- Howdy.

- [Audience] Howdy, howdy, howdy.

- So before we start just a couple of announcements.

Again, the way that we've been doing our lecture series, if participants on Zoom and students who are in the classroom have questions, please type them into the chat in Zoom.

But please keep your microphones muted so that we don't get feedback or reverberation.

I will ask the questions from the podium.

(clears throat) But, there's no other announcements unless Tan Kim, you have any announcements?

Zachary, you're good?

You'll make announcements at the end.

(indistinct murmurs) Okay, fantastic.

All right, so we'll get started.

So welcome to the Fall 2021 Architecture for Health Visiting Lecture Series.

My name is Dr. Greg Luhan.

I'm the department head of the Department of Architecture at Texas A and M. As you know, the Fall 2021 series has been focused on team, team building and design with a specific operational focus on health and hospital facilities for the future.

Over the last few weeks, we've heard from several leading architects and practitioners that have been driving design and showing the opportunities for collaboration and teamwork.

Today is no exception.

Today's focus will be on "Creating Team Success for the Scottish Rite Sports Complex" in Frisco, Texas.

Today's lecture will be introduced by Ronald L. Skaggs, FAIA, also LEED AP, FACHA and FHFI.

He's graduated from Texas A and M University with a Bachelor of Architecture degree in 1965 and a Master of Architecture in 1966.

Ron Skaggs is the Chairman Emeritus of HKS, where he actively engaged in the design of more than 750 projects, primarily in the health sector.

A fellow of several professional design organizations including the American Institute of Architects.

He served as AIA President in 2020 and the Chancellor of the AIA College of Fellows in 2013.

Many of his honors include the AIA Kemper Award and medal for outstanding service to the institute.

And the TxA Pitts Award and medal for lifetime achievement.

He was also elected as a member of the National Academy of Construction.

Ron has served on numerous professional and civic boards, and he's a lifetime supporter of architectural education at Texas A and M having created two chairs, one professorship and several student scholarships.

He also serves as a member of the College of Architecture Development Advisory Council or CADAC.

I've known Ron for several years.

He is not only a friend, but he's a mentor.

And it is my pleasure to introduce Ron Skaggs.

- Good afternoon.

It's always an honor to be here at Texas A and M and particularly an honor today to introduce the team that's gonna present how they created teaming success for the Scottish Rite's Sports Health Complex in Frisco, Texas.

And I'm gonna introduce, they're five speakers.

There have been some new speakers from what might have been advertised previously, but I'm gonna quickly introduce them and then give them time to speak.

So, bear with me.

The first presenter that I'm gonna introduce is Rachel Knox.

Rachel is a shareholder and principal with HKS, Inc. and serves as the pediatric practice leader for the whole firm internationally.

She's guided the overall design direction and planning issues of inpatient and outpatient pediatric projects across the firm.

She works closely with patients and families and caregivers to ensure that the vision of the project is fulfilled.

She feels strongly that process improvement should be a key driver on any project and I'm sure you'll hear about that today, where there's an emphasis on reducing waste in hospital operations.

Rachel is a Lean Six Sigma Green Belt, holds EDAC certification and is a member of the American College of Healthcare Architects.

I might just also add that I am vice president and secretary of the board of the Texas Scottish Rite Hospital for children.

So it's a great pleasure to introduce Don Katz, who is a member of the hospital staff.

Not only that, he's Vice President for Facilities and Process Design at the hospital.

Although historically he was an orthotist in training, very interesting background.

He is responsible for the oversight of all hospital capital improvement projects and supports several clinical and non-clinical departments in the hospital.

He's highly committed to continuous improvement in operations.

Don earned his Master of Sciences in Healthcare Administration from the University of Texas at Arlington, and is a Six Sigma Green Belt in Healthcare from Villanova University.

He carried that interest into other process design initiatives in his administrative role including the building of the hospital you're gonna see today, or actually health facility.

Next is Tyler Chapman.

Tyler is a Senior Project Manager with The Beck Group, a well-known construction company throughout the United States.

He's located in Dallas and is a team-oriented leader with a successful track record for delivering high quality projects on time and under budget.

He's passionate about service, excellence and attention to detail while advancing the design and construction industry by disrupting the status quo.

And I won't belabor that further, I think you can figure what that means.

He offers expertise in lean processes, target value design, integrated project delivery and prefabrication.

Also today with us is Douglas Lacy, a Senior Vice President with WSP USA, a large engineering firm specializing in mechanical, electrical and related engineering activities.

His education includes a Bachelor of Science in Architectural Engineering from Kansas State University.

And he currently holds his professional engineering license in the area of electrical engineering.

He's also a project management professional with the Project Management Institute and currently serves as Senior Design Director and Senior Project Manager while leading an engineering design studio of over 25 engineers at WSP.

And he's been the principal in charge of WSP's ongoing work on numerous Scottish Rite Hospital projects.

Lastly, with us today is Ramon Cavazos.

