Doctor-owned and fast growing, the Kansas City Orthopaedic Institute needed changes to keep their edge in a highly competitive sector. They planned to simultaneously renovate and build a new wing, all while continuing to serve patients and keep infection rates low. Not easy if you're building conventionally with drywall. After much deliberation, they decided to go with DIRTT. Two years into the project, the DIRTT bid is the only one that's stayed the same.
Join the KCOI team on their journey as they hit the halfway point of their construction project. If you've ever built or renovated, you'll be surprised to hear how calm and happy everyone is.
Speaker 1:0:03I'm Dr. Mark Rasmussen. I'm a orthopaedic surgeon at the Kansas City Orthopaedic institute and on the building committee that's helped to add on this new addition. We've been fortunate enough to work with DIRTTT during this time.
Speaker 2:0:17Hello and welcome to build better the DIRTT podcast that looks at building interior spaces with technology and manufactured construction. The Kansas City Orthopedic Institute is a doctor owned hospital. They were on the verge of choosing conventional construction to build their new addition and renovation when they decided they'd likely end up in the very same situation soon. KCOI is a fast growing organization in a highly competitive space. The doctors all got together one night to hear final arguments for how DIRTT could be better for their patients and their return on investment.
Speaker 1:0:54Oh, it wasn't necessarily a no brainer. Really came down to still looking at the numbers and we felt that it was the, the nicer end product was worth this hassle that that of getting everybody else on board.
Speaker 3:1:11They had several influencers that were very much pushing back chiefly, the contractor because they're not that familiar with the process either and nobody likes change.
:1:22Kristin Moore is DIRTT's director of healthcare. She was asked to give that final presentation to the KCOI board assigned to the project. She helped confirm for the doctors it would be worth the effort of educating the consultants and trades.
:1:37They as a group did a huge amount of due diligence. They really did a lot of research in what building out with manufacturered construction could look like. They talked to a lot of clients.
Speaker 1:1:47Well I think the benefit of being physician owned is I think physicians, a lot of times we'll will think outside of the box and not, not necessarily just look at what's the bottom line costs, but what's the overall benefit.
Speaker 3:2:01They did a lot of homework. They really needed just a little push to trust their gut. And, and we were able to, to do that,
Speaker 1:2:09If you listen to the contractors who sometimes don't realize the benefit. They'll tell Ya, you know, it's cheaper to build it the other way. But we looked at time savings and the lack of all the dust. And that. Really, you get something that was much nicer and, at a very similar price.
Speaker 3:2:28The business case for this particular project was trying to get over the fact that we were a little bit, we were penciling out a little bit higher because we were still brought in a little bit late. So we were trying to back in numbers with the general contractors showing the fact that we could knock three months off of the construction schedule, which is very, very substantial when you start looking at carrying costs and that sort of thing. And then the other business case that was interesting was the fact that this is a for profit facility and it's physician owned. The tax depreciation became quite an interesting story for them. When you looked at the overall project costs and looking at that depreciation, there was a substantial difference between what they could achieve in their first year of returns on manufactured construction versus what they would have been getting from a conventional standpoint.
:3:17Orthopedic hospitals typically have a different kind of patient come through their doors. Those patients have time to research the best facilities for their surgery. They look at the scores for the care patients receive the infection rates and the look and feel of the hospital itself.
Speaker 1:3:36Yeah. We're dealing with healthy patients with mechanical problems. Whether they've torn a ligament and their knee or their shoulder or they've worn out a joint. They're not sick per se, but they've got to have something done to allow them to become more active. Again,
Speaker 4:3:51I'm Kevin Purvis with Pulse Design Group an architectural firm that does exclusively healthcare projects. When I was in the air force, I did healthcare facility planning, design and construction, and we actually used DIRTT, Gosh, back in the probably 2006 seven timeframe, somewhere around there. We weren't using it in a healthcare occupancy like we did here, but they were outpatient health care facilities.
Speaker 5:4:18Hi, my name is Dave Ruf. I'm vice president of J E Dunn Construction Company here in Kansas City, Missouri. All of the systems in the walls, whether you have medical, gas, emergency power, nurse, call systems, emergency generators, transfer switches, just there are many, many things that differentiate healthcare construction
:4:41Somewhere fairly early on. DIRTT came up. Again, I don't know if it was initially from the physician and we chimed in from a schedule standpoint or if or if we maybe brought it up from a schedule standpoint, but the focus was really schedule related initially.
