as the project kicks off. The work becomes more defined during the design development stage as the individual space is documented to support the medical equipment specifications.
What is the most importance aspect of managing the construction phase?
Following the process - communication and adherence to the construction documentation
Not everything is defined in the construction documents, but without a good, transparent communication process it will be the fall back for all parties.
What is an RFI?
Request For Information
An RFI is submitted when the contractor runs into something either in the documents or in the construction arena that requires additional information from the design team
What is an Architectural Supplemental Instruction (ASI)?
The ASI is usually a response to an RFI, but may also be the additional scope that has been processed and requires documentation by the design team.
It is very important that the process for RFIs and ASIs be managed appropriately to assure the project can stay on schedule and within budget. Time delays add to the general conditions billed by the general contractor and are not always appropriate for contingency funds.
What are the three most important variables to focus on while managing the project process?
To be on time and on budget are the most important aspects of managing capital project's from the owner's perspective. All parties are committed to the same delivery schedule but each has their own priorities and the owner must be intensely engaged for a successful outcome. If time and money are critical, then the path to success is managing the process and controlling scope creep.
What is the single largest construction cost?
Construction, Labor and Overhead
In smaller projects, labor may be significantly greater as a percent of construction cost than in a larger, more complicated project. However, labor and overhead is almost always the single highest cost
What is the second highest cost in a construction project?
Construction material costs
On rare occasions, construction material costs might be larger than labor costs due to a unique project dynamic. In most cases, it is the second largest cost and represents a great opportunity for the general contractor to manage project cost control.
What are the associated costs of construction that the general contractor will include in the project?
*Construction labor and overhead
*Site isolation and preparation
*Contractor fees & permits
These are the primary categories for construction costs managed by the general contractor. However occasional special costs related to an owner's requirement might be added. Some of these "special costs" might be related to assisting the owner in procurement of Furniture Fixtures and Equipment (FF&E) which is traditionally an owner's cost
Who pays for utility costs during construction in a new health care construction greenfield project? (No previous health care on the site.)
The general contractor would negotiate with the utility to establish utilities on the site and include the costs, with overhead, in their construction contract.
In some instances, the owner might ask to pay these costs directly if they have multiple meters in the region. However, it would be difficult to define a benefit in doing so
Who pays for utility cost in a new construction or renewal project at an existing health care facility?
The owner will pay the utility cost as an extension of their existing metered utility costs.
There is limited benefit to the owner for the GC to cover these costs which is usually less than the expense of their overhead to do so
When should functional systems commissioning take place?
During pre-occupancy phase
The ASHE Health Facility Commissioning Guidelines recommend that a Health Facility Commissioning Authority be engaged at the outset of the project, when other key contracts are negotiated. During the project, pre-functional testing will be completed as dictated by construction progress. However, functional testing must be completed as the total systems are operational to assure they perform as a system for the owner.
What is the significance of the Testing and Balancing (TAB) report?
The Testing and Balancing (TAB) report documents the operational aspects of the HVAC system compared to specifications.
This is a third party analysis and the TAB contractor has the responsibility to modulate systems to meet the requirements. If the TAB contractor cannot adjust the systems to achieve design, then additional engineering analysis will be required. In addition, the TAB reports are a valuable tool when troubleshooting performance issues in the future as they document the system performance at the time of project acceptance.
Who has the primary responsibility for move coordination?
The owner or owner's move contractor
Usually someone from the user group that best understand the specific portable equipment that will require relocation takes the lead. If the owner hires a move coordinator then the user group will work with that team to assure everything is properly relocated.
When is the best time to educate the facilities personnel on proper management of the equipment?
Ongoing during the project, but specifically during the occupancy phase when all systems have been commissioned
It is best practice for the engineering and commissioning teams work with hospital enigineering staff throughout the project to assure they have the new skills necessary to effectively and efficiently own and operate the equipment. This should be more than the usual "turn over take over" training considering the high efficiency that comes with new equipment vs. older technologies
Who has responsibility to manage the project punch list?
The Architect of Record
This is always an area of concerm and the owner should pay close attention to see that the issues log is being properly addressed and that items on the punch list are being corrected. The architect has the lead as the owner's rep.
Who prepares the operations and maintenance manuals?
The general contractor prepares the manuals and submits them to the architect for review/approval.
Best practice supports transmission of the O&M manuals as they are developed rather than waiting for project closure This assures the facilities team has time to develop CMMS requirements prior to taking substantial completion of the project
After substantial completion and occupancy, who has the responsibility to transmit the record drawings?
The General Contractor (GC) submits the record drawings to the Architect of Record and transmission to the owner.
The GC develops the red line drawings, reflecting changes that were made in the field, then submits them to the architect record for final review, approval and transmission to the owner.
It is always a challenge to get the final record drawings. The owner must stay focused on the delivery and final acceptance of the documents to assure they have true record of the construction project for future use.