Ramon is a Senior Designer with HKS.

He's part of the healthcare practice and has extensive experience with pediatric projects leading the design from concept development through construction documents and throughout the construction of the project.

Prior to joining HKS, Ramon graduated with his undergraduate degree from MIT and later earned his Master of Architecture from the University of Texas at Arlington.

I look forward and I certainly know that each of you do to hearing their remarks today, so I will turn it to them.

(audience applauding) - [Announcer] All right, good afternoon.

So we're here to talk about creating our teaming success on the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco, Texas.

And we've already got such a great introduction from Mr. Skaggs there.

I think we'll move right along and let Don kick it off for us.

- [Don] Well, without further ado then.

So about our Frisco project.

So yeah, I'm looking forward to sharing with you a number of different aspects of this.

This opening slide as you see here has understanding the customer and giving children back their childhood.

That is our vision statement as Scottish Rite for Children.

And it really, it reminds me of a famous quote from Dr. Mayo, from the Mayo Clinic.

Everybody's heard of the Mayo Clinic?

We frankly share a lot of similarities to the Mayo Clinic in that we employ all of our physicians and all of our hospital staff.

We all kind of roll in the same direction if you will.

And Dr. Mayo once said, "The best interest of the patient is the only interest to be considered."

And I think that's very aligned with how we approach decision-making at Scottish Rite.

So we do have a history of orthopedic excellence.

And, you know, Mr. Skaggs had mentioned that my background actually is clinical.

I'm an orthotist by training, that's someone who specializes in the design and fitting of orthopedic braces, especially specializing really in scoliosis orthosis, for example.

And what I really especially enjoy is how clinical practice aligns so beautifully with the integrated approach to design and construction.

At Scottish Rite, clinically we're extremely collaborative in our clinical setting.

We have a physician then does refer a patient to the therapist who refers a patient to the orthotist, whatever else.

We're all literally together, shoulder to shoulder in the clinic, talking about and talking with the family and making the best decision with everybody's voice being heard.

And that's where we have that emphasis for the respect for people.

You have to obviously not only recruit the right team members, but certainly be good listeners as much as you are in sharing your own vision of something.

The same goes for our board of directors.

We operate oftentimes at a very high level of consensus, unanimous consensus, frankly, and especially with decisions as important as building our first ever second campus, which is what the Frisco Campus was.

The Scottish Rite for Children, we have our primary Dallas Campus just north of downtown Dallas.

So this really was an interesting and exciting opportunity for us.

Lastly, this, I think we would not have felt nearly as comfortable proceeding in this direction of building our second, our first ever second campus had we not had the long-term relationships that we've enjoyed with HKS, Beck and WSP, the partners we have on this very presentation.

Next slide, please.

(mouse clicking) Hope you're done.

So at the beginning of the project, really the Genesis of this started with our sports medicine practice.

Mr. Skaggs mentioned that this was sort of anchored by our sports medicine team.

We actually started, historically at least, the hospital, this is our 100th birthday, our centennial year in 2021.

It was in 1921 that the hospital was actually founded by the masons of Texas.

And it was in 2013 that we actually expanded our service line to including sports medicine.

At that time, our sports medicine team was on a totally different campus.

We were actually leasing some space up in Plano.

So we really wanted to design something that could not only support other service lines in the hospital that we certainly provide on our Dallas Campus, but also to make an anchored by sports medicine.

I'll talk about, in a moment on market data on the next slide, but with respect to legacy, that is certainly a very important element for Scottish Rite.

And that, HKS led us through some really helpful, what we call visioning sessions.

And in fact that, what we call a wordle on the right side of the screen there, that is a game for one of those visioning sessions.

We worked with hospital leadership and others on staff to really understand what do we want this new campus to look, feel, even smell like?

Because we're known for our popcorn.

You might even see the word popcorn in there, in the wordle.

But it's all about having a warm atmosphere, colorful, it shouldn't feel like a hospital, that kind of a thing.

And so that was really helping with that visioning session before we even started thinking about design.

And lastly, with respect to age groups, I mentioned sports medicine was the anchor, sports medicine typically might be treating young adolescents.

And so they're gonna be a little different than maybe some of the younger children that we do more typically treat on our Dallas Campus.

So we wanted to be mindful that yes, it's a pediatric campus, a pediatric building, but we didn't want it to be, we wanted to still appeal to children that are adolescents.

And in fact, usually sports medicine in particular, if you have a 12-year-old, they're gonna kind of associate more with the 14 or 15-year-old in their mind.

And so we wanted to be mindful of that from the design perspective.

Next slide.

So I mentioned market data.

This was some pretty extensive work that we had done in many respects.

First understanding where our patients came from.

This, the map on your upper right-hand corner, we found that really a little bit more than a fifth of the patients coming to our Dallas Campus were coming from areas north of Dallas and it's sort of an eight-county region there.

And you see all the dots in the map of Texas, that's reflecting a little over three years of data with each dot.