Speaker 1:4:56The sooner this this section of the building got opened where we can get more inpatient beds, the more people that we could get in, where before we had nine beds and all of a sudden now we've got 17 or 18 beds, so it makes a big difference and then we needed clinic space with all these doctors. We'd run out of clinic space
Speaker 5:5:14about 22,000 square feet of it was new construction and the remainder is renovation. We've added patient rooms, exam spaces, doctors' offices and the new construction and then on the second floor we're upgrading all of their surgical areas, preop postop sterile processing department and a little bit of office space and locker rooms.
Speaker 1:5:34We built the original building that was about 60,000 square feet almost 20 years ago, 18 years ago. And we've kind of outgrown that. We started with 13 orthopedists and now I believe we've got 23 or 24 and some other specialties in there and to allow everybody to reap the benefits of being able to take care of their patients here and the and the community that's requested to be able to be taken care of here. We had to expand the most recent expansion started year and a half ago to double our inpatient rooms and to really double our operating rooms so that the doctors here could all have a space to take care of their patients.
:6:16I'm the director of nursing for the Kansas City Orthopedic Institute. I have been here since we opened and, we did our first surgery January of 2000. Yeah, the physical space is extremely important in orthopedic surgery. Everything we do requires extra equipment and it's big and it's bulky. When we started this project to expand, one of the things we talked a lot about was how do we make our rooms so that we have plenty of room for all of our equipment that we need for the patients. Just everything having a spot so that it can be put away when it's not being used out when we need it. That we were able to do that with these rooms and having the DIRTT being so sleek just gives us more room to be able to take care of the patients with the equipment that we need for them.
Speaker 1:7:06You want to have a very clean environment because one of the biggest issues with orthopedic joint replacements is infection. Having a facility like this where the infection rate is so small, it is really important and it's really important to the patients when they research that and find that out, a lot of them come seeking this institute for that very purpose.
Speaker 6:7:24Back in the beginning of the project, I got to be a part of interviewing the general contractor, the architect. I've been with this project since it started and when we started talking about how the project was going to go, all I kept thinking in my head was how am I going to keep my four ORs running and keep my patients coming through here all while they're doing construction, you know, construction and requires dry wall, dust and all of those things. So I was sweating it.
:7:55We had to build an addition, and figure out what are the most appropriate functions to go in that addition? Well that really turned out to be the inpatient unit and the new outpatient clinics and the administrative space for the physician staff and then everything else is, is a renovation effort, which is ongoing now wholesale dramatic changes to all the spaces.
Speaker 1:8:15So we're still in the middle of it. We still have, they're telling us a year left in this and we've been a year and a half into it. Every few months you get to move into a new area, which is exciting.
Speaker 4:8:26Well, the challenges is really keeping them in business. While we're doing this, obviously you build the addition first you, you gain that amount of space, you move them into that, into that new addition and you, you create an open space on the chess board really and then we use that space next and we renovate that and then we move them into, and then you've created a different open space on the chess board and you renovate that. That's how we keep them operational. The overall goal is also not only to expand their facility but to renew it. I mean they, it was built I believe in the late nineties and, but it doesn't sound that old, but it's time to renew what they had and really bring them up to a competitive standard with the rest of the market in Kansas City, probably putting them at the very front of the pack.
Speaker 6:9:07when we were presented with DIRTT, it really excited me because I just kept going back to, oh my gosh, there is not going to be as much dust and it's going to go quick because I also know how the orthopedic surgeons work and they want things done and they want things done fast. DIRTT She gave us a solution to make it quicker and cleaner.
Speaker 1:9:31Since we're adding onto an existing building, we wanted to minimize the trauma to the doctors pricing here, while that was going on. So things like dust and especially when you're adding onto a building. All the dry Wall dust just from the other construction doing the DIRTT system has really helped with premanufactured walls on eliminating some of those issues for them.
Speaker 6:9:54When we first started talking about it, they were skeptical at best. They certainly thought it was just going to be prefab walls that went up
Speaker 1:10:07and once we started looking into it and they showed us around, it was really very impressive of what can be done with DIRTT.
