It's somewhat of a universal truth that successfully constructing large, complex healthcare projects requires specialized construction-phase expertise on the part of owners, design teams, and contractors. What is it that makes these projects unique, and how can a healthcare-specific partnering process minimize risks and enable all stakeholders to realize success?

Let's start by identifying the top five challenges unique to healthcare project success in our experience as a consulting group that specializes in designing and facilitating partnering processes for large, complex projects. These go beyond the conventional, well-proven benefits of partnering to minimize/eliminate claims and expedite project schedule/completion.

1. Managing the relationship with the state regulatory agency. The relationship with the individual regulatory agency inspector/ representative is often a wild card in a project's success. Too often this is reactive and involves the inspector after the fact in a relationship that is impersonal and bureaucratic. The consequences: project delay and a process in which agency design approval and change orders requiring agency approval frequently fall on the path of critical urgency.

The solution: involving the inspector(s) in the initial partnering workshop, giving them an opportunity to contribute to and genuinely buy into the project's overall goals. Our experience is that the vast majority of these inspectors want to be involved with a team committed to achieving common goals. However, this is with the explicit understanding that partnership goals and personal commitments in no way undermine/compromise the state's code enforcement. Typically, we invite state agency representatives to participate in the first half-day of the workshop where we define the overall goals and specifically address regulatory agency-related processes. If, as is sometimes the case, you cannot get the representatives to attend, the partnership can develop an alternative approach to engaging with them proactively and as one team.

2. Managing the impact of the construction process on the hospital's ongoing operations. All too often a project's stated or unstated goal is to “minimize complaints/impacts.” The result? At best, the stakeholders focus on reacting to complaints. Consider, instead, the possibility that the project might be basically a positive experience for patients, medical staff and employees.

For the construction of Los Angeles County's Rancho Los Amigos Hospital wing, for example, a partnership goal stated that “the project will be a positive experience for patients and staff.” As Wayne Lindholm, vice-president and regional manager for Hensel Phelps Construction, the general contractor, put it, “When we do major health care projects, like the remodel of Rancho Los Amigos hospital, we try to get the patients and surrounding neighbors involved in what we are doing as we ‘inconvenience’ them. On this project we had monthly contests that included guesstimating ‘how many cubic yards of dirt came out of the excavation?’ and ‘how many tons of steel are in the structure?’ We had a box for answers and the closest answer would receive a prize or cash. Some contests were for patients only, others were for medical personnel only, and others were open to all.

“Also, at Christmas, our superintendent would pass out turkeys to the facility's neighbors. When everyone gets involved in a project, they accept the inconveniences and also have a lot of fun with it!”

3. Managing the impact of owner changes (especially “large footprint” medical equipment) and owner-furnished FF&E. On a major healthcare project, both these processes can and do significantly change over the duration of construction. The solution: Involve an end user (medical staff and/or nursing) in the partnering workshop. This develops a personal relationship in which the end user appreciates the scheduling impact of their requested changes, and it establishes a specific vehicle for communicating these change requests early and quickly in a manner that minimizes scheduling impact, as well as cost to the owner.

The same is true of owner-furnished FF&E. The installation process cannot be started early enough. Typically, the healthcare institution has an individual dedicated to this process. His or her involvement in the partnering workshop facilitates and coordinates their move-in with the construction schedule. Not infrequently we see a partnership goal with phased owner acceptance (by floor) and move-in of FF&E while construction is still underway elsewhere on the project.

4. Managing MEP coordination. It seems that in comparison with other types of construction projects, healthcare MEP coordination is complex and involves more stakeholders (subcontractors, subconsultants, etc.). The consequences? Again, critical path delays and lots of what we call “tennis” between contractors and design team, with innumerable RFIs resulting.

The solution is to include key MEP trades and design subconsultants in the partnering workshop and develop a very specific collaborative process to expedite MEP coordination—and the RFI process—to support your overall project completion goal. In fact, in many of our projects, MEP coordination is a partnership goal unto itself.

Related to MEP coordination (as well as owner changes) is the reality that for many healthcare projects today, design is not complete at the outset of construction. Partnering can facilitate and expedite design completion during construction, with the contractors acting in an informal “design assist” role with the design team.

5. Expedited start-up and commissioning. More and more we are seeing dedicated and specialized commissioning firms involved in healthcare project start-up and commissioning. This process can benefit from a collaborative approach involving owner, designer, and contractors, as well as the commissioning firm. We go so as far as to identify this “team” at the initial partnering workshop and provide an early deadline for completion of the start-up and commissioning plan. Again, this cannot happen too soon and the team cannot be “too inclusive”; you should involve anyone (yes, including end users) who can contribute to expediting this process.

Conclusions

Major healthcare projects will always be challenging and involve risk. A healthcare-specific partnering process can openly acknowledge these risks and, more importantly, the opportunities for surmounting them, and enable all project stakeholders to work as a team in realizing true project excellence. It is not unusual to see over 50-60 attendees at a major healthcare project partnering workshop. What is satisfying is to see them leave as a team, committed to common goals and with a very specific game plan that will deliver on achieving these goals.

The only prerequisite for making this happen is senior management commitment to the partnering process. As Jim Bostic, Regional Manager for St. Joseph's Health System, says, “As the owner, you must be committed to the process and demonstrate to all stakeholders your commitment with your actions. And you cannot start the partnering process too soon.” HD

Jim Eisenhart is President of Ventura Consulting Group in Ventura, California, which specializes in designing and facilitating partnering processes for large, complex projects aimed at producing project results well beyond “business as usual.”

For further information, phone 805.650.8040, e-mail info@venturaconsulting.com or visit http://www.venturaconsulting.com. To comment on this article, visit http://www.healthcaredesignmagazine.com.