“Production Preparation” Process To Reduce Building and Construction Time and Expenses
I recently experienced a new medical office building that due to a series of failures resulted in about $200,000 in construction rework. That doesn’t include the time it takes to figure out who was responsible for the failures and who was going to pay.

Facilities Development is one area that is benefitting from lean tools and methodology (specifically 2P). Healthcare, with all of its growth, could stand to benefit by paying attention.

Architects, developers, owners, engineers, staff, vendors, physicians, construction managers, etc. face the challenge to complete new construction and renovation work as quickly, safely, and cost-effectively as possible. However, it is also critical to the success of any project, that the workflows required within the new space have been carefully analyzed, designed or redesigned prior to creating the plans. This rarely occurs. The plans always seem to be first.

Traditionally, architects are engaged by owners and meet with them to learn about the required program spaces. They create an initial drawing or concept. Later, drafts are discussed for adjacencies, sizes, occupancy loads, and equipment needs. This process usually involves engaging people individually and over many weeks, only to end up right where they started. A design is produced and then given to the developer for construction cost estimate. The estimate goes back to the architect and owner with the news that it is 25 to 50% higher than they hoped. The back-and-forth continues (typically again with staff, physicians, vendors, etc.) until there is some scope reduction (usually cutting the wrong corners or slashing things that typically are the least familiar to the primary stakeholders) until the estimate matches the preconceived project estimate established early on in the process. Changes are identified – plans are redrawn, and the whole process repeats. As time dwindles away, the documents are completed and approved. The developer, construction manager, and/or project manager are then left to construct the documented scope for the amount estimated. Often additional changes are required at great cost, or worse yet, rework because of failures in the design, gaps in requirements, changes in requirements or gaps in oversight.
The following problems are apparent in healthcare:

Care delivery requirements and processes are not being properly evaluated prior to the design of space. Wasteful processes are resulting in wasted space and poor design solutions.

The lack of early collaboration between stakeholders from user groups, staff, physicians, architects, engineers, construction managers, subcontractors, and vendors is not taking advantage of the value that each team member brings to the project. A single design is often “pushed” forward early and then molded to fit a preconceived budget.

This linear process of hand-offs was expensive, time-consuming, and most importantly resulting facilities were perhaps pretty, but no more efficient and supportive of new care delivery models than the facilities they replaced. Think hallways like bowling alleys or outgrowing the space in under two years.

Have you thought about any other apparent problems with healthcare? If so, we would love to hear from you. Feel free to comment on our blog or contact us today!

In our next blog, we will continue on with the problems in healthcare and focus on the alternative approaches.