4d models for safety planning of hospital renovations
DESCRIPTION
The paper describes the application of 4D virtual building information models (BIM) for the safety planning of hospital construction.TRANSCRIPT
Working Paper #5
4D MODELS FOR SAFETY PLANNING OF
HOSPITAL RENOVATIONS
Bert Lankheet & Timo Hartmann
COPYRIGHT © 2010
VISICO Center, University of Twente
4D models for safety planning of hospital renovations 1
Bachelor thesis Civil Engineering, 22th of april 2010, Enschede, Bert Lankheet 2
3 4 5 Bert Lankheet (s0150029) 6
Bachelor Student Civil Engineering 7 University of Twente, Enschede, The Netherlands 8
[email protected] 9 10 University supervisor: 11 Timo Hartmann, Assistant Professor 12 University of Twente, Enschede, The Netherlands 13 [email protected] 14 15 16
17 18 19
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1
Abstract 1
During hospital renovation, medical processes are, oftentimes, in progress at the same time as construction 2
processes. Maintaining hospital operations during hospital construction projects leads to hazards, following 3
from interferences between construction and medical processes. Conflicts between those processes are 4
undesirable because medical processes are very vulnerable. Hospitals and its inhabitants suffer from these 5
interferences. Therefore, aligning medical & construction processes during the planning stage is very important 6
for hospital renovation projects. Various specialists are involved in the planning of hospital renovations. It is 7
important that they have insight in the project, to detect errors in the construction plan, and to devise safety 8
measures effectively. Compared to traditional 2D scheduling methods, 4D modeling methods help planners 9
and practitioners to associate time and space in the pre-construction phase. I developed a 4D visualization 10
method to support project teams in the planning of safety measures, and hospital and construction processes. 11
This paper reports the findings from a case study, it also introduces the method. In the study, the 4D models 12
appeared to be useful for construction specialists and medical specialists, because they allowed for a better 13
understanding of the construction plans and drawings. This provides first evidence that 4D models can support 14
in hospital construction projects. 15
16 Keywords: 17 4D model, BIM, hospital construction, medical processes, construction processes, 18
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1 Introduction 1
During hospital renovation, medical processes are, in progress at the same time as construction processes are. 2
As a cause, construction processes often interfere with medical processes. These conflicts between equipment, 3
workers, and hazard spaces, are undesirable because medical processes are very vulnerable (Kamat & 4
Martinez, 2005). During construction projects hospitals and its users, suffer from construction dust, fires, and 5
cost & time overruns. As an example of unwanted effects from construction dust, hospital acquired infections 6
are a major problem during renovations because of the dust and spread of mold spores throughout the air 7
(Feldbauer, 2009). Researchers established construction activity as an independent risk factor for infection risks 8
(Weems Jr, Davis, Tablan, Kaufman, & Martone, 1987). Furthermore fire outbreak risks as a cause of advanced 9
hospital installations, medical gasses, and immobile persons, also make renovation projects risky. Besides this 10
the complexity of hospital construction, among others, leads to cost & time overruns. Therefore it is important 11
to involve different disciplines in the design and planning process, to create safe, feasible, and cost-effective 12
plans. 13
14
Planning of hospital renovation projects therefore requires an integrated project approach. When different 15
specialists are involved in the planning of the project, it is likely that the project will have a bigger chance to be 16
successful. Though an integrated project approach demands that all project team members understand the 17
construction plans. Only then, the project team members are able to take successfully part in the design and 18
planning process, and to give their opinions and solutions. Hence, when people understand plans, they will be 19
more aware of the risks, and they can think of solutions. 20
21
There are different ways to present construction plans. Usually project planners present information with bar 22
charts and network diagrams. Typically construction planners used these tools together with design 23
documentation (2D or 3D drawings and specifications) to produce a construction schedule consisting of a set of 24
activities and sequential relationships. Then the construction planner mentally associates this schedule 25
information with the graphic representations of the building. But this ‘mental modeling’ is limited because of 26
the ability to deal with project information changes and the limited memory of a planner (McKinney & Fischer, 27
1998). 3D drawings already give laymen, as well as engineers, a better understanding of project information. 28
But when presenting a construction schedule, these drawings lack a time dimension. Therefore project teams 29
3
should use 4D models, 4D models link components in 3D CAD models with activities from the construction 1
schedule (Fischer & Kunz, 2004). Taking this into consideration, the need for careful planning is obvious and the 2
application of 4D tools is likely to support the partnering process between architects, construction companies 3
and medical specialists (J Bartley, 2000). Therefore I developed and tested a 4D modeling method to support 4
project teams on hospital construction projects. 5
6
Researchers examined the application of 4D models on hospital renovation projects (Fischer & Kunz, 2004; 7
Garcia, Kunz, Ekstrom, & Kiviniemi, 2004; Heesom & Mahdjoubi, 2004; Kunz, Levitt, & Fischer, 2003; Webb & 8
Haupt, 2003) but there are no clear findings about usage to increase patient safety. In addition to this, there is 9
little known about how to model in 4D, few studies describe methods to model. I developed a modeling 10
method that applies color coding, objects, surfaces, symbols, and text, linked to time, to represent hospital & 11
construction processes and safety measures. The method which I introduce, should be a step towards the 12
wider use of 4D models during patient safety-related decision making in hospital renovation projects. I 13
developed and tested the modeling method during an exploratory case study on the preliminary design phase 14
of a middle-sized hospital renovation project in the Netherlands. 15
16
This paper reports the findings of this case study. The study showed that project teams on hospital renovation 17
projects can benefit from the use of 4D modeling. Some participants stated, that various specialists involved in 18
the renovation project planning, often did not understand 2D design documentation, 4D models seemed to 19
help practitioners to understand design documentation. This research finally leads to a method to visualize 20
safety measures, and hospital & construction processes. 21
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The paper starts with the theoretical points of departure for the research. After this theoretical background, 23
the paper describes the 4D modeling method for visualizing of hospital construction projects. Following this the 24
paper describes the case study methodology used in this research. Next to this the paper reports the findings 25
obtained during the introduction of the modeling method in meetings with project team specialists. Then the 26
paper lists the limitations of the research. In the following part of the paper I summarize the theoretical 27
contributions of the research. Following this the paper discusses the practical implications and contributions. 28
and possibilities for future research. 29