And the darker the dots, the more concentrated or densely populated from zip codes of patients coming to our Dallas Campus.

It was not only clear that we serve patients from all over the state of Texas, for which we're very proud of, but certainly there was a concentration not only in Dallas, but especially north of Dallas.

And the maps you see down here, the lower right, that was looking at, we were looking at different opportunities for purchasing some land for which to build.

And this was a map working with an outside group of the 10-minute drive test.

How long, you know, how accessible would these various opportunities for purchasing land to actually build this campus, what would be the easiest access for the majority of our patients?

And it's that Lebanon site access where we could reach a lot more people within a 10-minute driving distance than virtually any other property.

So that's the one we chose.

Next slide.

Okay, I think I'm now turning it over to Rachel.

- [Rachel] Yeah, thanks Don.

That was I think a great foundational information for all the hard work that Scottish Rite did before.

We jumped right in and started the design process.

So I'm gonna share a little bit about that.

We go to the next slide.

Okay so, you know, I think we were challenged.

As Don mentioned, you know, Scottish Rite has been in business, it's their centennial year, so for a long time.

But this was their first ever second campus.

So, you know, it was kind of a bit daunting when you think about it to think that we were doing something new and unique for them for the first time.

And we really wanted to make sure that we, being the entire design team and the client, wanted to make sure that we got it right.

So we started off, this was in August of 2014 with a number of site visits.

So, you know, I think in healthcare design it's easy to fall into, you know, what you know and you kind of get comfortable doing things the way that you've always done them.

But considering we were gonna get a chance to do it from scratch, we wanted to see what experts across the country were doing and what their physical environment and their operations looked like.

So, the sports medicine team was able to take a couple of trips to Florida and also up to CHOP in Philadelphia to visit those facilities and learn a little bit more about creating a state-of-the-art sports medicine environment.

And then from that, we said, okay, let's forget about what we know and just really brainstorm what the future can be like.

And we tend to call this phase in a project visioning.

I always like to say that visioning is not just one meeting that happens at the beginning.

Really, we should be visioning throughout the duration of the project at key moments.

But we did start this off by hosting a number of sessions.

I know Don did quite a bit of work even with internal stakeholders, so these were both formal and informal.

You can see even a visit there to look at the kiosk in our own office at HKS and we ended up deploying something similar.

So we even visioned around very functional items and, you know, related to the project design.

But really this was a great foundation for our team as we moved forward to know what those big picture ideas, what those metrics for success were gonna be moving forward.

The next slide.

And then we went to the Gemba.

This is, if any of you guys are familiar with lean terminology, this is a Japanese term that basically says, go to the place where the work is being done.

This is something as a healthcare designer, I feel very passionately about for a number of reasons.

First of all, it does give us an idea of what the current state is like.

What is their current operations or current environment?

What kind of patients are they seeing?

What do we need to take from their current process and move forward because it's working really well?

And what are those ideas that maybe we need to abandon or come up with a different way of thinking through something?

From a design standpoint too, and I just offered this out to the other designers that are in this presentation.

This gives you a great opportunity to develop a rapport with the people that you're about to sit down with for a long process and start designing.

I think it also gives you a bit of, it kind of gets you on their level.

They have a respect, more of a respect for the design team members if they would actually come into your space and take the time to get to know your space and your operations.

Just for grants I went back and looked, we did 25 Gembas for the project.

We went to every single clinic that would be operating in Frisco.

We went to the pharmacy, the lab, the gym.

We went to the ORs, the SPD, we gowned up.

We, you know, we were in all the spaces for an hour plus with each of these meetings.

So we really did invest a lot of time in making sure that we understood the current state before we jumped into the future state of design.

So the next slide.

So the future state.

This is a lot of fun.

We actually stuck all of those valuable lessons learned from the current state, from the site visits, from the visioning sessions.

And we started to build future state maps.

So for every one of those departments we visited that was gonna be going into the Frisco facility, we built a future state map where we analyzed the seven flows of healthcare.

So I think it's kind of second nature to think, well, where is the patient going?

But we also need to understand where medications are coming from.

We need to understand how supplies are getting into that exam room.

We need to understand where is the family while the patient is in surgery.

So really those process maps are a very robust way to kind of build what you'd like those future state operations to look like.

And these were also very important meetings where we gathered everyone in the entire department that was gonna be part of that design team.

Go to the next slide.

We also were fortunate, fun fact, Scottish Rite actually owns an old television studio, very close to their Dallas Campus which, I'm not gonna lie, is kind of creepy to walk into the first time, it had not been used for a while for anything but storage, but it made a fantastic mock-up space for us.

So, working closely with Beck and some incredible craftsmen from Scottish Rite who got really into replicating medical equipment out of cardboard.

We were able to mock-up all of the key spaces that were going up in Frisco and run some simulations, really.

You know, kick the tires if you will before we built it for real.

So really fantastic that we had the space and the team to pull that off.

