Healthcare Design - November 2015 - 106


C CONSTRUCTION | 11.15
Delivering results

Whether reduced cost, speed to market, risk mitigation, or ownership control is the
objective, there's a delivery method out there that's right for your next healthcare
construction project By Charles H. Griffin
You're a healthcare project manager responsible for
constructing a new building in your system. To date,
you've followed the strategic plan and the master plan
and have developed a conceptual project budget.
You've secured board approval, too. Now it's time to
review and make recommendations to your leadership
on the project delivery approach. This is the legal/contractual arrangement that will define the relationships
that the hospital will have with the project delivery
team, including the design team and consultants, and
the construction team and its subcontractors.
What are your project delivery options and how do
they vary?
Contracting methods are evolving in response to
the challenges of delivering a successful, large-scale
healthcare project. Meanwhile, as the Affordable
Care Act is more clearly understood, most hospitals
are learning to work with the regulations and are
motivated by new reimbursement models to pursue
outpatient or ambulatory care sites. This trend moves
patient care away from the inpatient environment and
into smaller, less complex facilities.
Depending upon the type, scope, and scale of a
project, the delivery method of choice will vary. Further
complicating the picture, there are a variety of pros
and cons to consider within even the most successful
delivery methods.
Design-bid-build
Design-bid-build is the traditional approach: The client
hires the architecture firm, which prepares design
and construction documents. Once the design and
construction documents are complete, the contractors bid on the work based on the documents. It's
good practice to prequalify the contractors, using a
request-for-proposal process similar to that used for
architectural selection. Major subcontractors can also
be prequalified, which is wise given that MEP systems
can cost as much as 40 to 50 percent of the construction budget.
Pros:
* It's the industry's most familiar delivery method
* Roles and responsibilities for the team are well
defined
* More firms can bid on a project
* The owner can benefit from lower market pricing in
a competitive environment, and the low bid may be
the deciding factor in a selection.
106

HCDmagazine.com 11.15

Cons:
* The lowest bid leaves little or no room for the changes
(and potential conflicts) that can be expected on
complex projects of long duration, such as a hospital
* The owner is often required to act as an issues
resolution agent when architectural documents and
construction conflict
* Relationships can be adversarial
* Owner control over the general contractor team is
limited
* Bids can be high in a tight construction market.

Contracting methods are evolving in response
to the challenges of delivering a successful,
large-scale healthcare project.
Construction manager at-risk
In the construction manager at-risk model, the owner
hires both the architect and construction manager (CM),
which is brought onto the project team during the early
design phases to assist with constructability, logistics, and estimating, providing an early opportunity for
collaboration. Under this method, the CM will define a
scope of work, construction duration, and a guaranteed
price and, by doing so, takes on the risk of the project.
With comprehensive and complete estimating, a CM
can help the team keep the project within the budget.
This requires transparency and effective communication
between the design and construction partners to be
sure that as the planning and design evolves, the CM is
responding with cost information that accurately reflects
any changes.
This method is the most common delivery method for
large-scale healthcare projects, and is especially helpful
in renovations because the CM is part of the team and
can better watch the budget and schedule goals as well
as allocate resources for unknowns that often arise.
Pros:
* Cost and change risks are more easily mitigated
* There are more opportunities for a faster construction
schedule with less risk than other methods
* Tension between project team members is reduced
* Work from project team members, excluding the CM
and architect, can be competitively bid.
Cons:
* The construction team is required to play a larger

