This Project Delivery Guide is designed to do just that, to guide delivery. But why should a project for the California Prison Receivership (CPR) -- or any project -- be delivered on a lean basis?
The general answer is simple, "It will be better built, injure fewer, cost less, get done faster with greater ability to cope with uncertainty. Customers are better satisfied and there is greater accountability and less suffering in the project team." These results have been demonstrated throughout California, and around the world, on projects large and small. The management practices rest on solid, tested conceptual foundations that lead to continuous improvement and cost savings.
Why do projects for CPR on a Lean Basis? Because design and construction will be complex, uncertain and quick. Finding and delivering the best solution -- one that assures both custody and health care requirements are met with minimum operational costs, and can be built safely, quickly and efficiently in a changing construction environment -- cannot be delivered by traditional design, bid, build.
-- Greg Howell
The California Prison Health Care Receivership Corporation (CPR) was established to assume the management of the State of California prison health care delivery system. All the activities of the CPR have one bottom line in mind: To create a system where custody and health care staff together guarantee access to care and quality of medical services in California prisons that meets constitutional standards. The CPR, in collaboration with the California Department of Corrections and Rehabilitation (CDCR), will build certain new health care facilities to provide minimum constitutional levels of care. CPR will also remodel health care facilities at existing institutions. Delivering those projects, through the combined efforts of CPR and CDCR will provide facilities in which the provision of health care to constitutional standards can be provided, but also can bring significant cost and operational efficiencies to the delivery of health care in California state prisons.
This Program Delivery Guide (Guide) was developed to describe how the CPR's new health care facilities will be constructed. The Guide is divided into four main sections that discuss the general outline of the delivery method (Introduction), how the construction program was developed and what it entails (Program Development), how specific projects will actually be constructed (Project Delivery) and how completion of these projects will affect prototype facilities and prison health care delivery (Conclusion).
In 2005 the U.S. District Court for the Northern District of California placed California's prison health care system in receivership. The underlying case generating that action was filed in April of 2001 and is now titled Plata v. Schwarzenegger. The Plata plaintiffs alleged inadequate medical care for prison inmates. Other cases made further allegations of inadequate care: Coleman v. Schwarzenegger (mental health care), Perez v. Tilton (dental care), and Armstrong v. Schwarzenegger (ADA compliance).
The Court appointed the Receiver in the Plata action only after the CDCR was unable to meet agreed upon deadlines for system reform. The Court found it was uncontested that, on average, one California inmate dies every 6 to 7 days because of constitutional deficiencies in the state prison health care system. The District Court removed CDCR from direct control of the medical system and imposed a Receiver to "radically transform" the system.
Several joint orders in Coleman v. Schwarzenegger (mental health care), Perez v. Tilton (dental care) and Plata v. Schwarzenegger (medical care) approved various coordination agreements between the representatives of the three health care class actions. These agreements created the opportunity for a number of efficiencies and allowed the Plata Receiver to assume responsibility for direct oversight of shared functions of the medical, dental, and mental health care programs. Among other areas of coordination, the Receiver is tasked with assuming the lead role in the implementation of contracting, information technology and pharmacy operations serving the medical, dental and mental health programs. The Receiver is also tasked with coordinating construction efforts for new facilities that will be constructed within existing prison sites.
On August 4, 2009, a Three Judge Court appointed by the Ninth Circuit Court of Appeals found that inadequacies in prison health care were primarily caused by overcrowding and thus ruled that CDCR was required to reduce the inmate population to 137.5% of capacity within 2 years (the "Population Cap Order"). CDCR has predicted that the Order will require a reduction of more than 40,000 inmates.
The California Prison Health Care Receivership Corporation (CPR) is the non-profit organization created to house the activities of the Receiver. CPR is charged with:
Creating a system where custody and health care staff together guarantee that access to care and quality of medical services in California prisons meet constitutional standards.
Once the prison health care system is stabilized and a constitutionally adequate medical system is established, the federal court will remove the Receiver and return control of prison health care administration to the State.
Shortly after its creation, CPR identified the need to construct new health care facilities. Studies conducted for the Receiver indicated that statewide, a total of approximately 5,000 beds for medical inmate-patients were necessary. Corollary studies conducted by CDCR found that 5,000 beds for mental health inmate-patients were necessary to fulfill the Court's mandate. CPR planned to build all facilities near urban areas sufficiently large to provide qualified pools of skilled professionals to work in the facilities. Planning details for the health care facilities, including the type, location and number of beds, are continually being reviewed. Proposed prison population reductions (both due to budget concerns and the Population Cap Order), the State of California's financial capacity and efficiency opportunities within CDCR are all factors that could inform CPR's decisions regarding what and where to build the new facilities.
CPR originally proposed to construct new health care facilities of no more than 1,500 beds at any one location. Given the urgency of the problem, the Receiver's time line from concept to completion for all facilities was three years.