And I would have to say, a client that believed in us spending the time and money and resources to do that.

The next slide.

- [Douglas] Right, so, what I'm gonna talk about is some of the tools that we used from a teaming perspective to keep ourselves organized as we went through all these steps with the customer in making sure we understood what we needed to do to deliver them the project.

So, one of the techniques we used was Last Planner System.

So any of you that are familiar with Lean Construction Institute or any of their work and maybe you've heard the term pull planning.

This is how we organize the activities that we need to do in cross-disciplinary teams, starting from a milestone and then pulling backwards.

It's, if I need to deliver this on this day, then so-and-so needs to do something five days before that and somebody needs to do something 10 days before that and so on.

And we used a space within the existing hospital where we had giant pieces of paper on the wall and everyone had sticky notes of a different color.

You know, HKS had a different color than WSP than Scottish Rite than Beck than some of our trade partners we'd brought on board and we could kind of organize what needed to happen in what sequence just to do some of the pre-construction design and delivery steps.

This is a technique absolutely employed in the field by the construction teams and was carried through the entire project but we started by doing it during design.

There were some other things that we did to organize the group.

We broke the team down into component teams.

So these were cross-disciplinary teams where for instance, I'll give an MEP example since I'm the electrical engineer.

The MEP component team included staff members from WSP.

So our mechanical, electrical, plumbing, low voltage design, all of our designers, it had members from HKS architects, it had our trade partners that we brought on board.

So some people in old speak call those subcontractors.

So the mechanical subcontractor and the electrician, they were part of the team as well.

And so we broke the design down and we got input from not just the designers, but also the owner was there and the builders were there, so that we were managing the process to deliver a project that Scottish Rite could afford as well as we could build and it met all their needs.

So we had kind of a triangle of things that we had to make sure we were keeping in mind, you know, scope, budget, schedule and all those things.

We also did Big Room Thursdays.

So what that was is that you had all these component teams, you had a component team from AP, you had component team for the exterior skin, you had a component team for structures and in those structures meetings, it wasn't just the structural engineer involved, the architect, the builders as well.

But on Thursdays, we all came together in a big room in the afternoon.

And that's where we coordinated, we planned our schedules.

Each of the teams reported out on how they were doing.

We had this dashboard that you see here that was on an A3 that was helping us track things like cost schedule, any decisions we needed from each other, any constraints we had, so we did that as well.

We also did team surveys along the way to see, make sure that everything was going well, to get everyone's opinion about how the process was working.

If there's anything we needed to tweak, if, you know, we're having too many meetings, we're not having enough meetings, I don't get this information, you know.

We wanted people to give us their opinions so we could adapt and kind of steer the ship.

I already mentioned the last planner.

One of the other things we used was A3 reporting.

This is another back to like Gemba being a Japanese word.

A3 reporting kind of has its roots in Toyota Lean Culture.

And it's a way to make sure we're solving problems and documenting them in a way that we remember why we did what we did.

Too often on a lot of our projects in the past, I think people made good decisions but you didn't have a good running record of why the decision was made, what factors were taken into account in making that decision.

And this helped us keep track of those and actually come to a consensus agreement on what the best path forward was on very specific designer construction needs throughout the job.

We couldn't have done any of that without a really talented and big team of people.

So this picture right here, this is just a pre-con photo.

This is, you can see it as the day we got the model.

So we all gathered around the model at the existing Scottish Rite facility.

We took a picture and pretty much everybody in the photo was either a designer on the pre-con team, from the builders on the owner's team.

We did have some of our trade partners involved.

Obviously there's way more people that it takes to build this 300 plus thousand square foot building than you see in this photo.

But we wanted to kind of celebrate us all coming together around this, so we did that.

And then as we went through the project, I think it was mentioned how important the board of trustees is and how Scottish Rite operates on more of a consensus building, a decision-making structure.

So this photo is of the member from the board of trustees, Mr. Nobles, visiting the construction site and taking a tour.

So he was highly engaged in the process all along the way.

So we had, you know, there's the stakeholders, there's the doctors, the nurses, the orthotist, everybody who works in the building.

But there's also a, there's a leadership structure and a funding structure that these institutions rely on to continue their mission.

And we wanted to make sure everyone was involved in that process, so we did that.

Another thing, all those workshops that Rachel mentioned where we were engaging with all of the staff members to get those great ideas on how their processes are gonna work.

We don't wanna then go off to our offices and just draw a set of plans and then not involve them in the thing we're building for them, because this was gonna take a couple of years to go from drawings to a real thing.

And that's a whole lot of time for people to feel like they're not part of it anymore.

And we didn't do that, so these photos are actually members of hospital staff from different departments coming out and visiting the site to see how things were going to giving us input.

The two gentlemen in the middle worked with the IS&T group, the information technology group for the hospital.

So they were coming out and doing periodic visits as well.

So it was good to have everybody still be part of it as we built it.

Making sure we did collaborative walks during construction so the designers that worked on the job went and saw the job.