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2 Theoretical points of departure 1
Construction in hospitals causes risks and problems, the most important resulting from construction are: 2
infections, fires, budget overruns, and construction delays. Therefore construction, renovation, and 3
construction activities in health-care facilities require substantial planning and coordination to minimize the 4
risks both during projects, and after their completion (Sehulster, et al., 2003). The impact of construction 5
activities in hospitals depends firstly on the size of work and the “patient group area” where the work takes 6
place (Werkgroep Infectie Preventie, 2007). For instance the impact of construction work in the entrance hall 7
of a hospital is less severe than the impact of construction work in a surgical department. Furthermore during a 8
renovation, a hospital often remains in operation, because closure is very expensive. Therefore project teams 9
have to consider carefully, which impacts construction activities have on hospital operations. Analyzing the 10
most important incidents occurring during hospital construction is a starting point, for the development of 11
visualization tools for project teams. 12
13
First construction activities can indirectly cause hospital acquired infections, because construction dust and soil 14
almost always contains pathogenic spores. The spreading of construction dust may occur via shoes, clothes, 15
gravity, and air flows in the building (J Bartley & Bjerke, 2001; Werkgroep Infectie Preventie, 2007). To prevent 16
spreading of harmful dust, project teams have to coordinate: patient & medical staff routing, construction 17
worker & material routing (Wischer & Riethmuller, 2008). Thereby contractors have to isolate the construction 18
site from the rest of the hospital. As a consequence construction workers and material are not allowed in areas 19
where patients, medical staff, and medical material are. But it is often not possible to fully isolate the 20
construction site from the rest of the hospital. To solve this problem, project teams can decide to transfer 21
patients to other hospitals or departments. But transferring is often not possible due to a lack of capacity. 22
Therefore authorities and researchers established guidelines and protocols with measures to reduce the 23
amount/and spreading of dust during hospital construction. Practitioners may choose to isolate the 24
construction site with dust barriers, dust barriers keep dust out of patient areas. Thereby it is necessary to plan 25
routes for patients, material, medical staff, and construction workers. 26
27
Next to the problem of hospital infections, construction activities in hospitals also increase the risk for the 28
outbreak of fires. Hospitals are full of dangerous equipment. For instance anesthesia equipment contains 29
5
medical gasses as oxygen, carbon dioxide, medical air and nitrous (Inspectie voor de Gezondheidszorg, 2008). 1
Hospitals have to control the storage and transport of these gasses to prevent the outbreak fires. Inadequate 2
use and storage can lead to disasters (Onderzoeksraad voor de Veiligheid, 2008). To reduce the harmful effects 3
of the outbreak of fires, hospitals must have an adequate evacuation plan. Fire evacuation plans for hospitals 4
differ from plans for other buildings and institutions, because hospital patients are often immobile. The 5
evacuation plans of hospitals consist of emergency escape routes and protocols for the treatment of patients. 6
Project teams have to take fire safety into account already, during the start of the facility design. 7
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Having discussed the tangible problems, a hospital construction project also faces financial and schedule 9
challenges. Renovations of hospitals are often more expensive and last longer than planned. Thereby 10
renovations are oftentimes even more expensive, than the construction of a new hospital (Wagenaar, 2006). 11
Cost and time overruns have several underlying causes, for instance incidents and time-space conflicts 12
between different contractors can cause construction delays. 13
When renovating a hospital, contractors have to take various safety measures. These safety measures costs 14
money and time. The underestimation of these measures and overestimation of the conditions of the existing 15
building, lead to budget overruns in the execution. 16
17
Thus it is not only important to maintain patient safety, but also to reduce cost overruns and construction 18
delays. Therefore it is recommended to keep the previous risks in mind during all phases of the construction 19
process. Hospitals intend to reduce risks by establishing regulations and measures. Project participants should 20
comply to these regulations and measures when creating and executing plans, but oftentimes practitioners do 21
not do this, due to errors in mental modeling and misunderstanding of design documentation. These errors 22
occur because hospital construction demands a variety of impacts and measures. As a result practitioners face 23
problems during the planning of renovations, because they have to associate various construction sequences 24
and spatial features of the construction site (Barlow & Köberle-Gaiser, 2008). Next to this the implementation 25
of some measures may have a negative impact on other measures and construction activities. For instance 26
placing dust barriers has impact on the evacuation plan; dust barriers isolate areas, while planners must 27
maintain fire safety escape routes. Therefore practitioners require a tool that gives insight in hospital & 28
construction processes, and safety measures. 29
6
Table 1 provides a summary of topics discussed in project team meetings of hospital renovation projects. 1
Hospitals must approve plans of the architects and other consultants, before the hospital auctions the project. 2
It is important to know the place of doors, because together with dust barriers they play a key role in the 3
separation of clean and dirty areas. Hospitals also use air pressure differences to keep dirty air away from 4
patients. It is important to maintain these air pressure differences during construction, therefore construction 5
specialist must have insight in the pressure level of rooms. 6
Preventing infections planners also design routes for medical staff, material, construction workers, and 7
construction material etc.. Keeping dirty people and clean people separated, limits the risk for infections. 8
Thereby planners also design routes for evacuation of a department, in order to reduce the harmful effects of a 9
fire outbreak. 10
Maintaining hospital operations is desirable because it cuts the costs of the renovation project. The more 11
rooms are in operation during construction, the less the costs of construction are. But maintaining operations 12
does cause additional safety risks. 13
14
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Table 1 Subject project team meetings (Lankheet, 2009) 1
Explanation: Clean means sterile, if a person comes into the surgical department he is sterile. But operated patients and construction workers are not clean but dirty. This 2 means everyone and everything that not increases the risk for infection, is called dirty. 3 4
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Subject Requirement Participant responsible/involved Representation in meetings
Place of doors Separate ‘clean’ areas from ‘dirty’ areas.
Architects, microbiologists Traditional symbols of doors on 2D floor plans.
Isolation of construction site A dust barrier must isolate the construction process from the medical processes
Architects, microbiologist, installation advisor, medical staff
2D drawings with lay-out of walls in different phases in the construction process
Air pressure level The high air pressure of clean areas must be guaranteed.