Speaker 6:10:13That was probably one of the biggest deciding factors for them. When you can actually see it in use and talk to the end users there. How did it go when they did their construction?
Speaker 2:10:26DIRTT is listed in the construction specifications, institutes master format as special construction. That means it's a method rather than a building product. Things like design assist and preconstruction activities are expected, which you wouldn't need for a simple product. As a different method of construction with a different schedule and labor requirements. It's important the DIRTT team integrates with the other teams and consultants early on
Speaker 5:10:52as the, as the architect of record doing the project we're coordinating with countless consultants and really the DIRTT design team is really just another consultant and they were integrated I think very well with the design team
:11:04And there was a lot of collaboration between the architect, the engineer and also the DIRTT folks with the ICE program there were fly throughs so that we could make the client understand what they were getting and they could see some of that stuff before they actually purchased the product. So when my client gets a set of 2D drawings, usually they don't understand them. We can walk through the floor plans and elevations. And lots of times they can't envision what is actually on the drawings and what is going to be built as some construction guys can. Having the ICE software and the 3D modeling help them understand
Speaker 6:11:39these guys are very visual. Being able to put it up on the screen and actually see what a room is going to look like. We were able to move all of the walls around if that's what we so chose to do. We were able to put the artwork on the walls. We were able to draw in where the TV was going to go. Did we like that space? Did we not like that space? It was good that we could do it so quick.
Speaker 1:12:00You cannot expect a client to understand two dimensional drawings. I mean you can review those drawings with them a dozen times and they're going to be surprised when it gets built. There's just no way around that. So yeah, having the clients see the end result three dimensionally is just critical.
Speaker 2:12:17The ICE software platform is the backbone for everything at DIRTT. It informs the clients with a vivid video game experience while constantly producing and instantly revising all the pricing engineering and installation instructions. The software team is always looking for ways to make the experience even better. Like augmented reality. You use your mobile device to explore what a space is going to look like at KCOI the nursing staff went over to the raw building where the inpatient rooms were going. They were able to walk around with a mobile phone to see what the rooms would look like when they were finished.
Speaker 6:12:54For someone like me who is not in construction, I'm not an architect, I am a nurse. It makes it easier to visualize and see how it is really going to look in the end cause I don't do well with seeing a drawing on paper
Speaker 3:13:09because we were communicating graphically. We weren't trying to communicate with lines. It was like, here you are in your space, let's fly through it. That was one of the projects, one of the very first projects that we actually use the augmented reality on and so being able to stand in their cold shell. Our rep Kerri Brocker had the ICE file on her iPhone and was walking people through and showing them the augmented reality file superimposed onto their cold shell.
Speaker 6:13:33You can say, hey, that's on the wrong side, or that's not going to work because the bed's going to be there. We're not going to be able to put our big CPM on that side. Those sorts of things are key to being able to deliver care the way you want to deliver it.
Speaker 2:13:48While, the general contractor easily understands architectural drawings. That doesn't mean they know what to expect during their first experience on a DIRTT built project.
Speaker 5:13:57The first phase, nobody really understood what was coming. We kind of had an idea, but until the stuff actually got here and it started, the piece started going together, then people understood better. The second phase of the project has gone a lot smoother. Everybody understood what was coming and everybody was a lot more prepared for. It
Speaker 1:14:17With any type of new technology and it's, I know it's really not new, but it's new to a lot of the people and you know contractors that have been building the same way for 50 years. Those were roadblocks; dealing with some of the contractors and dealing with some of the subs that weren't used to doing it. It was a learning curve for everybody, but I think they've all learned a lot from it. For the most part, they've been impressed with what it could do.
Speaker 5:14:43My favorite part, will be finishing up the project and saying we have completed a DIRTT job all the way from start to finish. We will be able to tell our clients that we've learned from our mistakes and we know how to do stuff better the next time
:14:57in the 21st century here. I'm surprised that more of our construction, it is not automated, done in a warehouse, shipped to the site rapid assembly. We still build buildings the way that we did like in 1950 for the most part, which is surprising. There are operating room ceiling systems, that kind of come complete from the factory and they install very rapidly. And that's just one area where we've seen something similar to the DIRTT approach where the manufacturing is done somewhere else. It's shipped and it's erected very quickly. We liked that approach. I mean you would think that would be catching on more and more. For some reason the construction industry seems to be behind the curve in terms of adopting the technology that may be available and I think as it proliferates with other construction, assemblies and systems, I think DIRTT will just be a natural component that was maybe there from the beginning.