So Rachel, me, Ramon, like we were all out there every week.

And even Tyler, who's gonna speak in a moment, he and I in the photo to the right, we even used some of the lean techniques that we were using during the design and construction process to help Scottish Rite plan their mobilization to move into the building.

So that was actually a move in.

That was actually a move in photo where we were pull planning the steps of what the owner was gonna do once the job was built.

So, we always like to throw in this fun picture to remember that this whole respect for people and making sure we're leveraging all the talent we bring to the job.

So that's me in the background holding Rachel's son.

She had two children during this process and she needed to run a design meeting.

So she needed to have the red pencil in her hand.

So she couldn't have Kace in her other hand.

So between Alison and I and many others, I think Don even heated up a bottle during this meeting in the physician's lounge.

We kind of laugh about this, that there were children born during this project that, you know, we're a children's hospital, we're gonna serve the children, even the ones that need to be in the design meetings so.

- [Rachel] We did lose power at our daycare that day, that was the reason he was in the meeting.

Otherwise I don't, I'm not in the habit of bringing my kids to meetings.

(laughs) - [Douglas] She gotta keep, you gotta keep going.

So Tyler's gonna talk about some of our challenges.

- [Tyler] Yeah, so I mean, like they talked about, we built this amazing team and I wish we could say that it was all gravy from there on out.

We didn't have any issues, got to sing Kumbaya and hold each other hands, but unfortunately that's not the real world we live in.

And also I would say that if you aren't having those difficult conversations as part of your team, you're probably not the healthiest of teams to start with.

We should be pushing each other and challenge each other to do better and do more.

And so, conflict isn't necessarily a bad thing.

So some of the specific, you know, challenges that we got into right as we were starting is wanting to make sure we were doing the right thing.

Yeah, Doug and Don both talked about the hospital board input and the decision making process.

So, as you can imagine us trying to form consensus, there was a lot of different opinions on what this should look like and what the cost should be, what the schedule should be, where it should be.

So, you know, that's an opportunity there.

It was on a 40-acre campus.

So there were opportunities to partner with other medical practices and other healthcare facilities to explore different partnerships for Scottish Rite.

Which, you know, they were going to have their own opinions as well.

And then one big part of Scottish Rite is their community outreach.

And so as part of the 40-acre campus, how much of that do we want that to be for community outreach?

How big do conference rooms gotta be?

What can we utilize this space for?

And then real big one is making sure that we're doing the right thing for the future so that we're building this right the first time, you know, with the, it was originally built as a ASC, an ambulatory surgery center.

But there's always been plans for it to be a full blown hospital one day so we had to go through and make sure that we understood what the requirements were for a hospital and trying to future proof it so that we're doing the right things from day one to allow for growth in the future.

So next slide, a couple of the ways we overcame that, some of these challenges, is leaning on each other and our IPD approach.

One thing we did is set based design.

So the theory behind this is it really allows us to explore multiple different options, design options, while we don't have necessarily all the information that we need in order to make the decisions at that time.

So if we can keep pushing forward these multiple design options, as we get more information we can start ruling them out rather than trying to make a decision without all the information and then end up going back to the decision.

So the set based design allowed us to continue to explore a couple of the different options there.

Target value design, really rather than Rachel and her team drawing and then we, Beck, put an estimate to it and everybody realizes we're over budget or under budget or whatever it is and then we have to go through a VE process and start back over again on the design.

We implemented a target value design system where it allowed us to kind of set a detailed estimate and then design to that estimate.

And that way we were trying to eliminate that VE process.

And through the work of component teams like Doug was mentioning, we were really able to do it, maximize everyone's efficiency.

Let's draw this one time and not have to keep revisiting it 'cause we're over budget or it's not working.

And then conditions of satisfaction.

Basically what that is is how are we, yeah, how are we?

At the end of the day, what are we gonna say is a win for this project?

We established that whenever we had faced any challenges, is we leaned on these conditions of satisfaction to, some people call it a True North of how we want to, you know, decision-making process.

Go ahead, Doug.

And then the next major challenge was, this was pre-pandemic.

The city of Frisco go was one of the fastest growing cities in the US at the time.

And so we were building in a major boom time.

The amount of tower cranes in the DFW area in Frisco specifically, it put a lot of stress on the project.

The permitting process was quite a bit longer than we were anticipating.

The labor market wasn't there.

Prices were increasing due to the amount of projects going on at the time.

So, next slide.

A couple of ways we overcame that and overcome these challenges.

Phased document delivery.

Feeding the construction team the information that we needed at the last possible minute so that we could, you know, hit our original date, start earlier, kind of fast track the design process.

The use of pull plans, re-pulling when something didn't work, something came up.

Let's set up a pull plan, re-evaluate our plan, get that buy in from our trade partners and the entire team to come up with a new game plan.

And then really just safe communication.

Having respect for everyone at the table.

Understanding that they're coming from a place of what is best for the project.