Installation advisor, microbiologist, architects Pressure levels are specified for each room, this is done with text, and the place of installations is on the 2D drawings.
Working times of medical staff and construction workers
Operating rooms must be operational as long as possible
Medical staff, housing advisor, contractor The construction project duration is not clear on the 2D drawings, this is because no contractor is involved yet, and it is difficult to estimate duration of construction activities.
Routing of patients, staff & construction workers (during construction, and evacuation)
‘Clean’ and ‘dirty’ people must be separated,
Microbiologist, medical staff, architects, contractor The routing of patients, staff and construction workers is not visualized in 2D
8
2.1 Current planning process 1
The planning of hospital construction projects involves various phases. Practitioners with different fields of 2
expertise are involved in each phase of the planning process. Analyzing this process, is necessary to develop 3
new visualization methods, therefore the steps of the planning process are explained in further detail. 4
Hospitals frequently work with consultants during the planning phase, when generating plans for new facilities. 5
These consultants are architectural and construction companies (J Bartley, 2000). Architects begin with a 6
sketch, this is based on first needs and ideas of the client. After the architects present 2D and 3D drawings of 7
the lay-out to the client, they get comments, and start the next phase of the design process. In the next phase 8
of the process, the architectural designers generate the 2D floor plans with a higher level of detail, and they 9
also generate 2D or 3D models of construction details as window frames, stair constructions etc.. The project 10
team then generates several basic alternatives for the sequence of construction activities. Eventually they 11
come up with multiple alternative schedules for the reconstruction of the facility. The architectural designers 12
present these alternatives with multiple 2D drawings for each alternative schedule. But this 2D documentation 13
gives no information about the detailed sequence of construction activities, the drawings represent only a 14
snapshot of the construction (Koo & Fischer, 2000). The drawings are a summary of several construction 15
activities. It is also almost impossible to provide information about each detailed step in the construction 16
process with 2D drawings. Because the creation of such an amount of 2D drawings is a time consuming effort, 17
and the use of such an amount of drawings during meetings is dysfunctional. 18
These detailed 2D schedules are the result of collaboration between architects, cost estimation specialists, 19
legal specialists, and the client (Millsap, 2007). As a result of this the hospital is responsible for the safety 20
during construction. Therefore hospitals have medical, financial, and construction expertise at their 21
construction offices. During the planning of renovation projects, diverse project teams plan site access, site 22
logistics, safety measures, and evacuation plans (Finchley Memorial Hospital, 2009). All specialists have focus 23
on particular aspects of the construction plan. For instance, the installation specialist is responsible for the 24
coordination of the work on Mechanical Electrical & Plumbing (MEP), and microbiologists are responsible for 25
the routing of staff, patients and material. As a result the various specialists are interested in different pieces of 26
information. 27
9
Having analyzed the planning process, it is clear what problems planners face during the planning of hospital & 1
construction processes and the devising of safety measures. Analyzing these clarifies what the requirements for 2
4D tools are. 3
2.2 4D modeling 4
Researchers developed computerized methods to represent construction plans graphically, by adding the 5
temporal dimension to 3D CAD models, this are 4D models. Figure 1 gives a schematic representation of the 4D 6
modeling process. 4D models integrate the logical, temporal and spatial aspects of construction planning 7
information, thereby reducing the need for individual conceptualizations of the construction schedule (Koo & 8
Fischer, 2000). A 4D model results from the linking of 3D graphic images to the fourth dimension of time (Koo & 9
Fischer, 2000). The time dimension is the construction schedule. 4D construction animations show the virtual 10
construction and/or demolishing of a structure. 11
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In recent years more and more construction practitioners used three-dimensional/four-dimensional (3D/4D)
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models to support management tasks (Hartmann, Gao, & Fischer, 2008). Researchers describe various 24
applications of 4D models, for instance: site management (Akinci, Fischer, & Kunz, 2002; Chau, Anson, & Zhang, 25
2004; Coles & Reinschmidt, 1994), multi-stakeholder input (Eastman, Teicholz, Sacks, & Liston, 2008; Fischer & 26
Kunz, 2004), communication of the construction schedule (Eastman, et al., 2008; Koo & Fischer, 2000; 27
McKinney & Fischer, 1998), evaluating different schedules (Chau, Anson, & Zhang, 2005; McKinney & Fischer, 28
1998), and tracking construction progress (Ma, Shen, & Zhang, 2005; Webb & Haupt, 2003). 29
30
3D CAD objects
Linking 3D objects to schedule
4D visualization
Schedule data 2D drawings
generate 3D model
Tasks
Figure 1 schematic representation 4D modeling process
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Based on these applications, researchers established advantages of 4D models over traditional methods. A a 1
first advantage 4D models are effective in evaluating the executability of a construction schedule (Koo & 2
Fischer, 2000). Next to this 4D models allow for identification of construction problems prior to construction, 3
(McKinney, Kim, Fischer, & Howard, 1996). 4D models are also beneficial in communication with a diverse team 4
of project participants, because 4D models are easier to understand than traditional planning representations 5
(Fischer & Kunz, 2004). And therefore it is easier for project teams to use 4D modeling as input information for 6
the construction planning, as an example Fischer & Kunz (2004) describe a case where 4D modeling supported 7
the decision making for processes outside the hospital, during construction. 8
9
Although researchers conducted case studies on various possible areas of application for 4D models, there is 10
little research done on the 4D modeling of hospital processes. Researchers studied the use of 4D modeling on 11
hospital construction cases and other researchers on construction worker safety (Benjaoran & Bhokha, 2009; 12
Chantawit, Hadikusumo, Charoenngam, & Rowlinson, 2005), but researchers did not focus on patient safety 13
related information. Despite North et al. (2004) already mentioned the need for virtual healthcare modeling. 14
15
The theory supposes that there is a need for 4D modeling for safety at hospital construction projects. 16
Determining the required insight in hospital & construction processes and safety measures, is a step towards 17
the development of a tailor made 4D modeling method. 18
2.3 Required insight in hospital and construction processes 19
2D drawings and safety guidelines of the reconstructed area give first information about possible problems 20
occurring during construction. Applying hospital construction safety guidelines on this documentation, 21
practitioners have an indication of measures to take on a particular project. But practitioners need insight in 22
the impact of measures on the hospital & construction processes. For instance if the construction site must be 23
isolated with dust walls, then practitioners need to know what consequences this has for the routing of 24
patients. When knowing this, project teams can generate alternatives for the routing of patients. 25