The Receiver was not equipped to undertake the ambitious new construction program it had determined was so necessary to solving the constitutional problem. Consequently, in January, 2007 it advertised for a Program Manager to act as its agent and liaison in assessing needs, developing concepts, hiring necessary planners, designers, contractors and other consultants and developing the appropriate new facilities response. URS/Bovis Lend Lease Joint Venture was chosen to be the Program Manager in June, 2007. Three major sub-consultants were part of the agreed upon PM team -- Robert Glass & Associates, LBL Architects and Brookwood Program Management. Carter Goble Lee was later added to the PM Team.
The mission of the Program Manager is:
...to act as a management resource to CPR and to provide broad coordination of the full range of technical resources and management processes necessary to identify and implement the planned capital improvements. The PM will be responsible for assisting the Receiver and other directly engaged professionals in quantifying the capital resource needs and providing overall management of the Receiver's Facilities Improvement Program. Since the Receiver has no existing standards, policies and procedures for the design and implementation of capital projects, it is anticipated that the PM will be responsible for facilitating the development of appropriate standards, policies and procedures.
Core services required by the Program Management contract include:
The Program Manager has worked with the CPR to fulfill these various responsibilities. In general, the PM researched current available responses, techniques and methods for addressing the capital needs of the CPR and made recommendations on specific courses of action. The approved recommendations led the PM to undertake the following specific tasks:
Using a group of industry experts representing a broad spectrum of prison health care, the PM developed a Facility Program Statement (FPS). The FPS describes the "what" of the Program. It describes the characteristics of the new facilities to be built. The FPS emerged as the culmination of numerous planning sessions as well as site visits to review comparable institutions.
The PM contract with the Receiver requires the PM to make recommendations on project delivery methodology and coordinate technological expertise with Integrated Project Delivery (IPD). The PM and CPR determined that responsibility for the architectural and engineering design and the construction of the individual facilities would be contracted to three Integrated Project Delivery teams using IPD. Integrated Project Delivery, using Lean principles was adapted from the manufacturing sector and is designed to maximize the efforts of all participants on the project to deliver the project at the lowest possible cost in the least amount of time that is practical for the project. At the same time, quality and safety are improved in job delivery. IPD emphasizes planning and design with the entire design/build team and uses both budget and schedule as design criteria.
The PM selected three design-build teams comprised of leading correctional and health care designers, well-known national general contractors and specialty trade partners:
The PM and the Integrated Project Delivery teams have used the information collected in the FPS to design a prototypical health care facility for the delivery of constitutionally adequate health care in California prisons. The prototype has been designed to meet each of the criteria developed by the FPS for the facilities. Because of uncertainty as to the size of any given facility or the number of facilities that will need to be constructed or the geographic location of those facilities, the prototype has been developed as a "kit of parts." The "kit" contains a number of different options that can be combined to create any given, necessary facility, to assist in remodeling current facilities and to guide future facility development. The "kit" has also been designed to maximize operational efficiency inasmuch as the largest cost associated with the new construction program will be the cost of operating each facility over time. "Lessons Learned" are crucial in prototype development so that Continuous Learning and continuous adaptation can take advantage of further, developed operational efficiencies. Thus, each facility constructed after prior facilities will "learn" from the experience of the previous construction and operations experiences.
CPR and the PM concluded that Lean Construction principles would be implemented in an effort to optimize value and minimize waste in delivering the program. Lean Construction principles were therefore incorporated into the IPD team contracts. Those principles are integral to the overall management approach for constructing the new facilities.
Initially, the PM asked the three IPD teams to design three separate prototypical health care facilities in a "co-opetition" that would have resulted in the award of the first project to the IPD team that distinguished itself from the others. However, the strength of early collaboration led the three selected IPD teams and the PM to agree in January 2009 to coordinate all design, construction and delivery services through a unified organization known as the Single Lean Enterprise (SLE).
The Single Lean Enterprise was conceived as one team comprised of the best resources from the Program Manager (the PM) and each of the Integrated Project Delivery teams retained by the Receiver to plan, design and construct the new facilities.
While the PM and IPD teams each have contractual liabilities and responsibilities to the Receiver, they have collectively agreed that integration of ideas before recommendations are made to the Receiver is true to the spirit of the Integrated Project Delivery method.
Each of the IPD teams has contributed various resources to the SLE. The PM has gone through a series of "right-sizing" resource efforts to bring only necessary disciplines to the SLE. The SLE also includes representatives of the CPR staff and outside counsel and consultants. This single organization has participated in finalizing the FPS, designing a "kit of parts" for the Prototype and creating this Program Delivery Guide so that the facilities can be constructed using the most productive Integrated Project Delivery tools and still within budget and schedule constraints.
The SLE is not designed to abrogate contractual responsibilities or duties but rather to provide an umbrella group of talented professionals to investigate and recommend appropriate design and construction solutions for the CPR's new facilities program. It acts as an advisory group that develops and vets recommendations of the PM before they are forwarded to the Receiver.
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