And, I guess you'd call it like the trust tree, you know, knowing that there's no bad ideas.

What we're saying here is safe and no one's getting judged for what they're saying so don't be the guy that's afraid to bring that bad information.

Let's bring that bad information forward and work together to solve the issue.

Yeah, and then it was celebrating our team's success as we went through this process.

I think as a high performing team with a bunch of big personalities, it's easy to focus on that, you know, five, four, 1% of stuff that didn't go right.

But we as a team consciously made the decision of, let's celebrate these wins along the way.

Yes, we will continue to improve and push each other and challenge each other.

But, we also don't wanna forget all the great things that we've done.

So a couple of pictures of different ways we did that and, you know, had several retrospectives of taking a pause during the middle of the project.

What are we doing well?

What do we wanna keep doing well?

What can we be improving?

And then, the project just as a whole was a great success.

I think Doug's gonna kind of flip through some of these next couple of slides kind of showing just how great of a job the project was.

And honestly, one of the best, if not the best projects that I've ever been a part of.

Topping out ceremony, like I said, taking an opportunity to thank those craftsmen out there for all of their hard work and setting up a lunch for them and showing them some respect.

Dallas Business Journal Awards for the project, that's Don and me and Jeremy and Dominic, accepting that award on behalf of the team.

Of course, Ramon and his excellent design, award-winning there with the healthcare design.

And then being recognized by the city of Frisco for their chamber of commerce and what the project was able to do for it.

And then Ronald McDonald, we built a space out for them within the facility.

An opportunity for kids or for families to have a place to stay while their kids are receiving treatment.

We actually got a visit from Ronald himself.

Yeah, go ahead.

And then the big one, the ribbon cutting ceremony, officially opening it for the facilities so that they can start seeing patients, a big day for everyone there.

And then I think Ramon is gonna go into a little bit more about the project and the design aspect of it.

- [Ramon] Thanks Tyler.

So the team has done a great job of telling you all about what went into making this project a success.

And so it's my pleasure then to share with you how it all turned out.

And so what you can see here, we're just gonna flip through some of the finished photography and point out a few things.

Really, you know, this project was special to Scottish Rite being a second campus, but we wanted to make sure that they didn't lose that familiarity that they have in their main campus in Dallas.

So, there was a lot of thought and care put into making this a place that would be an extension of that and really elevate their brand.

So talking a lot about being, not a, you know, going back to it not being sterile, that this is a place for children and their families.

It's not intimidating, it's not scary and we tried to put as much fun into it as possible.

So, one of the main features on the outside, you know, it has the colored lights and so.

(mumbles) We've got lots of artwork and lots of color throughout the entire facility.

And so, in the next couple of slides I just wanna show you how we took our vision and really we delivered, you know, the entire team really helped deliver on that.

So here's what the drawing looked like for our site plan and then the next slide is gonna show you the, our actual plan looks very, very similar.

You overlay those, there's hardly any differences other than the fact that the trees need to grow up a little.

So, you know, you look at the next rendering and we spent a lot of the time making sure that it was, you know, just, you know, the beauty of BIM, you know, Revit and Building Information Modeling is that you can model everything very accurately and therefore you can then render it out very accurately.

So then the next slide is gonna show you that, you know, we executed on that.

We feel like it looks a lot like what we set out to do.

And part of that is that we didn't have to take things away.

You know, as we've talked about, we were designing towards a target, a target budget.

That we never put something out there that we didn't feel like we could achieve as a team.

So we were always checking ourselves.

This is what we set out to do, are we still on track to get there?

And, are we gonna make sure that we're delivering on the promises that we've made to all of the stakeholders involved?

Keep going.

And so some of those milestones, you know, some of the things that we celebrated along the way was that we were able to complete the project on time, that we were hitting certain dates and whenever we weren't, the entire team was aware and so we adjusted other parts of the project in order to make sure that we didn't skip a bit, that even if there were things outside of our control, that we were still ultimately gonna meet our deadline.

And one of the things to Beck's credit, they ran a great job site.

And so there was zero loss time to accidents on this project.

Just some additional photos of some of the fun elements here.

I know Doug is also very proud of the lighting, being an electrical engineer on the project.

In fact, in the original renderings, the colored lighting was a lot more subdued.

And, Doug showed us that we could really take it up a few notches.

(laughs) So, keep going.

Again, just some finished shots here, showing you all the bright colors and how bright and light-filled this space really is.

We get into some of the clinical spaces.

State-of-the-art gym, you know, they were so happy to have a space like this.

So this is showing that balance of trying to cater to an older patient population while also keeping it, you know, fun and inviting for, you know, children of all ages really.

Keep going.

Just a few more shots of some of the other clinical areas.

So we, you know, we kept, you know, Rachel and, you know, the spaces that they walked with us at the beginning of the project.

And then we brought some, you know, we brought some of those things into this, and others we improved upon.

And so, we felt like this is a continuation of that process to really evaluate, you know, what's working and what's not.