Charles H. Griffin


http://www.HCDmagazine.com

Table of Contents for the Digital Edition of Healthcare Design - November 2015

Healthcare Design - November 2015
Contents
HCD Online
Editorial
Monitor
The Center
The Retailing of Healthcare
Mixed Methods
Come Together
The Driver’s Seat
Generation Next
Going Deep
New Neighbor
Ready, Set, Show
Construction
Research
Special Advertising Section: Buyers Guide
Special Advertising Section: Project Watch
First Look
Healthcare Design - November 2015 - Healthcare Design - November 2015
Healthcare Design - November 2015 - Cover2
Healthcare Design - November 2015 - 1
Healthcare Design - November 2015 - Contents
Healthcare Design - November 2015 - 3
Healthcare Design - November 2015 - 4
Healthcare Design - November 2015 - 5
Healthcare Design - November 2015 - HCD Online
Healthcare Design - November 2015 - 7
Healthcare Design - November 2015 - Editorial
Healthcare Design - November 2015 - 9
Healthcare Design - November 2015 - 10
Healthcare Design - November 2015 - 11
Healthcare Design - November 2015 - 12
Healthcare Design - November 2015 - 13
Healthcare Design - November 2015 - Monitor
Healthcare Design - November 2015 - 15
Healthcare Design - November 2015 - 16
Healthcare Design - November 2015 - 17
Healthcare Design - November 2015 - 18
Healthcare Design - November 2015 - 19
Healthcare Design - November 2015 - 20
Healthcare Design - November 2015 - 21
Healthcare Design - November 2015 - 22
Healthcare Design - November 2015 - 23
Healthcare Design - November 2015 - 24
Healthcare Design - November 2015 - 25
Healthcare Design - November 2015 - 26
Healthcare Design - November 2015 - 27
Healthcare Design - November 2015 - The Center
Healthcare Design - November 2015 - 29
Healthcare Design - November 2015 - The Retailing of Healthcare
Healthcare Design - November 2015 - 31
Healthcare Design - November 2015 - 32
Healthcare Design - November 2015 - 33
Healthcare Design - November 2015 - 34
Healthcare Design - November 2015 - 35
Healthcare Design - November 2015 - 36
Healthcare Design - November 2015 - 37
Healthcare Design - November 2015 - 38
Healthcare Design - November 2015 - 39
Healthcare Design - November 2015 - 40
Healthcare Design - November 2015 - 41
Healthcare Design - November 2015 - Mixed Methods
Healthcare Design - November 2015 - 43
Healthcare Design - November 2015 - 44
Healthcare Design - November 2015 - 45
Healthcare Design - November 2015 - 46
Healthcare Design - November 2015 - 47
Healthcare Design - November 2015 - 48
Healthcare Design - November 2015 - 49
Healthcare Design - November 2015 - 50
Healthcare Design - November 2015 - 51
Healthcare Design - November 2015 - 52
Healthcare Design - November 2015 - 53
Healthcare Design - November 2015 - 54
Healthcare Design - November 2015 - 55
Healthcare Design - November 2015 - Come Together
Healthcare Design - November 2015 - 57
Healthcare Design - November 2015 - 58
Healthcare Design - November 2015 - 59
Healthcare Design - November 2015 - 60
Healthcare Design - November 2015 - 61
Healthcare Design - November 2015 - 62
Healthcare Design - November 2015 - 63
Healthcare Design - November 2015 - 64
Healthcare Design - November 2015 - 65
Healthcare Design - November 2015 - The Driver’s Seat
Healthcare Design - November 2015 - 67
Healthcare Design - November 2015 - Generation Next
Healthcare Design - November 2015 - 69
Healthcare Design - November 2015 - 70
Healthcare Design - November 2015 - 71
Healthcare Design - November 2015 - 72
Healthcare Design - November 2015 - 73
Healthcare Design - November 2015 - 74
Healthcare Design - November 2015 - 75
Healthcare Design - November 2015 - Going Deep
Healthcare Design - November 2015 - 77
Healthcare Design - November 2015 - 78
Healthcare Design - November 2015 - 79
Healthcare Design - November 2015 - 80
Healthcare Design - November 2015 - 81
Healthcare Design - November 2015 - New Neighbor
Healthcare Design - November 2015 - 83
Healthcare Design - November 2015 - 84
Healthcare Design - November 2015 - 85
Healthcare Design - November 2015 - 86
Healthcare Design - November 2015 - 87
Healthcare Design - November 2015 - 88
Healthcare Design - November 2015 - 89
Healthcare Design - November 2015 - 90
Healthcare Design - November 2015 - 91
Healthcare Design - November 2015 - 92
Healthcare Design - November 2015 - 93
Healthcare Design - November 2015 - Ready, Set, Show
Healthcare Design - November 2015 - 95
Healthcare Design - November 2015 - 96
Healthcare Design - November 2015 - 97
Healthcare Design - November 2015 - 98
Healthcare Design - November 2015 - 99
Healthcare Design - November 2015 - 100
Healthcare Design - November 2015 - 101
Healthcare Design - November 2015 - 102
Healthcare Design - November 2015 - 103
Healthcare Design - November 2015 - 104
Healthcare Design - November 2015 - 105
Healthcare Design - November 2015 - Construction
Healthcare Design - November 2015 - 107
Healthcare Design - November 2015 - 108
Healthcare Design - November 2015 - 109
Healthcare Design - November 2015 - Research
Healthcare Design - November 2015 - 111
Healthcare Design - November 2015 - 112
Healthcare Design - November 2015 - 113
Healthcare Design - November 2015 - Special Advertising Section: Buyers Guide
Healthcare Design - November 2015 - 115
Healthcare Design - November 2015 - 116
Healthcare Design - November 2015 - 117
Healthcare Design - November 2015 - 118
Healthcare Design - November 2015 - 119
Healthcare Design - November 2015 - 120
Healthcare Design - November 2015 - 121
Healthcare Design - November 2015 - 122
Healthcare Design - November 2015 - 123
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Healthcare Design - November 2015 - 148
Healthcare Design - November 2015 - 149
Healthcare Design - November 2015 - 150
Healthcare Design - November 2015 - 151
Healthcare Design - November 2015 - 152
Healthcare Design - November 2015 - 153
Healthcare Design - November 2015 - 154
Healthcare Design - November 2015 - 155
Healthcare Design - November 2015 - 156
Healthcare Design - November 2015 - 157
Healthcare Design - November 2015 - 158
Healthcare Design - November 2015 - Special Advertising Section: Project Watch
Healthcare Design - November 2015 - 160
Healthcare Design - November 2015 - 161
Healthcare Design - November 2015 - 162
Healthcare Design - November 2015 - 163
Healthcare Design - November 2015 - 164
Healthcare Design - November 2015 - 165
Healthcare Design - November 2015 - 166
Healthcare Design - November 2015 - 167
Healthcare Design - November 2015 - First Look
Healthcare Design - November 2015 - Cover3
Healthcare Design - November 2015 - Cover4
Healthcare Design - November 2015 - AIA1
Healthcare Design - November 2015 - AIA2
Healthcare Design - November 2015 - AIA3
Healthcare Design - November 2015 - AIA4
Healthcare Design - November 2015 - AIA5
Healthcare Design - November 2015 - AIA6
Healthcare Design - November 2015 - AIA7
Healthcare Design - November 2015 - AIA8
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Healthcare Design - November 2015 - AIA13
Healthcare Design - November 2015 - AIA14
Healthcare Design - November 2015 - AIA15
Healthcare Design - November 2015 - AIA16
Healthcare Design - November 2015 - AIA17
Healthcare Design - November 2015 - AIA18
Healthcare Design - November 2015 - AIA19
Healthcare Design - November 2015 - AIA20
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