The Healthcare Master Planning Journey: Three Keys to Mitigating Risk & Optimizing Outcomes

Extensive preconstruction planning, including optimization of offsite prefabrication plans, were key to minimizing risk and accelerating the schedule for the University Health System, Women’s & Children’s Tower Addition in San Antonio, Texas.

THE HEALTHCARE MASTER PLANNING JOURNEY:

THREE KE Y S T O M I T I G AT I NG R I SK & O PTIMIZING OUT C OM ES

BY PAUL ZUBECK, SENIOR HEALTHCARE PROJECT MANAGER

Today’s hospitals are focused on multiple priorities such as improving patient outcomes, gaining operational efficiencies, retaining staff, transforming the customer experience, incorporating new technology, reassessing service line priorities, competing for local market share, and meeting financial targets.

These priorities—and the plans and strategies that impact them— are inherently quite dynamic. Each of these priorities either impacts or is impacted by the hospital’s physical infrastructure, which is why multi-year, multi-phase, campus-wide design and construction initiatives are such complicated and critical components of many hospitals’ strategic plans.

With their potential to impact many hospital priorities, these types of projects require the right approach to ensure success, especially because they present many unique challenges and complexities. For instance, these initiatives typically consist of a series of interrelated renovation and expansion projects over several years. With that comes a bigger resource requirement for everyone involved, from the construction manager and trade partners to the design partner and owner. According to Healthcare Vice President Russell Templin, “Anytime more stakeholders are involved, risk and complexity increase.”

Also, because these projects are underway for multiple years and the initial design and preconstruction planning phases are much longer, funding and design must be more future-proof and flexible. With investments of this size, projects must remain just as relevant when they finish – to demographic needs, clinical best practices, leading technology, customer preferences, revenue potential, current building codes, etc. – as when they were first envisioned. Many owners also leverage multiple funding sources for various pieces of the project.

For example, they might use revenue generated from a new space to fund a future phase of work. “The risk and complexity of estimating, budgeting, and funding are closely intertwined and inherently greater on projects like this, too,” added Healthcare Preconstruction Services Director Sam O’Connor.

Despite the increased risks and challenges of master-planning initiatives, embracing best practices in three key areas can make all the difference in the multi-year journey and ultimate outcomes.

Proper planning is critical for all construction projects. But with years-long project trajectories and higher stakes, a rigorous and successful preconstruction planning phase is imperative for master plan initiatives. “Today’s preconstruction services can’t just focus on estimating,” said Templin. “It takes more than just pricing to set up a project for success. Logistics, safety, phasing, scheduling, lean management, and virtual design and construction (VDC).

When done well, these ‘pre-building’ services are all about mitigating risk and providing the best opportunity to influence project outcomes before physical construction begins.”

RUSSELL TEMPLIN, HEALTHCARE VICE PRESIDENT

There are several key ingredients to preconstruction services success, including collaboration, early involvement, and effective communications. Healthcare Preconstruction Services Director David Harlow says communication starts with effectively listening to all stakeholders, especially the owner, “because good plans shouldn’t just consider what we think is important; we also need to make what is important to them important to us and our planning, too.” Early involvement of key stakeholders – owner, contractor, design, and trade partners – along with embracing lean construction practices helps lay the foundation for effective communication, collaboration, and trust throughout the project. “Getting everyone involved and leveraging lean from the earliest stages of planning create the mindset of collaboration, respect for others, trust, and accountability needed for long-term teamwork and success,” said Harlow.

Effective communication also impacts the budgeting and estimating components of successful preconstruction services. “Because the budget needs to be relevant for multiple years and projects, being able to provide the owner with near-instantaneous pricing updates as ideas and designs change is essential,” said O’Connor. This means budgets must account for year-over-year phasing and escalation throughout the entire project, and contractors must be able to quickly articulate how budgets are changing relative to all other moving parts of the design and planning process. “This allows owners to have all the facts needed to make informed decisions by enhancing transparency, and therefore increasing trust throughout the planning process,” he added.

Similarly, early involvement of VDC services sets the project up for good decision-making in areas such as prefabrication planning, trade partner selection, and constructability. Because there are multiple buildings and spaces, each with varying ages, involved with these master plan initiatives, there are “more layers of the onion to peel back, which means more risk to mitigate,” said Sara Curry, Healthcare VDC director. “We can help make the design partner aware of what they can’t see on campus, so they can account for those challenges in their drawings, rather than waiting to discover them during construcHCA Centennial Medical Center tion, which could result in rework, delays, Tower Addition, Centennial, Colorado and additional costs.”

JE Dunn Construction | groundbreaking |

Perhaps most critically, master plan initiatives impact so many areas of a hospital’s campus over multiple years, so there is far more potential for disruption to daily operations than with a typical construction project. This increases the complexity of phasing, logistics plans, and “make-ready” work necessary for business continuity in countless areas of the hospital, in addition to loading docks, utilities, parking, patient entrances, ambulances, helipads, and the like.

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Optimize Construction Success through Preconstruction

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Employ Strong Leadership and Foster Communication

Another key success factor for these multi-year efforts is strong leadership and an equally strong team. Because key stakeholders must work together for multiple years to complete a project, collaboration, trust, and leadership are even more essential. Similarly, every facet of the team needs strong leadership.

Without leaders capable of maintaining focus on both the big picture and the details, too many pieces can fall through the cracks.