So, keep going here.

We were proud of being able to design this facility to make sure that we accommodate the possibility of it becoming a full-fledged hospital in the future.

And part of that, a big part of that is the infrastructure that goes into it.

And so we were actually really happy with the way the central plant turned out.

So we took the opportunity to photograph it, as well as the rest of the building just because, it shows not only the great work that's done, but also the planning that was involved for that future capacity.

And then here, the playground at the Dallas Campus is a huge part of what makes bringing people onto the campus, whether they're patients at Scottish Rite or not.

And so, we had always planned to have a playground in Frisco.

The problem was, is that it wasn't part of our original budget.

And so it was a real challenge when the board, you know, we had several discussions, we went back to the board and the board said they felt really strongly that this needed to be part of the project.

And so, it was up to the team to try to figure out, how do we make this happen within the amount of time and money that we have allotted?

And we were able to make this a reality along with the rest of the building.

So it's mainly for anyone and everyone of all ages.

In the lower left hand corner, you see a picture of Mr. Walker, who is the CEO of the hospital.

And then another addition that we made to the project, this is a specific treatment that is within the sports medicine practice.

It was originally not part of the project because of the budget.

And so, because we were able to hit our numbers and actually be under the allotted amount of money, the hospital had the decision, you know, do we just take that money back and not spend everything that we intended to or do we add things to the project that we previously thought weren't gonna be able to make it in?

And so, Don had that conversation with the board and they were in full support of making sure that we left nothing off the table that could have potentially been included to deliver better care.

And just to wrap it up, there's a few key takeaways and it's really about, no matter what it is, whether it's a real life project, a student project, or any other challenges that you find in life, how are you picking your team?

Are you setting yourself up for success?

Does everyone know how you're gonna measure success?

Really, our team was always asking ourselves, you know, "With our conditions of satisfaction, are we actually meeting our goals that we set out to do?"

- [Rachel] Another, you know, thing to kind of take away and think about is, are you involving all the stakeholder groups in your process?

So if you're designing an intake room in a clinic, you don't need the orthopedic surgeons to weigh in on that even though they might.

You really need that medical assistant that's gonna be using the space.

So really thinking through the detail of what stakeholder needs to weigh in at what point in the project.

Are you letting people use their strengths to make the project better?

So really thinking of all the individual talents we bring to the table, it's no different than a project that you may have going on in your architecture studio.

We're all gonna have our different strengths, our different skillsets.

And you'll hopefully see that translate to real life outside of college as well.

And are you checking along the way and making sure that you're doing things right and doing the right thing.

Those are two different ideas, but they both have to be present in a successful project.

- [Don] And with respect to building lasting partnerships.

Again we, Scottish Rite we've had such a wonderful relationship for many, many years now with both HKS and Beck and WSP.

Could we have done it with others?

Perhaps, but there's really something to be said for the speed of trust.

For those of you who might be familiar with Stephen Covey's work on a book called "The Speed of Trust."

That wouldn't have occurred if it weren't for the efforts that Tyler described and sometimes having those tough conversations, you need to have those tough conversations.

In fact, as an owner, I would oftentimes reach out to Tyler and say, "Listen, we're still making decisions along the way and sometimes those decisions can be tough wins and they might take a little more time than you want."

But I would always approach Tyler and say, "Listen, don't let me be a constraint to this process.

If I'm holding you back, let me know and I will ratchet it up and we'll get a decision as quickly as possible," that kind of thing.

So you need to have those open, just completely transparent discussions for this to all come together and we work well together.

That's it.

- [Douglas] All right.

So with that, that was kind of how we worked together, an overview of the project.

And so we'll take questions if you have any.

- Presentation.

I have a couple of questions here from the students in the audience.

To Mr. Katz, "How has serving as the vice president of the Scottish Rite for Children required the need to work with various disciplines and specialties?"

- Wow, that's an interesting question.

You know, I really had to harken back to my, like clinical experience here at the hospital.

And being, since we are so collaborative clinically, you reach out to a number of different disciplines to really provide the optimal care to the patient.

And so, that was an easy thing to then translate as I think you got the sense for how much we needed to collaborate with not only the key players on the call today, but literally dozens and dozens of others that really made this project go as seamlessly as it did.

- Okay, and I know that we've talked a lot about the collaborative context, there's another context question.

"What fields do you need to collaborate with and what factors are most considered when designing health facilities for children?"

- Is that a question for me or for perhaps, Rachel?

- I think for Rachel.

- Okay, yeah, so I would think some of the unique aspects of designing for children and I've got a lot of info I can share after this if someone wants to do a deeper dive into that, certainly.

But I think we really have to think of the patient, first and foremost.

And one of the other things I always say is, you really have to think not just as a patient, but you're designing for their family.

Not to say if you go into an adult hospital you won't see family members with an adult patient, but there's just a hyper-focus to that in a pediatric setting.

