This major expansion was connected to a large operating hospital with the expectation that there would be zero impact to patients and visitors. Harder developed a robust Lean plan to meet the challenges of little-to-no laydown area, deliver coordination on a busy street, and vertical construction with craft activities occurring across seven different floors. To combat these challenges, Harder prefabricated underground trench modules consisting of seven piping runs that were delivered on 40-foot truckable racks and flown into place. We also prefabricated over 2,000 feet of piping and significant amounts of work in the mechanical room, helping to maximize everyone’s efficiencies on the congested site. Everything was constructed on wheels so nothing hit the ground, and all tool boxes were labeled and organized specific to this work.