Other than assuring that operation performance parameters were met, what is another value of the TAB report?
Compliance documentation with required indoor air quality standards
Health care occupancies have very specific and sometimes challenging indoor air quality requirements that all authorities having jursdiction (AHJs) review during their survey process.
During a phased startup project such as a multistory high rise, how is the TAB report managed?
Each phase, prior to accepting substantial completion, requires the TAB report to be reconciled to specifications.
If there is an issue, the TAB contractor must resolve the concern prior to the owner's acceptance of the space.
Multiphase projects require significant acceptance processes that must be duplicated for each phase prior to acceptance and occupancy. These projects might be phased over several years so early occupancies must meet all requirements set forth by the AHJ prior to move in before the total project
What is the value of using well-defined and comprehensive contracts for all parties involved in the project?
Contracts describe the process to be followed and define the parameters of the contractual agreement for each party (which is a key factor to success).
There are various contracts that can be used The gold standard is AIA project group of contracts, but there are others such as Contract Documents "ConDocs" as developed by a consortium of industry partners, led by the Association of General Contractors (AGC) There are standard fees for the use of these products which are usually covered by the design team, unless the owner specifies a different set to be used.
What is the best preliminary process to assure success?
When the project is approved and funding has been secured, begin with an Owner's Project Requirement (OPR) charrette to clearly define the owner's desired outcome.
The OPR meeting allows all parties to understand and participate in the predevelopment and project objectives It is also a time where the owner can define issues they consider non-negotiable such as energy efficiency requirements and design parameters such as building branding, etc.
After the OPR charrette, what is the next step to assure a successful project?
Select and use an appropriate delivery process that delivers the Owner's Project Requirements
Processes vary depending on the various practices and policies of the institutions. However, once the proper process has been defined, following the progress ngorously will assure success
As the project progresses, what should the owner focus on to assure the OPR is met and the project is successful?
Management of the project schedule
The project schedule should be agreed upon by all parties and everyone's responsibility to manage However, the owner has tho responsibility to assure that their various contracts and contractors are performing as desired
What is the most utilized model for project delivery?
Most CFOs and financial professionals believe that documenting the project and then bidding, awarding the bid and delivenng on construction is the most efficient delivery model It has the unique benefit of usually providing the lowest first cost of construction, but not the best total cost of ownership in health care
What is the benefit of the design-build delivery process?
The design-build firm has all of the competencies within their company to design and build the project.
Theoretically this gives the owner the advantage of speed to occupancy as their internal processes have been streamlined.
What is the purpose of the construction manager at risk (CM at Risk) delivery method?
The CM at Risk contractor will either step in as the owner's agent to assist them with the management of the project, or fully manage project delivery for the owner.
Construction management firms have many different competencies and competitive advantages If the institution feels like they need help managing either a more complex project or just don't have the resources, they should submit for qualifications to determine which firm best suits their need. The architect of record can assist the owner with review of qualifications if there is not somoone on staff with those competencies
What is the Integrated Project Delivery (IPD) construction delivery method?
IPD is the most collaborative approach to project management and requires that all parties perform in a multiparty contract for mutual benefit and risk management.
IPD is difficult to perform, not from the contractors and consultant's perspective, but from the institutional legacy perspective. Most health care institutions use some form of IPD, but not in its purest form
What is Job Order Contracting (JOC)?
JOC requires single procurement contracts that are negotiated for use throughout the institution's business cycle. The contractor can perform multiple projects within the dollar limits for each project by the assignment of a new task order.
Each will set upper limits for the JOC process that conform to their policies The institutional team can then assign a new task order for any project that fits within those financial limits and the competencies of the JOC contractors. Most institutions will have multiple JOC contractors and best practice would include JOC contractors for mechanical, electrical & plumbing projects
What is the Negotiated GMP construction delivery process?
The Negotiated Guaranteed Maximum Price (GMP) contract assures the contractor has the resources necessary to be successful, given the scope of work, and has agreed to perform the project within a specified price.
In a Negotiated GMP contract the owner should focus on managing and restricting scope creep which will result in additional fees paid above the GMP
What is an IDIQ contract for construction delivery?
Indefinite Delivery/Indefinite Quantity (IDIQ) delivery process allows the contractor to provide services as defined in a preliminary procurement process for projects that have repetitive elements such as MEP projects.
This type of contract is used a lot in the MEP delivery process IDIQ allows the owner to work with contractors for a specified type of capital renewal and deferred maintenance projects that represent repetitive olements such as HVAC and controls hardware
What type of project delivery process usually presents the lowest cost and the highest risk to the owner?