Besides this, practitioners need to have insight in the specific features of rooms in, or adjacent to, the 26
renovated area. For instance air pressure levels are important during the reconstruction of surgical 27
departments, clean rooms must have a higher air pressure level than less clean rooms. This is done to keep less 28
11
clean air outside clean rooms. Visualization of these pressure levels, gives practitioners the possibility to plan 1
suitable patient routes and sequences of construction. 2
The temporal dimension in visualizations gives practitioners insight in the timing of measures, and problems 3
resulting from this. Associating time and space with 4D models is easier than with traditional methods 4
(McKinney & Fischer, 1998). Transitions between phases can cause problems, as an example contractors must 5
thoroughly clean reconstructed areas, before they are ready for use. If this area is a corridor, it can delay the 6
project as the corridor must be used for routing of patients and medical staff. In this case it might be sensible 7
to first create a new, temporal, access before reconstructing the old. The temporal dimension also allows 8
practitioners to evaluate multiple project schedules. Practitioners get insight in the duration of various 9
alternative schedules; for instance renovating a department at once takes less time than renovating a 10
department in multiple phases while a part remains in operation. 11
Furthermore the visualization of information allows planners to detect safety hazard situations prior to 12
construction. Detecting these hazards, gives practitioners the possibility to devise solutions. The visualization 13
allows practitioners to virtually implement the solutions. This gives them insight in the consequences resulting 14
from implementation of possible solutions. 15
2.4 Application of 4D models 16
Concluding from the discussed theory, 4D models are an appropriate tool to support the information and 17
thereby the decision making of practitioners. I examined the application of a 4D modeling method on hospital 18
construction projects. The 4D modeling method I developed, aims to visualize hospital & construction 19
processes and safety measures. The 4D models created with this method give practitioners insight in hospital & 20
construction processes, and safety measures during hospital renovation projects. The 4D models consist of 21
various elements: spatial, textual, and temporal. Figure 2 gives a schematic representation of the process 22
diagram of the 4D modeling method. Information visualized with this method, results from a combination of 23
information, namely building design documentation, hospital safety guidelines, and information about ongoing 24
hospital processes. The method derives safety measures from existing public health agency documents 25
(J Bartley, 2000; J. Bartley, 2006; Centers for Disease Control & Prevention Healthcare Infection Control 26
Practices Advisory Committee, 2003; Werkgroep Infectie Preventie, 2007) and protocols of the hospital itself. 27
12
Hospital process follow from analysis of the department involved in the renovation work. For instance surgical 1
departments have other processes running than a pediatric ward. 2
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Figure 2 Process diagram of 4D modeling method for hospital renovations
Link tasks to task
types and selection sets
3D model of building with visualized
measures & processes
4D model
Client demands, requirements Building design data
Generation 3D models
Basic 3D building model
Construction schedule
Generating tasks and sequences
Safety guidelines data
First indication required measures
Hospital process data
Spatial method:.
Addition 3D objects
Textual method:
Addition text & symbols
Spatial method: Addition surfaces
Selection
appropriate
visualization method for
each measure and process
3D models of measures & processes
Temporal method: Creating tasks and task- types and add colors to these
Creation selection
sets
Selection sets
2D construction sequence drawings
Appending 3D models with
measures and processes to basic 3D building
models
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4D models are amongst other things created with 3D models. To create basic 3D models, the method uses 1
existing 2D and 3D design documentation. The basis of the 4D model consists of two 3D models of the building, 2
one model of the building before the renovation, and one model of the building after the renovation. 2D 3
construction sequence drawings provide a starting point for the scheduling of the activities. These 2D models 4
summarize multiple activities of the hospital renovation project. Reason for using 2D is, that sketching in 2D is 5
less time-consuming than directly creating 4D models. Therefore 2D models allow for a quick generation of 6
multiple basic scheduling alternatives. These scheduling alternatives provide the basis for a list of sequential 7
tasks. 8
9
To add a temporal dimension to the model, the method uses colors. Previous researchers already proved the 10
appropriateness of color coding for 4D visualization (Chau, et al., 2005; McKinney, Kunz, & Fischer, 1998; Wang, 11
Zhang, Chau, & Anson, 2004). To apply color codes in the 4D model, the method uses created selection sets out 12
of the 3D models, and then adds task types to these selection sets (See Figure 7 for an example). A task type 13
represents a categorized task group, for instance the task type demolish. Selection sets added with this task 14
type then have this color during the activity. The demolished parts are invisible at the end, through setting the 15
end appearance to “hide”. Linking all task types and selection sets, results in a 4D model. When a task is active, 16
the linked 3D objects gets colored, appears, or disappears. Task types and tasks represent the temporal 17
dimension. Integrating these temporal and the spatial dimension, which the objects and the building are, 18
makes the model a 4D model. Inserting a legend helps people to understand the colors of the model. 19
20
To show dust barriers, the method applies a spatial method, by adding models with 3D objects (Figure 3) to the 21
3D model of the building. 3D models with these objects are merged with the existing 4D model. This 22
visualization gives practitioners insight in barriers, obstacles and risks during construction. Linking the added 3D 23
objects to a task-type, allows for 4D visualization. Practitioners may use this information to detect accessibility 24
problems, and impacts on adjacent areas. Using the method I saved the 3D objects in separate models, 25
because saving in different model files supports the quick visualization of project changes. 26
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To visualize zone conditions as air pressure, the method applies surfaces, a spatial method. Creating these 9
surfaces the method also uses 3D modeling software. Visualizing for instance air pressure zones I used floor 10
surfaces. The surfaces are 3D objects created with 3D modeling software. I choose to give each room a 11
separate floor section, because this supports the creation of selection sets. Applying color coding on the 12
surfaces supports to identify them, see Figure 4. These surfaces in 4D visualizations give practitioners insight in 13
the conditions in areas, and functions of it. In case of visualizing air pressure zones; this gives installation 14
specialists an indication of the feasibility of schedule alternatives. Installation specialists must isolate the HVAC 15
system of the construction site from the HVAC system of the rest of the hospital, to keep dust away from 16
patients. 17
18 Figure 4 Snapshot of a 4D visualization of a schedule, the blue floor 19
surfaces visualizes areas with air pressure level B 20
Figure 3 Snapshot of a 4D visualization of a schedule alternative with 3D dust Barriers (red) surrounding a reconstructed area, new constructed elements
are transparently green.
