The urban sprawl of Los Angeles has resulted in numerous hospitals located in a dense, urban fabric. HMC Architects recently worked with one such hospital, a multi-specialty academic medical center, to expand its emergency department, which has more than 75,000 annual patient-visits, and is just one of many ongoing construction projects occurring at the busy campus.
It finds itself having to adapt to meet technological changes, be competitive in the marketplace, and attract and retain new staff, among others challenges. To meet these demands, the campus is under a constant stage of construction. How do they handle it all, while ensuring projects are completed on schedule and on budget?
The medical center’s program management handles a large volume of projects and their successful approach can be applied at medical facilities of differing scales and locations.
Steps for Success
Work with a systematic program management process
Start with the basics—with hundreds of projects and tens of millions of dollars involved, select a sophisticated, yet flexible program management software—it does what you want it to, not what the software programmers want. Clearly this is both a time and dollar commitment, so research options carefully before making a decision.
Program management tools can provide reports on a daily basis and at any logical regular point to respond to administrative demands and requirements. There are many types of reports but an informative “dashboard” summarizing the status of cash flow and project variances is critical for quick and easy reference leading to “deeper digging” when variances are not within agreed tolerances.
For instance, a project with a 20 percent variance in cost that represents only $3,000 may prompt a request for a project manager’s explanation. However, 3 percent variance in cost that represents $55,000 may be worthy of more in-depth research. Remember, this is a tool for management and the reports must assist the managers to do their job.
Hire experienced management, design, and construction professionals who work collaboratively
A program and construction management effort involves three strata team—your own employees, your design professionals and your construction professionals. In some cases the design and construction professionals may be retained under one design/build contract but the expertise remains divided. One of our clients uses most commonly accepted project delivery methods, but for remodel projects, such as the expanded and renovated Emergency Department (shown above), the usual method is design-bid-build. In healthcare and especially in regulation-heavy California, experience is essential. The most successful program management includes experienced project management where anticipating the issues and problems saves both time and money.
Equally, collaboration between all parties working in an interactive and non-adversarial relationship will produce measurably better results on any project. Putting effort into getting the job done rather than protecting self-interest is a guarantee of reducing costly change orders affecting both time and money.
Build trust with governing agencies, such as OSHPD/AHJ
In California, the governing agency for acute care facilities is OSHPD—the Office of Statewide Health Planning and Development. Other states have similar but perhaps less regulated “Authority Having Jurisdiction” due to the lack of seismic safety influences.
Within these agencies are professionals who have expertise in building code and licensing issues. Very often they have come from private practice and understand the design and documentation process but their focus is ensuring code compliance and public safety.
A vital part of a relationship between a design and/or construction professional and the OSHPD/AHJ professional is trust. Trust breeds cooperation and as a result can speed up the process especially during the construction phase when time quite literally is money.
Have a built-in construction contingency
Healthcare projects are one-of-a-kind ventures. Often, there are “lessons learned” that can be applied to influence actions and decisions, but inevitably the details are different and lead to new lessons learned. Any program management system must allow for changes during both design and construction within their budgeting process. Clearly a remodel project will have a different approach than a new build project, but the need for design and construction contingencies is common.
Healthcare staff must deal with technology changes, and not surprisingly want to have the most up-to-date conditions when the project comes online. Healthcare projects require years of design and construction effort. In California, it is not unusual for a major project to take ten years from initial strategic planning to patient treatment. Project duration is always a challenge. With a contingency, the impact to the budget is lessened if changes are required to meet new technological demands.
Remodel projects must deal with field conditions. The design professional begins with field investigation to identify as many conditions as possible that may affect documentation and construction. However, concealed conditions only revealed once construction begins often result in additional work, additional time, and require added documentation to comply with code related requirements. An appropriate contingency plan will mitigate the impact of cost increases.