Speaker 1:15:56Oh yeah. I mean I, think as soon as they let DIRTT get in here to put the walls up and the watch those go up, I think everybody saw the benefit of that just from the, you know, the non-dry wall to the insulation in there with the recycled jeans to just how quickly it went up. Now it took them, like we've said, there's some growing pains with the contractors learning just exactly what they're supposed to do before DIRTT gets here and the first part of that was a little sluggish, but the second part was a lot better.
Speaker 2:16:29They truly brought the panels and on Tuesday and the panels were up on Tuesday night.
:16:35Doctor Rasmussen mentioned recycled jeans. Well, when the panels are first erected, You can see the blue acoustic layer of recycled denim. It's inside the wall frames for Acoustics and once the frames are plumb and level and the electrical data, Med gasses are all connected, the finished wall tiles arrive and are clipped onto the frames. The site instantly transforms into the finished space.
Speaker 5:16:57Oh, I think all the doctors have been happy with how clean a look it is and and just how functional both the clinic space and the inpatient rooms are.
Speaker 6:17:07One of the things that we were struggling with in our old inpatient unit was quietness of the patient rooms. When we were able to see this and actually be in a room with the door shut and somebody having a conversation on the outside of the wall and you could not hear them. I knew that we could get this unit to be quiet and peaceful, which is what we want for a good healing environment. It's now so quiet that my nurses, they don't like to keep the doors completely shut. They cannot hear what's going on in their patient rooms because it is so quiet.
Speaker 1:17:40The favorite part for me has been these inpatient rooms. and then the nurses station and I think it's really been nice and significantly different from what our inpatient rooms were before
Speaker 3:17:53when people come to interview they are very excited to see what this place looks like. They want to be a part of something new and innovative in Kansas City and we really do stand out as different with this type of construction that we did
Speaker 1:18:09and even if you go into our older part of the building, it's a, it's kind of night and day between the clinic spaces, all these different things. You see in the rooms I think really adds to the benefit not only to the patient but to the physician and to the nursing. Very easy to keep these rooms clean with everything behind walls. The pictures aren't hanging on the walls, the TV's aren't hanging on the walls. Everything can be wiped down, but still a very clean look to it.
Speaker 2:18:37The look of the inpatient rooms is very soothing and comfortable. The care team can write instructions of the walls. The TVS are integrated into the walls with glass tiles over them where they can be kept secure and don't take up valuable real estate. Beautiful iconic images of Kansas City. Landmarks are used for artwork and they are integrated into the walls to the photos are crisply printed onto Corning willow glass. It all looks and feels very permanent and solid. Yet KCOI can remove the tiles to access the components inside and even move entire walls around.
Speaker 3:19:14It's interesting when you look at health care, everybody focuses on the capital budget. That upfront cost. It's interesting because the operational budget is usually 10 times the size of the capital project, but nobody really looks at that. The shifts in technology, the shifts in patient demographic, the challenge when you're dealing with operational changes, now you're dealing with it in an occupied facility, which means you have to be very, very cognizant of the impact that's going to be on patients that are in those spaces as well as staff. So it becomes a little bit tricky. You have to be very concerned in the conventional world about drywall dust. Having to get into a wall in, in any sort of patient environment usually entails having to shut down the two adjacent rooms cause of infection prevention and control issues. So there's a big cost not only in decommissioning and hoarding the space to make sure that drywall dust doesn't get everywhere, but then the cost of lost revenue for now, three rooms that are being shut down. When you're dealing with change in a conventional environment, you're losing time, you're losing revenue, you're having to punch into the wall. You have to rip the investment that wall out that you've already made. You need to do what you need to do in the wall. You need to then repair the wall and refinish the wall and that can be a multi day project as well as the labor costs on site with DIRTT. One of the biggest benefits in health care is the fact that their facilities team has the tool to be able to come in and remove a tile at any point without having to punch or penetrate into the wall.
:20:42The flexibility was always a big piece of entertaining it further. We designed half of our clinic space into doctor's offices. Should we run out of room? Those walls can be reconfigured into clinic space and no longer doctors' offices.
