1. Sutter Medical Center Castro Valley Images from VSM Meetings

2. Sutter Medical Center Castro Valley Images from VSM Meetings Wall 1 – Multidiscipline design team Wall 2 – Hospital Operations Wall 3 EIR Team

3. Sutter Medical Center Castro Valley Images from VSM Meetings

4. Sutter Medical Center Castro Valley Project Schedule at Validation – Accelerated Schedule 12/30/2008 Submit Complete OSHPD Package 7/1/09 OSHPD Approval on Structural Start of Construction 9/15/07 Start of SDs 16.5 Months

5. Sutter Medical Center Castro Valley Project Schedule at Validation – Accelerated Schedule 12/30/2008 Submit Complete OSHPD Package 7/1/09 OSHPD Approval on Structural Start of Construction 9/15/07 Start of SDs 16.5 Months General Observations All Discipline drawings submitted to OSHPD at one time. Review time from 12-16 months or more. SD,DD,CD phases arbitrary. Risk of rework during SD, DD, CD phases (late program freeze). Design can change through SD, DD, CD phases (all disciplines). Risk to construction start date – traditional review process (12-16 months) EIR impact on process.

6. Sutter Medical Center Castro Valley Current State Map VSM Goals Arrive at a common understanding of workflow. Identify key cross discipline discussions and information flow. Re-define intermediate project design milestones based on systems and information flow. Identify last responsible moment to make decisions on program. Reduce rework during design by avoiding starting tasks prematurely. Redefine traditional design process to leverage Phased OSHPD Review Process. Better understand the EIR process in relation to design process, permitting, and construction. Develop team collocation approach. Identify opportunities to reduce handoffs from design to construction (BIM and Direct Digital Exchange).

7. Sutter Medical Center Castro Valley First VSM Workshop 10/19/07 Freeze Floor Plan Overall attitude must start design ASAP (behind schedule) Started Value Stream Map at Macro Level Direction given to team is to focus on identifying major tasks and constraints

8. Sutter Medical Center Castro Valley On Line Meetings (10/29/07) Freeze Floor Plans 3/01/08 User Input Multi-Discipline input via online meetings Continued focus on information flow and constraints. Introduced process time (time it takes to get a task done without rework) Target Program Freeze 12/24/07

9. Sutter Medical Center Castro Valley Value Stream Map (11/09/07) Focus on workflow leading to program freeze / floor plan freeze. General OSHPD Phased Review approach. Target Floor Plans Freeze 3/01/08 Target Program Freeze 12/24/07 User InputLRM to start multi-discipline design

10. Sutter Medical Center Castro Valley Value Stream Map (11/19/07) Detailed review of workflow for program freeze and building floor freeze. Detailed multi-discipline discussions about LRM for start of detailed multi-discipline design.

11. Sutter Medical Center Castro Valley Value Stream Map (11/19/07) User InputLRM to start multi-discipline design Target Floor Plan Freeze June 08 Program Freeze 3/08

12. Sutter Medical Center Castro Valley Value Stream Map (11/24/07) – EIR Process Value Stream User Input LRM to start multi-discipline design Target Floor Plan Freeze June 08 Program Freeze 4/21

13. Sutter Medical Center Castro Valley Value Stream Map (1/19/08) – More Frequent Key Project Milestones Identified project milestones based on level of completion of various design elements. Identified key project milestones based on building components Identified need to break large detailed design activities into smaller batches. Began transition to swim lane approach. Began to map the EIR process in greater detail.

14. Sutter Medical Center Castro Valley Value Stream Map 5/6/08 – Transition to Production Planning

15. Sutter Medical Center Castro Valley Overall Concept Evolving Future state Identify milestones Validate overall schedule Line of Balance Revise future state map incorporate lessons learned to reduce schedule and risk Pull schedule between milestones & Weekly Production Planning SPS| Production Manager Collocation strategy Track commitments

16. Sutter Medical Center Castro Valley Images from VSM Meetings