This type of construction delivery generally results in the lowest initial cost (first cost) of construction because of the bid's competitive nature. However, competition also demands accurate and high quality construction documentation used in the bid development. If the documentation does not meet these standards, owners risk a senes of change orders during construction to complete the work correctly Another risk is timely access to revenue, as this is the longest delivery cycle. This stands to reason, as lowest cost and highest quality are not mutually achievable.
What is the fastest construction delivery method that assures optimal quality?
Integrated Project Delivery (IPD) or IPD "ish" as defined by the institution's tolerances
IPD allows for work to begin as much as 20% sooner than other construction delivery methods, which can have a critical impact on the institution's capacity to see revenue from the new space The highest level of quality is achieved due to the collaborative nature of the project
What risk assessment is required by all AHJs that regulate the construction within the health care built environment?
Pre-Construction Risk Assessment
The AHJs want to assure that the owner took into consideration all health associated risks from the delivery of the health care project. These risks need to be identified and mitigated to assure that the project team understands and is engaged in reducing the risks of construction
Where can one find the required elements for construction within a health care environment?
FGI Guidelines (2014 Edition) Local code official's regulations & addendums
Guidelines for Design and Construction of Hospitals and Outpatient Facilities (FGI Guidelines) are not universally approved, but represent the best set of documents to describe the requirements for health facilities construction projects
What is the purpose of an Infection Control Risk Assessment (ICRA) in health facilities project management?
The purpose of ICRA is to preplan processes to minimize the risk of infection to the patient community for an active construction project in the area.
The scope of the ICRA is focused on issues from construction such as debris and dust that might be detrimental to patients in the area. Generally the infection control department, in conjunction with the facilities team, has a predetermined checklist of concems based on the patient population served and seventy of the project. This review will establish contractor work rules for the specified area that are unique to the project and augment standard work rules within the institution.
Who is ultimately responsible for the Infection Control Risk Assosment (ICRA)?
The health care institution retains full responsibility regardless of how they manage the process.
Some institutions hire a contract health care infection control preventionist, however the responsibility remains with the institution.
What is the highest risk category as defined by the ICRA risk matrix?
Type D- Major demolition and construction projects
Type D projects require full assessment and will usually result in the highest level of infection control mitigation If in doubt on the rating of your capital renewal project, it is recommended to defer to Category D
Along with the construction type, what is the other element (y axis) of the ICRA risk matrix?
Patient population at risk in the area of construction.
As with construction types, if not sure about the immediate patient population or if it varies in the area, defer to the higher risk group to assure proper protection
What is the Infection Control Risk Assessment purpose of the (ICRA) matrix?
The purpose of ICRA matrix is to identify the level (I-IV) of mitigation that will be required based on the complexity of the project and the critical nature of the patient population at risk.
Although most health care contractors understand the use of the matrix specifying that all contractors attend ASHE Health Care Constuction Workshop and that at least one person from each firm hold Certified Healthcare Constructor (CHC) certitication is the best practice Close management by the owner to assure all parties honor the process and procedures is key to success.
What is the proper handling of construction materials and debris in a health facilities construction project?
Clean and cover materials before entering the building; cover and wipe down all debris handling carts before exiting the construction containment, assuring carts travel across a sticky mat.
Some projects can be loaded from the exterior and this would always be the desired path for debris when possible: Construction personnel should minimize their time in the built environment outside of containment and care should be given to their clothing to assure they are not negatively impacting the environment of care.
What are the three principal design codes and standards references used to develop health facilities projects?
Guidelines for the Design and Construction of Hospitals and Outpatient Facilities 2014 edition
NFPA 101°, Life Safety Code- 2012 edition
NFPA 99, Health Care Facilities Code - 2012 edition
Check with local AHJ to assure they support these documents if they have addendums It is to understand which edition they require.
Of the four major occupancy types usually found in hospitals, which ones are the focus of the AHJs with deemed status from the Centers for Medicare and Medicaid Services (CMS) when doing compliance surveys?
A business occupancy and area of assembly are not required in the condition of participation but may exist, and usually do, in most health care facilities. It is important to know where one occupancy starts and the other ends within the institution which dictates construction practices. However, if a business occupancy project is adjacent to the Health Care occupancy, the more stringent rules apply.
Whose responsibility on the project team is it to determine the occupancy rating for the project?
The architect of record
Not only are architects of record the most qualified, but they must design the space to meet the requirements defined by the scope of the project This responsibility includes assurance that their design meets or exceeds all regulatory and compliance requirements
In addition to the requirement that a sink must be provided in the patient rest room, where is the sink to be located within the patient room?
As near to the entrance to the room as possible with unobstructed access by the health care provider
In a multi-bed configuration, the sink must be located outside of the patient privacy curtain
Why are RFIs time limited for processing?
To assure the project stays on schedule
RFI - Request for Information
The contract with the design team is with the owner, as is the general contractors (GC). The GC will stop work based on pending response for the RFI. The Owner's Project Requirements will define the acceptable turnaround time for the response.
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