Integrating Design and Construction

Integrating project teams to build healthcare facilities smarter, faster and better.

Health care facilities are some of the most complex and costly buildings ever built. They are full of expensive equipment, require elaborate infrastructure and take a long time to design and construct. These facilities require translating a large number of user inputs into an effective design which can then be turned over to a construction team and built.

Such projects are largely self-organizing acts of one-off production. Typically, an owner selects an architect based on qualifications who then selects consulting engineers based on qualifications. Later in the process the owner selects a Construction Manager based on a fee for the work and qualifications. The CM then selects subcontractors based largely on relationships, price and past performance. Subcontractors select suppliers and manufacturers based on the same criteria. These teams of design, construction and manufacturing companies come together to produce a project in a unique set of relationships. When the work is complete, they immediately disengage.

As a result, collaboration of a full design and construction team rarely happens. In such a competitive environment of short-lived contractual arrangements, without incentives for collaborative relationships, there is little economic incentive for transformative change. At a time of tremendous change in the healthcare industry with a rapidly evolving model for delivering services, requiring nimbleness, speed and flexibility, this traditional project delivery process is inadequate.

Additionally, in order to arrive at an effective design, multiple end-users must be engaged to make a myriad of decisions that ultimately shape the design. The process of engaging these end-users is critical to the quality of their decisions, which in turn is critical to the quality of the facility design. Using effective techniques that allow an end-users to make firm decisions is essential. It is the only way that a design team can rapidly and confidently build on the decisions and avoid the risk of back-tracking when end-users reconsider previous decisions. 

This presentation will review a case study where speed to market, high levels of quality and long term flexibility were essential goals that needed to be achieved. In order to accomplish these goals a revolutionary project delivery model was used that addressed many of the limitations of traditional project delivery process outlined above. It involves early selection of many key subcontractors and manufacturers and allowing them to assist and ultimately develop elements of the building design.  It also involves innovative ways to engage end-users to insure rapid, high quality and high reliability decisions are embedded in the design.

The project also exploited the latest and rapidly evolving Building Information Modeling (BIM) and virtual reality to increase accuracy, speed, constructability, long term flexibility and maintenance. It also exploited opportunities for prefabrication to enhance quality and shorten the project duration.

Learning Objectives

• The elements of Project Integration – who to involve and how
• How to gather effective end-user decisions
• How to organize an Integrated Project Team
• The challenges managing an Integrated Project Team
• The value of Project Integration –how an Owner benefits