15
To visualize routes for people, material, and evacuation of these, the method applies textual annotations and 1
symbols. Chantawit et al. (2005) also used textual annotations for safety planning of activities. Addition of text 2
and symbols happened through creation of another 3D model. The method uses a 2D floor plan of the building 3
model within a new 3D model, to put text and symbols on the right place. Merging the model with text and 4
symbols with the other 3D models, allows to model in 4D, see Figure 6. 5
6 Figure 5 Snapshot of 4D visualization, in the upper left corner a legend for the used colors 7
8
Figure 6 Snapshot of 4D visualization, text an arrows visualize evacuation routes and routing of 9 sterile and non-sterile material 10
4D models created with the above explained method, theoretically give practitioners insight in hospital & 11
construction processes and safety measures. The method addresses to the need for new visualization tools to 12
support the planning of hospital renovation projects. But until here it is only theory described, therefore the 13
4D models are tested in practice. The case study focuses on testing, and validating the 4D modeling method. 14
16
1 Figure 7 Task type interface (Timo Hartmann, 2009) 2
3 Research method 3
It is plausible that 4D models are useful for the planning of hospital renovation projects, because they have 4
various advantages over traditional design documentation. The main goal of the study is to explore the 5
applicability of 4D models, for hospital renovation projects, and the described 4D modeling method in 6
particular. 7
8
Examining the usefulness of the 4D modeling method, I used ethnographic action research methods (T 9
Hartmann, Fischer, & Haymaker, 2009) and exploratory case study methods(Yin, 2002). Case study methods 10
are useful for the goal pursued, because then the resultant theory is likely to be empirically valid (Eisenhardt, 11
1989). 12
I conducted Ethnographic-action research using qualitative methods as interviews and observations. 13
Researchers usually describe the action research process as iterative cycles of observation of practitioners, 14
identification of problems, development of technical solutions, and implementation of the developed solutions 15
(T Hartmann, et al., 2009). Observing working routines and meetings within a project, allows to develop a 16
useful method for practitioners. Figure 8 outlines the research and validation process. Using this cyclic 17
approach I aim continual improvement of the modeling method. This cyclic approach is based on the 18
ethnographic-action research cycle of Hartmann et al. (2009). Research cycles are typical for action based 19
researches. The case study should be a first step in the validation of a 4D modeling method for hospital 20
17
construction projects. First I generated a 4D model based on 3D models of the company, and available safety 1
guidelines. Introducing the model to specialists, and discussing it with the specialists resulted in adjustments 2
and thus validation of the model. 3
4 5 6 7 8 9
10 11 12
13 14 15 16 17 18 19
Using these exploratory case study methods I conducted the case study at an architectural design firm in the 20
Netherlands. Being one of the biggest architectural firms in the Netherlands, the firm gained experience in 21
delivering a variety of projects, including hospital renovations. The firm was working on a plan for the 22
renovation of a surgical department of a middle sized hospital (€12-17 million) in the Netherlands, see Figure 9. 23
Realization of the project is scheduled to start in the summer of 2010. The renovation was necessary, because 24
equipment and architectural features were outdated and did not longer meet today’s requirements. 25
Figure 8 Cyclic research and validation process for 4D modeling method
method
Case 4D model
Theoretical points of departure;
Theoretical 4D modeling method
Case specific information
Interviews, documents Generation of 4D
model
Observations and information
obtained during introduction of
4D movie in meetings
4D movie
Theory
Data analysis
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This case is deliberately selected, and thus not random (Yin, 2002). Multiple characteristics make this case a 17
suitable for the aim of the research. First reason for choosing this project is that surgical sites are among the 18
most vulnerable areas of a hospital. Operated patients are very susceptible for infections, because they often 19
have open wounds, patients also have a poorer functioning immune system. Therefore the environment, 20
medical staff, and material must be absolutely sterile. As a result of this, project teams faced various problems 21
during the planning of previous surgical department renovations (AORN, 2008; J Bartley, 2007; J Bartley & 22
Bjerke, 2001; Burril, 2007; Madrid & Hernandez, 1999; Mee Cheng & Streifel, 2001; Patterson, 1987; Streifel & 23
Hendrickson, 2002). 24
The second reason for choosing this case, is that hospital managers wanted the department to remain in 25
operation during the renovation. This increases the likelihood of incidents, as hospital processes may interfere 26
with construction processes. Hence the project team must devise strict safety measures. 27
Figure 9 The surgical department
19
As a third reason, surgical departments are full of dangerous equipment, this causes risks for the outbreak of 1
fires. Project participants dealing with this risks, must have insight in the consequences of fire safety measures 2
in relation to the other processes in the surgical department. 3
Furthermore many Dutch hospitals plan to renovate their surgical departments in the coming years, because of 4
higher requirements following from new regulations (College Bouw ziekenhuisvoorzieningen, 2004). This makes 5
the study a sound and representative sample for future hospital-, and especially surgical site renovation 6
projects. 7
8 Task of the firm was to deliver a feasible plan, feasible meant: executable, within the available budget, and 9
fulfilling the functional requirements of the client. During the planning phase, the firm collaborated with 10
advisors of the construction office of the hospital, which was the client in this project. The architectural design 11
company was concerned with the preparation of a first plan for construction sequences. The sequences of the 12
renovation activities have a significant impact at the safety, the duration, and the direct & indirect costs of the 13
project. The firm was involved in this, in order to examine the feasibility of a new constructed department, 14
and/or full closure of the department during construction operations, instead of maintaining operations during 15
construction. As a consequence the company was not familiar with their new (extra) role (College bouw 16
zorginstellingen, 2006) in the construction process. 17
18
The selection of processes and measures to visualize in 4D models, occurred by choosing in a way that each 19
modeling element is represented in the 4D models. The subjects relate to Table 1. The selected subjects are 20
summarized in Table 2. Selection of safety measures occurred in collaboration with medical and construction 21
specialists, who applied existing safety guidelines. 22
23
Practitioners of the architectural design firm used the model, to support the discussion of scheduling 24
alternatives during an internal project team meeting. The internal project team consisted of two architects, an 25
two architectural designers and a project manager. Additionally participants described in Table 3 discussed the 26
4D models during semi-structured interviews (Wengraf, 2001). The meetings support the validation of the 4D 27
model. The participants of these meetings represent a number of specialisms involved in hospital renovation 28
planning. Selection of specialists occurred by availability. The meetings allowed to obtain information about 29
the usefulness of the 4D models in giving insight in hospital & construction processes, and safety measures. 30
During these meetings, the experts discussed traditional design documentation and 4D models. At the end of 31
20
the meetings, I introduced 4D models to the participants. Presentation of the models occurred on a laptop, 1
except the presentation for contractors, this happened with a beamer. Table 3 provides a summary of the 2
specialists, that participated in the research. 3
Table 2 subjects, traditional presentation, 4D presentation 4
Represented plan requirements in 2D drawings
How represented in traditional meetings
Representation in 3D/4D
Separate ‘clean’ areas from ‘dirty’ areas. Traditional symbols of doors on 2D floor plans.
