San Francisco General Hospital: Building a Pivotal New Facility

San Francisco General Hospital (SFGH) has provided a critical safety net for the city’s poor and underserved populations since it was founded over 160 years ago. The hospital played a pivotal role in identifying and treating some of the earliest cases of HIV and AIDS, and is the primary public hospital and the only Level I Trauma Center for all of San Francisco proper and northern San Mateo County. So when voters approved an $887.4 million bond in November 2008 to replace the aging facility, the hospital administration moved to find a construction approach and qualified expert to build a facility that would meet the demands of tomorrow’s medical practices without disrupting the operations of the existing – and deserving – hospital.

SFGH’s search ultimately led to Webcor Builders (Webcor), a San Francisco-based general contractor that consistently ranks amongst ENR’s Top 100 General Contractors. “Our previous healthcare experience was not focused on projects of this complexity,” says Tom Taylor, vice president of Webcor and onsite SFGH project leader. “However, over the last three-and-a-half years we have brought in a number of people and now benefit from the over 200 years of collective experience in healthcare.”

It is clear as to why SFGH chose Webcor; the company has a strong reputation for leveraging the best emerging technologies and taking a proactive management approach to ensure projects deliver exactly what was promised. This made SFGH’s decision to bring Webcor on as both construction management and general contractor easy, as it enabled Webcor to be highly involved throughout the preconstruction phase. Webcor worked closely with the project’s engineering teams as well as with the project’s architect of record, Fong & Chang Architects. “We came on very early to help define best practices and building tolerances among other things, and those extensive preconstruction efforts have proven a great investment,” adds Taylor.

Facilitating Groundbreaking Medical Treatment

The new 460,000-square foot hospital will provide a total of 282 beds, 14 operating rooms and the only Level I Trauma Center in the city. But that isn’t all; the hospital will also boast a 40,000-square foot emergency room, a 20,000-square foot radiology department and units for neonatal intensive care, intensive care and critical care. SFGH opted to squeeze the new center onto the main lawn of the existing hospital campus, allowing for a swift relocation of services once the hospital is completed. However, building on an occupied, urban hospital campus presented a number of challenges.

Luckily, Webcor thrives on challenges, and the team developed a multipronged approach to ensure work progressed smoothly on a tight construction site and without disrupting the existing hospital’s operation. First, the Webcor team took very detailed as-built measurements of the site, to verify what was already on paper. Webcor also took the time to perform selective potholing to verify utility placements on site. “We then overlaid the existing information with the new information in our modeling, which resolved a lot of conflicts ahead of actually breaking ground,” admits Taylor.

An Anchor of the Community

The Webcor team completed additional modeling to provide detailed information to show the proposed placement and depth of the structure’s tiebacks, as well as to illustrate the zone of influence and the amount of undisturbed earth needed to support each tieback, according to Taylor. The extra information ensures the seven-story hospital and its two basement levels will be able to meet the state’s stringent seismic requirements. The building relies on 115 base isolators to shift a full 30 inches in any direction in the event of a serious seismic event without compromising the building’s operations, which could prove critical as it will be the only hospital in the city equipped with such seismic protection.

Webcor’s extensive modeling and surveying has paid off beautifully so far. For example, crews were tasked with rerouting a century-old utility tunnel without disrupting service to the existing hospital, which Taylor estimates to represent $30 million in utility work alone. “It was a very elaborate process to essentially reroute 100 years worth of utilities, but we managed to do it without incident by building a new utility tunnel underneath the existing hospital,” states Taylor proudly. “When we finally completed the switch over, it was a great relief to everyone.”

Webcor not only completed the utility rerouting ahead of schedule, the team also managed to shave $1 million off of the total cost. To boot, Webcor re-sequenced scheduling so that excavation, shoring and utility work progressed simultaneously and completed the work a full three months ahead of schedule.

When Ambition Leads to Innovation

Such an accomplishment was only possible with the full support of every party involved, and the city of San Francisco structured the project specifically to encourage transparency and accountability through the Integrated Project Delivery (IPD) method. The IPD method allows core trade teams to come on early in the preconstruction phase to contribute their respective expertise and ensure conflicts and errors in the design phase are resolved early on so work can progress smoothly. Each respective core trade was then periodically required to submit an estimate for the next phase, which was compared to the city’s independently prepared estimate. Only those core trades whose estimates were within a certain tolerance of the city’s estimates were allowed to progress.

“It’s a really unique procedure and we’re very happy to report that five of the original six core trade contractors made it through that process,” admits Taylor. The five trades include mechanical, electrical, plumbing, fire suppression and drywall trades, representing over $200 million of the full contract value by Taylor’s estimates.

Webcor and the SFGH project teams celebrated the topping out in June 2012 for the LEED Gold-aiming hospital, which is still on schedule for completion in 2015 as originally estimated. The existing SFGH will eventually be repurposed as needed once the transition to the new space is completed. When the new hospital opens, Webcor Builders will join San Franciscans in toasting to another 160 years of leading medical care at San Francisco General Hospital.