Parsippany, NJ — I was delighted to read the July-August issue of DATELINE focusing on healthcare. The authors collectively made a compelling case for the efficacy of design-build delivery in the health arena. Based on my own experience, I am certain that the time is right. The need for an effective delivery approach has never been greater.
The healthcare construction market exceeds $17 billion annually, according to the McGraw Hill Construction Research & Analytics healthcare sector study, “The Steady Pulse of Healthcare Construction.” We can anticipate that the pulse will quicken as people continue to live longer and the baby boomers’ increasing requirement for healthcare services weighs down the nation’s healthcare infrastructure. The fact is, the healthcare market is experiencing a facility crisis and needs delivery of replacement facilities quickly and seamlessly. The design-build delivery method offers the healthcare industry an alternative solution.
Design-build is currently used with success in certain types of health-care facilities such as medical office buildings and outpatient facilities, because the buildings are not technically complex and are often smaller in both size and cost. Con-struction of outpatient facilities and medical office buildings are relatively straightforward, with repetitive plan requirements. Moreover, these building types are often physician-owned or otherwise privately held. That is, cash-strapped hospitals sell or lease a tract of land to a developer to build the outpatient facility. Often, physicians associated with the hospital will form a group to purchase or lease these types of facilities.
To some extent, design-build is not commonly used in delivery of hospitals due to owner misconceptions. Many hospital owners believe that design-build cannot accommodate the complexity of their facilities and programs. Some perceive that design-build results in lower quality. They become concerned that they will “lose control” of the construction process and will be locked into decisions that cannot be changed. Their perceptions could not be more wrong!
It is interesting to note that design-build has been used fairly commonly and with success in the pharmaceutical industry, where program and facility complexity, high quality standards and control (by regulators as well as owners) are hallmarks. The pharmaceutical sector recognizes that design-build provides an ideal solution to compress time-to-market.
It is a natural progression for design-builders to leverage this experience in the hospital market, where integrated project delivery can help solve the facility crisis. The fact is, many hospitals are challenged to provide the staff needed to coordinate and properly execute large projects. They need a methodology that integrates the process of design and construction to deliver the product quickly and seamlessly based on their program needs and quality standards — without the need for dedicated daily involvement.
Design-build is a natural fit for construction management (CM) and design firms involved with healthcare projects. After all, CMs are frequently asked to handle more than the construction process by managing the design effort as it relates to time and budget, acting as owners’ advocates, and maintaining responsibility for budget and overall schedule. CMs are in a good position to oversee the programming and design management responsibilities, working alongside the designers. Many CMs are fully capable of serving as managing partner in healthcare design-build projects because of their ability to manage risk.
As an industry, we need to do a better job of educating hospital owners to the realities and benefits of the design-build approach. We need to point to our successes, most notably in the pharmaceutical industry, and use them as a model for the healthcare field. And we must help hospital owners understand their key decision-making role in the design-build process — that is, to delineate clearly their program needs and quality expectations.
As you know, DBIA is offering a series of healthcare project delivery conferences that include sessions that focus on design-build from the owner’s viewpoint. As I write this, two of the conferences (Berkley and New Haven) have already been convened, with Chicago and Orlando to follow. It is well worth participating in these conferences to get a better understanding of the issues that matter to owners and to help address them. Together, we can bring design-build to the hospital market.
With great enthusiasm,
William K. Flemming,
Senior Vice President Pre-Construction
Skanska USA Building Inc.