Colored cubic objects over the areas Colored floor surfaces
A dust barrier must isolate the construction process from the medical processes
2D drawings with lay-out of walls in different phases in the construction process, the walls are colored, Also the border of the construction site is colored
Colored wall without doors The border of the construction site is also visualized with colored walls
The high air pressure of clean areas must be maintained.
Pressure levels are specified for each room, this is done with text, and the place of installations is on the 2D drawings.
Pressure levels are represented with colored surfaces, operating rooms are represented with colored cubes and/or colored walls
‘Clean’ and ‘dirty’ people must be separated, and an evacuation plan must be available
The routing of patients, staff and construction workers is not visualized in 2D
3D text and arrows.
Construction sequences Multiple 2D drawings Appearing and disappearing objects, changing colors of objects
Maintaining hospital operations Construction site is surrounded with a line
Rooms in use for medical operations have a surface
5 Table 3 Participants of meetings, and their specific responsibility 6
Participant Responsible for: Number of meetings with participant
Architect Planning & design 2
Architectural designer Detailed design of room lay-out 2
Project manager Ensure that customer demands and wishes are translated into construction plans, continual review of the feasibility of the plan
2
Infection control professional (ICP) Patient safety 1
Contractor Safe, time & cost effective execution of the construction plans
1
Communications advisor Communication with clients of the Architectural design firm
1
7
8
21
4 Findings 1 To support the discussion about feasibility of scheduling alternatives of the surgical department renovation, 2
the internal project team used a 4D model in an internal project team meeting. In the beginning of the 3
meeting, the project team used a schedule consisting of several 2D drawings of phases of the construction. 4
Using the 4D model the participants began asking questions about the transition between the phases of the 5
construction, and the accessibility of the construction site. 6
7
To maintain hospital operations during the construction project, medical staff and patients must have access to 8
the construction site. The team planned to construct an internal wall next to a cavity wall, in the end of the 9
renovation project. This operation should take place in the main entrance corridor of the surgical department. 10
The 4D model helped to make the participants of the meeting aware of the fact that this may lead to 11
accessibility problems during construction. 12
Figure 10 snapshots of phases visualized with 4D movie, the last snapshot shows the construction activities in the entrance corridor
22
Furthermore, when one phase is finished, i.e. when construction workers and installers finished their work in 1
one part of the surgical department, they should begin with the renovation of the next part of the surgical 2
department. With 2D documentation the project team did not detect problems that may arise during this 3
transitions. Using the 4D models the participants start asking if it was very optimistic to assume this. Then it 4
appeared that operating rooms need equipment validation and conditional validation when constructed, this 5
validation took about three weeks. Knowing this, the project team asked the client if it should be sensible to 6
close the whole surgical department, as the validation period could lead to delays. 7
8
Figure 11 2D Drawing of construction phase 9
Another issue forgotten, or assumed not to lead to problems, is the impact of placing dust walls. 2D drawings 10
only represented summaries of construction phases, for instance Figure 11. Using the 4D model (see Figure 12) 11
the project team discovered that placing of the dust barrier itself may cause problems, as it is a construction 12
operation and thus produces dust. As a result the project team decided to reserve a period for the placing of 13
the barriers. Next to the placing of dust walls, workers then also clean the department during this period. 14
15
23
1 Figure 12 snapshot of 4D model of construction phase 2
3
Next to the internal project team using the model, they and other specialists mentioned in Table 3 gave 4
feedback on the model after looking at it during interviews. The findings follow from discussions during these 5
interviews. Concluding that some topics recurred in every discussion, these topics are categorized and 6
summarized in Table 4. Validation findings are categorized following these topics. This should help in improving 7
the 4D modeling method in general. 8
Table 4 Topics discussed in validation meetings 9
Topic
Comparison of 2D based methods with 4D modeling
Required information
Level of detail
Possible areas of application
Feedback visualization methods 4D models
General feedback on 4D models
10 Starting with comparisons between traditional methods and 4D, the architect made the first comparisons. He 11
said that during a project team meeting about the surgical site renovation, he experienced problems 12
presenting schedule alternatives. ‘2D drawings provide a summary of the activities, but presentation becomes 13
chaotic due to multiple alternatives, and thus multiple sets of 2D drawings’. Describing a meeting with project 14
team members of the hospital, he said ‘First specialists did not understand these, and then specialists began to 15
give comments’, this resulted in a chaos, because all specialists want to give their opinion, and 2D drawings are 16
not suited for this applications’. According to the project manager; the 4D models may support in these 17
meetings, ‘4D models may clarify the plans, certainly better than 2D drawings’ because they 4D models insight 18
24
in the spatial and temporal dimension of the plan. The project manager also mentioned the advantage of 4D 1
models, in understanding the lay-out of installations; ‘where 2D drawings have a reasonable picture of 2
buildings, 2D drawings of installations are very hard to understand for laymen’. The medical specialist said, ’2D 3
drawings are rather hard to understand for non-architecturals, 3D models already allow for a better 4
understanding, and 4D models certainly do’. The contractor suggested that 2D drawings did not give as much 5
insight in planning errors as 4D models do , ‘because 4D models are a combination of spatial and temporal 6
information’. 7
Discussing the required information presented with the 4D model, the architects asked, ‘can you show 8
architectural details with the model?, like the connection of floors to walls’. In relation to this the architectural 9
said that ‘linking detailed 2D construction details to the 4D models might be a solution’. On the other hand the 10
medical specialist wanted ‘to see how beds are placed in the rooms of the surgical department, this often leads 11
to problems in newly built hospitals, because beds do not fit in the rooms or cannot turn in corridors’. She also 12
stated ‘for infection control planning, it is important to visualize people and material routing’. The contractor 13
suggested ‘are you able to show more detailed sequences of activities?, doing this we are able to detect errors 14