Speaker 1:21:03Medicine's always changing. And Orthopedics is probably even a little higher just because of all of the different things we use in the operating room. Things that used to be done through open procedures and now we do them arthroscopically. That decreases people's pain and their stay in hospitals. That's constantly changing as far as the changing in the medical construction part of things we're kind of living that and learning that right now. But I think we're also set with the way it was all designed that if things change, we can adapt to that too.
Speaker 4:21:40Sometimes those systems go in the wall and they stay and they function for years on end and there's never any need to get to them. But I mean if something needs to change, if medgasses need to be changed out or additional quantities or closed off or, or, or more likely, low voltage systems are what's going to change. And probably much more likely than med gasses, I would think. Because as long as there's wiring and those walls, those things will be changing. So the flexibility it brings from that perspective I think is great,
Speaker 6:22:06right. Being able to access the walls and to fix any problem that we might have in the wall quickly with the type of surgery we do and the type of equipment that we use here. we can be very hard on walls and hallways. And so if we have a bed that runs into a wall or a piece of equipment and it's your typical drywall, then I have a hole in the wall and I have to shut that room down in order for our facilities people to come in and patch the wall and paint the wall and get it back up and running because it's an infection control issue. If I have a hole in a wall, I cannot use that room. If I can't use the room, I can't put a patient in it. Knowing that, , we can just order the panel and keep using it until the panel gets here, which is a very quick turnaround was a big selling piece to me as well.
Speaker 4:23:04From an aesthetic perspective, DIRTT bring some really nice things to the table. The the artwork that can really be back painted glass integrated with the wall, the TVS that can be integrated with with the wall. We've, we've used that in other even outpatient clinical settings now, those aspects, some of those things actually are hard, harder to achieve in a stick built environment. But overall the aesthetic is not the issue. But I think for the end user it's, it's cleanability and durability. I mean, you know, in an inpatient setting where they're going to bang these walls, they're going to, we already have deans in the dry wall that somebody is going to have to come fix. Well the, so there are any dings in the DIRTT. I mean it just, it really just doesn't do that. It's, it's, it's more, it's more durable. You know, if something significant has to happen to a panel you just replace it.
Speaker 6:23:49And I don't have to come in and demolish it and clean up that mess. And I have seen plenty of demolishing and cleaning up messes as we have been renovating. So we've really gotten to see the expansion piece, which is, you know, building clean from the beginning and just coming in and putting walls in. And we've also gotten to see the renovation and how buckets of dry wall that come out and the dust that come with that. During renovations. We've really gotten to experience both both ways
Speaker 3:24:22with their hard won experience building conventionally and later renovating with more conventional construction. The KCOI team is pleased with their decision from aesthetics to infection control to acoustics and employee retention. However, the schedule is proving to be the biggest win for the hospital.
Speaker 1:24:41As we're doing all this, the longer we drag it out, the more painful it is for everybody. So when you watch these DIRTTT walls go in, once they have everything else done and they go up in a couple of weeks, that's pretty impressive.
Speaker 6:24:54It's been very exciting to be a part of something new to this region. I'm hoping that there are other hospitals that really will come and see how well it works and how the patients like it, how the nurses like it. Hopefully they'll, it will become more of the norm in healthcare.
Speaker 3:25:15DIRTT is delivered locally by distribution partners all over North America. Built Interior Construction is the DIRTT partner on the KCOI project. This was their first healthcare client. The first one's always the most challenging because it's new for everyone. They did an amazing job at getting the local code officials educated. They did a fantastic job with getting the contractor educated and on board. They went from having a naysayer, from a GC standpoint to somebody very supportive in that market. It's, it's an amazing learning experience. At the end of the day, it turned out really quite lovely.
Speaker 1:25:51One of the biggest takeaways is the DIRTTT bid is the only bid that has stayed at the bid that we were given almost two years ago now, where I don't think we can say that about a single other sub or the contractor.
Speaker 3:26:15Thanks for listening. To Build Better, we'll have many hosts for this podcast. For this one, I'm your host Julie Pithers. If you'd like to see what the Kansas City Orthopaedic Institute project looks like, check out the video case study in the project section of DIRTT with two t's dot net and if you have ideas for future episodes, reach out at helloatDIRTT.net. Thanks for listening.