“On smaller projects, a team might be able to compensate for one weak link,” explained O’Connor. “But you can’t claw your way through a big project for three to seven years. Teams just can’t recover if each stakeholder’s key players aren’t strong enough and consistently in sync with each other.”

Perhaps most importantly, the onsite project team should be willing to go above and beyond to meet the owner’s needs and lend a helping hand, even when it is not part of the contract or project scope.

“The wrong team can wear out its welcome pretty quickly on projects like these, especially because you touch so many areas of the hospital over several years,” explained Gross.

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Minimize Disruptions to Ensure Business Continuity

Similarly, part of being a good partner is understanding that the “jobsite” is not primarily a construction zone. Rather, first and foremost, it is a hospital full of staff, patients, and visitors 24 hours a day, seven days a week. So, when projects transition from design and planning to construction, one of the biggest priorities is minimizing disruption to the hospital’s campus and daily operations.

Superintendent Jim Hert helps a woman to her car after noticing a puzzled look on her face as she tried to navigate around the construction site at Tyndall Air Force Base in Panama City, Florida.

One of the most important qualities for successful project leaders is a willingness to be nimble and flexible. Since projects unfold over the course of years rather than months and construction must revolve around the hospital’s daily operations, plans are always subject to change at a moment’s notice. “We always have a plan when we start jobs like these, but how we get there will inevitably change,” elaborated Healthcare General Superintendent Adam Gross. “Being able to adapt is critical.”

To that end, building strong relationships with the hospital’s key stakeholders is also pivotal to success. This includes the hospital’s facilities team, executive leadership, as well as the end users of the areas being built or renovated. Listening to and understanding what they want and need when the space is complete — and keeping those objectives in mind alongside the hospital’s overarching goals — will ultimately lead to a smooth turnover of the finished space and higher client satisfaction.

Furthermore, fostering strong, authentic relationships also keeps the lines of communication open to remain adaptable and helps prevent surprises. “Being able to pick up the phone and quickly discuss changes and challenges so the facility is never caught off guard—and so we can get the information we need about the hospital’s operational plans, current census, daily surgical schedules, and other key details—is invaluable to keeping projects on schedule,” said Gross.

Good contractors and trade partners see themselves as an extension of the hospital and will jump in to help solve problems or make the client’s life easier.

It’s just the right thing to do as a good, long-term business partner.”

ADAM GROSS, HEALTHCARE GENERAL SUPERINTENDENT

One of the main ways to do this is ensure all logistics, safety, phasing, and scheduling plans limit the impact to hospital operations as much as possible. Naturally, planning, communication, and flexibility are all keys to success. Take for example a hospital with the state’s highest labor and delivery census, which required triple the phasing to accommodate patients and maintain business continuity. “It might have slowed us down, but it was essential to stay out of the hospital’s way as much as possible,” said Adam Riggs, Healthcare project manager.

In order to keep projects moving, teams should make sure everything they could possibly need to stay productive is fabricated, delivered, and stocked. Plans can change, and the team needs to be ready with labor and materials to shift gears at a moment’s notice.”

University Health System, Women’s & Children’s Tower Addition, San Antonio, Texas

ADAM RIGGS, HEALTHCARE PROJECT MANAGER

Similarly, logistics can be particularly complicated on these projects. Busy campuses create tight sites for cranes and laydown areas for materials and equipment.

They also require safety and logistics plans that account for constant patient, visitor, and hospital movement on the campus.

“Due to phasing and the particular logistics on one unique campus, we literally had the flow of traffic driving through part of our construction zone to maintain the hospital’s operations,” said Healthcare Vice President Brandon Moore. “I’ve also led projects where we’ve relocated critical utilities three or four times throughout construction to ensure the hospital had what it needed every step of the way. These aren’t greenfield construction sites,” he added, “so the logistics required for success can be intense.”

Minimizing disruptions also involves hiring the right trade partners and educating them on the intricacies of hospital construction.

In addition, because daily work plans are always subject to change, teams should be prepared with available materials and supplies for alternative work.

BRINGING IT ALL TOGETHER FOR LONG-TERM SUCCESS Given the long-term, high-stakes nature of these master planning initiatives, this work requires a level of sophistication and capacity for complexity less typical on shorter, simpler projects. But with the right people and partners, smart plans, and a willingness to go above and beyond to protect the hospital’s investments, operations, and patients, success is sure to follow.

JE Dunn Construction | groundbreaking |

Keeping the patient at the heart of plans is also key to minimizing construction’s impact on the facility. That could mean scheduling construction during off hours to reduce risk of vibrations to delicate surgical procedures, or it could mean choosing quieter saws to limit disruptions to patients focused on healing. Smart teams also try to relocate as much of the work off campus as possible, which can improve trade partner productivity while also eliminating some noisy activities from the hospital, such as banging ductwork together.

Because hospitals are full of vulnerable, fragile patients, one of the most important ways these teams minimize construction’s impact is not just by planning for what can be seen, but also for the risk of the unseen — infection. Demolition and construction are inherently messy, creating dust and potentially exposing decades-old contaminants hidden behind walls and ceilings.

“Infection control gold standards are absolutely imperative on these projects,” underscored Gross. “The last thing we want to do is compromise a patient’s health with our work. So, we must take meticulous measures and work closely with the facility’s infection control leaders to develop detailed plans for protecting patients and preventing infection.”

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