in the construction process’. Following this he stated ‘we want the 4D model to present the detailed 15
construction activities for, for instance building a wall’. The contractor stated that ‘using the model is only 16
worthwhile if it contains detailed visualizations of construction activities’. This leads to the next topic discussed 17
in the meetings; the level of detail. 18
The communications advisor found that ‘no matter what information you want to present, it is always 19
important that all information presented with the model is clear, a high level of detail results in a surplus of 20
information, and thus ambiguities’. The architect said ‘the required level of detail depends on the participant 21
using the model, ‘I want to see architectural details, but this is not relevant for medical practitioners’. 22
According to the project manager, ‘the level of detail should change during the planning process, where in the 23
beginning there are many uncertainties, then it does not make sense to show details, this only raises a lot of 24
questions’. The medical specialist considered, that people without a technical background, ‘should particularly 25
understand the visualization, and therefore it is necessary to show for instance doors, and windows’. As 26
discussed earlier contractors said they require ‘a high level of detail ‘ 27
25
Reviewing the practical use of the 4D models, all participants came up with possible applications on hospital 1
construction projects. The architect was especially interested in use of 4D models for external communication 2
and input for project team meetings, ‘we want to use 4D in the future to clarify plans to clients, to get them 3
involved in the planning process’. The architect also already used the model to get insight in different 4
scheduling alternatives. The ICP said that 4D models are ‘an opportunity to really involve medical specialists in 5
the planning process’, while they normally not really got involved. Also mentioning the possibility to use the 6
model to inform construction workers, ‘in order to make them more aware of the risks’. 7
8
The project manager stated that 4D models are useful to avoid ambiguities in project team meetings, ‘we 9
experienced problems in previous project team meetings with medical specialists, this is a meeting where 4D 10
models could serve as a supporting tool’. Contractors found 4D models an opportunity to save on failure costs, 11
‘errors in planning and design lead to failure costs that form a large part of construction costs’. Besides this 4D 12
models are useful ‘in the communication with clients, when clients and hospital users know what the plans are 13
they will be more aware of the duration and risks.’ 14
As a next topic all specialists gave feedback on the used visualization methods. The architect said that ‘color 15
coding is an effective way of visualizing the temporal dimension of project plans, it is also useful to put 16
emphasis on a particular point of the plan’. However the communications advisor criticized the color coding 17
because ‘it contained too much different colors and text’. The architect & project manager also said this during 18
the second meeting. The architect found that ‘it is important to find balance between the amount of 19
information showed in the model, and the clarity of the model’. According to textual methods, the ICP stated 20
‘such method is useful when working with routing of various things, like construction workers, medical staff 21
and patients’ because use of for instance arrows with multiple colors, confuses viewers. The duration and 22
playing speed of the 4D visualization also lead to discussion. Both the communications advisor and architect 23
found that the speed of the animation should be adapted to the presentation. ‘When we want to use the 4D 24
model, it must be integrated in the oral presentation of the architect, therefore it should be slow enough to do 25
this’. 26
In general all participants reacted very positive to the development of new visualization methods, such as 4D 27
models, for hospital renovation projects. The contractor considered, ‘new visualization methods are can help 28
26
cutting total project costs’. The architect and project manager found that they want to use the model as ‘input 1
in project team meetings’, but therefore it is necessary to visualize installations like the HVAC system, as 2
‘installations play an important role in hospital renovations’. ‘4D models may help to involve medical specialists 3
in the planning of hospital construction projects’ the ICP said. 4
5 Limitations / Future research 5
Although the study is a representative sample for hospital renovations, and 4D models generated are 6
complete, there are some marginal notes. Future research may help to fill these gaps, there is also work 7
resulting from the case study. 8
9
As a first note, I conducted the case study during the preliminary design, this is very early in the construction 10
process. The validation of the method was not complete, the introduced 4D modeling method needs 11
development. Stakeholders can use 4D models for communication, schedule evaluation, and even in the design 12
process. Until now only few participants validated the model, it is important to gain more knowledge about the 13
execution of hospital construction projects to develop the method. Therefore validating and testing the model 14
in collaboration with contractors will help to detail the different 4D models further, thereby it is also sensible to 15
integrate installations in the models. Researchers also have to examine the integration of 4D modeling 16
methods in existing working routines and planning processes (Hartmann, et al., 2008), to actually implement 17
4D models in practice. 18
19
Secondly it is also important to know that the architectural design firm just started implementing 3D modeling, 20
therefore 3D models already appeared to be a major improvement compared with the traditional method, 2D 21
drawing. However the company is convinced that 4D modeling offers many possibilities in future projects. But 22
practitioners experienced that integrating installations in the models is a must. 23
24
At this moment the 4D models are not suitable for meetings with installation specialists, integrating 25
installations fell beyond the scope of the study. Nevertheless installations are a very important part of hospital 26
construction project, medical equipment is very sophisticated, and determines an important part of the plans 27
and thus of the direct costs. Future research and work, will leads to solutions for this. It is important that 28
27
contractors, for example installation advisors must also work with a 3D modeling method. This in order to use 1
their drawings for 4D modeling of Mechanical Electric & Plumbing (MEP) system. MEP coordination has already 2
proven to be effective (Khanzode, Hartmann, Fischer, Reed, & Mack, 2006; Staub-French & Khanzode, 2007) . 3
4
Next to this 4D modeling has some general problems, as software compatibility. The 3D modeling software 5
used during the case study is not fully compatible with the 4D modeling software, although I generated the 3D 6
models with software of the same software publisher. Compatibility problems manifest during the 4D 7
modeling. The 3D objects are connected to each other in the 3D model. In order to assign tasks to these apart 8