I think, you know, one of the other things that we have to think about is designing spaces that, you know, how do we bring in ideas, vendors, et cetera, that can kind of create spaces that delight, you know, and serve as a positive distraction?

The term positive distraction we use all the time in pediatric design.

So whether it's a piece of furniture or a donor installation, you know, we are really challenging our team and, you know, really any trade that touches the space to be thinking about those opportunities.

So something as simple as a static donor wall can really become an opportunity to take a kid's mind off of what may seem like a potentially very scary visit or, you know, Ramon talked about the playground.

In fact, I was headed up to Frisco with my boys the other day and I drove them around the facility and they wanted to get out, I mean what, you know, and play on the playground.

And I think that that, you know, it's that attention to detail and the entire team's attention to that detail that's gonna kind of transform that from just an everyday medical facility into one that is appropriate and fun for kids and their families to visit.

- I have another question that, "It seemed that you were able to do mock-ups, you used target value design, you did integrated project delivery, and you tried to forecast and simulate as many problems that you would come up with and come up with creative solutions.

Were there any other discoveries along the way that those processes did not give you in the front side that you enabled and responded to in the design?"

- I'll take part of that.

I think one of the things that we didn't mention is, when we started this project, we were a bit unsure of what the scope needed to be.

We knew what the initial scope, Don would be for the sports medicine program to relocate that.

And we knew there was a desire to relocate other core service lines for Scottish Rite up to the Frisco Campus.

But beyond that, our team really did spend time grappling with how much is needed for future growth.

If we wanna create an iconic building, how tall does it need to be?

So we went through several iterations of just the massing of the facility itself.

The first few iterations, we didn't have much shell space.

And then we realized that we were probably missing an opportunity to provide Scottish Rite with a lot of future flexibility.

So Donald, I'll let you kind of jump in and.

- Well, yeah, no, I think you've raised an excellent point.

And again, the term of, hey, this isn't our first rodeo, well really was kind of our first rodeo as an institution, you know.

It's like, yes we, there was, I think a strong consensus in leadership that we needed to have another point of access for the care that we provide because we take great pride in that.

But okay, we decided we need to do that.

But, well, how big does it really need to be?

And ultimately we ended up building not only a hospital set specifications even though it's not a hospital now, it's an ambulatory surgery center, but we wanted to be able to allow it to become a hospital when the time was right, looking ahead, planning ahead that way.

But also we had over 30% of the square footage was actually shell space to meet future growth needs.

And then here we are, two and a half years after opening, almost three actually.

And we're already looking at doing a master plan for that campus, that additional 30% of shell space, even as we speak as it's been so successful, the amount of patients we're seeing.

- Yeah, so I guess it's not to say that you won't have those obstacles even, it's that you have the team that can tackle them and not get disheartened if something changes or doesn't go your way.

- So what I was gonna add to that, the hospital, planning to be a hospital part, one of the key groups that we didn't mention that we actually coordinated with along the way was the state.

So we took a van, we all loaded into a rental van and we drove down to Austin, Texas, and we met with, at the time what was called Texas Department of State Health Services, they're now HHS.

And we had a pre-review meeting at the kind of design development level to go through what it would mean to build it as a ASC today and then need to have it be a hospital in the future.

So, we wanted to make sure that the best we could, we weren't reducing the owner's flexibility for the future.

- We have a question from Maya Kyle.

Maya, maybe you can speak it out loud.

- Yes, yes.

So you were talking about the future growth.

And have you set up priorities in terms of, you know, perhaps a women's clinic or a women's hospital that's, you know, connected with the pediatrics in terms of, you know, that future growth, you know, talking about a full hospital, but are you looking at specialties as well?

- That's a great question Maya, thank you.

You know, we specialize in pediatric orthopedics and then we have other service lines that support that mission of pediatric orthopedics, such as neurology, rheumatology and services like that.

We are, as you might guess, with this property and the building that we built, we were certainly approached by different entities saying, "Hey, would you like to possibly partner with us and bring in a new service line possibly within the building?"

We certainly, we value having partners in the healthcare community throughout the metroplex.

And that's, we never wanna say no, but we still have to be really committed to our mission for pediatric orthopedics.

So there still might be other service lines such as neurosurgery, that type of thing that we presently don't have as an example, that's more closely aligned perhaps than perhaps women's health, for example.

But just as a mission in this organization, that's where we rely so much on such a dedicated and well-informed board to help collaborate with hospital leadership for making those important decisions.

But right now, as it stands, everything is still a matter of, there is such a growth that we're still seeing and for the demand for our services, you know, that I think pediatric orthopedi that we'll continue to be taking - Well, we've reached the end of our time today.

I'd like to, again, thank our esteemed guests for their presentation And I look forward to next week's presentation on Friday October 8th, 12:40-1:30 "Re-imagining the Multispecialty Medical office Building Collaborating with the Multidisciplinary Team From Concept to Concensus by Ewing Cole So thank you all for joining us and I look forward to next week's presentation.