objects, it is necessary to unlink the objects. Therefore generating 3D models takes a lot of time, because the 9
software is not optimized. As a cause I was not able to produce many models. Future development of the 10
software will solve this problem, it is even possible that practitioners may generate models themselves, instead 11
of letting trained modelers do this. 12
13
As another area of future work, practitioners themselves may be able to generate 4D models of hospital & 14
construction processes and measures. Doing this practitioners can focus attention of the part of the model that 15
is important for them. But for this, practitioners need a manual with 3D & 4D modeling guidelines. This paper 16
provides in a basic explanation of the modeling methods, but widespread use requires clear standards and 17
manuals that explain the method step by step. 18
6 Theoretical contributions 19
The study contributed to several aspects of the theory about 4D modeling. 4D models likely do this better than 20
traditional methods as 2D design documentation, bar charts, and network analysis. Thereby the research 21
explored the applicability of 4D modeling in supporting safety planning of hospital renovation projects. So far 22
most research done on 4D modeling did not focus on patient safety related issues. Previous researchers 23
focused especially on construction planning of hospital construction projects (Fischer & Kunz, 2004; Garcia, et 24
al., 2004; Heesom & Mahdjoubi, 2004; Kunz, et al., 2003; Webb & Haupt, 2003) and construction worker safety 25
(Benjaoran & Bhokha, 2009; Chantawit, et al., 2005) rather then in-hospital construction planning. 26
27
28
Previous applications of 4D modeling on hospital construction projects, such as Fischer & Kunz (2004) and 1
Heesom & Mahdjoubi (2004) , did not describe a concrete method to involve practitioners in the planning of 2
activities and safety measures. Thereby Hartmann et al. (2008) suggested that researchers need to examine 3
how practitioners can use 4D models easily. A limited number of papers show simple and useful 4
implementations of 4D modeling on projects, and however the method is not implemented, this research is a 5
step towards it. The research provides a 4D modeling method for visualization of hospital & construction 6
processes and safety measures in hospital renovation projects. Introducing spatial, textual, and temporal 7
methods to visualize hospital & construction processes and safety measures, the method aims to give 8
practitioners insight in problems and hazards arising during hospital renovation projects. This combination of 9
previously examined methods (Chantawit, et al., 2005; McKinney & Fischer, 1998) enables practitioners to 10
choose an appropriate way of visualizing for several processes and measures. 11
12
Results of the study also showed that the required information in a 4D visualization differs by the specialist 13
using the model, for instance architects are interested in the architectural features, where medical 14
practitioners want to be informed about the routing of patients. Therefore project teams need several models 15
to adopt 4D modeling successfully, and thus achieve integral use of 4D models. 16
17
As a next contribution this research is one of the first studies to give construction related practitioners insight 18
in the risks and safety problems arising during hospital construction. The research views construction activities 19
as hazardous for both medical staff, patients and construction workers. Previous construction related 20
researches merely saw hospital operations as normal constraints (Fischer & Kunz, 2004; Garcia, et al., 2004; 21
McKinney, et al., 1996). This implicates that researchers are not all aware of the health risks resulting from 22
construction activities in hospitals. 23
24
In summary the research contributed to theory, by introducing a 4D modeling method for visualization of 25
hospital & construction processes, and safety measures. The 4D models created give practitioners insight in 26
the effects of construction activities on hospital operations, and the effects of safety measures. 4D models are 27
likely to be more effective than traditional methods such as 2D drawings. 28
29
29
7 Conclusion 1
By visualizing multiple aspects of hospital construction, the 4D modeling method supports practitioners in 2
planning hospital renovations. The 4D modeling method is developed on the preliminary design phase of a 3
hospital renovation project. Multiple elements of visualization of processes and measures, showed to have 4
great potential in planning hospital construction projects. However further research is needed to come to the 5
actual implementation of 4D modeling in the planning process. 6
7
Besides contributing to theory the study also contributed to practice. With the 4D modeling method 8
practitioners are able to effectively devise safety measures. Visualizing these measures, practitioners have 9
insight in the consequences of safety measures on other measures and processes. 10
11
The 4D models visualizing hospital & construction processes, and safety measures, are relatively easy to 12
generate, therefore practitioners might create these models themselves. Another feature that contributes to 13
the usability, is the fact that all measures and processes are saved in different models, thus implementing 14
changes in the model is relatively easy. While practitioners have better insight in project plans, and can 15
implement changes quickly, they will detect safety hazards, and errors that lead to cost and time overruns. 16
17
Next to the primarily discussed application as input for decision making meetings, practitioners can use 4D 18
visualizations to communicate plans to users and staff before the execution phase of the project. Users being 19
aware of hazards and risks, will likely handle accordingly safe. Another fact that argues for the use of the 20
method is that practitioners suggested they are willing to use the method in future projects. This is supported 21
by the fact that the architect explained about problems he perceived during project team meetings. 22
23
Another opportunity for the implementation of 4D modeling is a change in the Dutch regulations for hospital 24
renovations. The hospital approached this particular renovation project at a relatively new way. Due to changes 25
in the Dutch law, hospitals no longer had to submit plans to a central governmental authority, which normally 26
must grant approval (Ministerie van Volksgezondheid Welzijn en Sport, 2009). As a consequence hospitals 27
should fully ensure the safety of the construction project themselves, this is an opportunity for the application 28
of integrated planning methods such as 4D modeling. 29
30
Last but not least, conducting a case study about 4D modeling at a Dutch company is a small step towards the 1
use of 4D models in the Dutch construction industry. Applying 4D models on this specific case is a stepping 2
stone in conducting case studies on various projects. To convince companies of using 4D models on Dutch 3
construction projects, companies need to have evidence from conducted case studies. Case studies can serve 4
as a starting point for practitioners to understand better, how 4D models can be applied on their projects 5
(Hartmann, et al., 2008). 6
7
31
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