When it comes to obtaining a regulatory green light in the rule-filled world of building hospitals, a Building Information Modeling (BIM) approach can make it happen faster and with more clarity. Based on CO Architects' ongoing experience in a pathbreaking California state program—which used the 741,000-square-foot Palomar Medical Center West (PMCW) in northern San Diego County as its pilot construction project (figure 1)—a design and construction team using BIM has been able to improve and accelerate the regulatory approval process for new hospital construction. Bottom line? We estimate that the regulatory approval process on the structural engineering portion of the hospital was sped up by nine months.

Palomar Medical Center West in northern San Diego County is currently under construction

As widely noted, BIM has already stimulated the “Integrated Project Delivery” model for owners, design professionals, and builders, and is now opening a window for bringing regulatory agencies into the mix. It collapses what was once an iterative and sequential decision-making exercise into an information-rich and easier-to-understand process, with much more simultaneity. In keeping with the integrated team's motto—where transparency and trust go together—well-informed regulators are happy regulators.

The regulatory circumstance

In California, the Office of Statewide Health Planning and Development (OSHPD) is the code enforcement agency, and whether in fact or by “urban legend,” OSHPD plan-checking and field inspection duties represent a goodly portion of a project's schedule. But, to be fair, the pre-BIM integration, all-at-one-time plan-check submittal and review process is an onerous and time-consuming effort for any entity. Pre-BIM integration, regulators had to interpret codes and standards in one clump, and then re-review the resulting inevitable changes in the planning and design of the project in other clumps.

Also, the field phase inspection process was (and still can be) fraught with opportunities for variations between permitted design documents and contractor-induced “innovations.” In other words, pre-BIM integration, the permitted documents might not match up with the built version, leading to a redo cycle of redocumentation and rechecking. The feared “do-redo” cycles could emerge, costing countless hours, and throwing monkey-wrenches into planned synchronized work schedules.

The opportunity of BIM

Happily, BIM integration allows for earlier integration of the design and construction team's input, thereby providing earlier design progress for regulatory review—reviews that realistically consider the variables of trade practices, of manufacturer-specific configurations and performance characteristics, and of constructability conditions. Thus, BIM allows for earlier involvement of OSHPD before the design and construction teams spend thousands of hours in the documentation and planning process. The expected result at PMCW (which is currently under construction, is a radical reduction, if not an elimination, of the risks of untimely and expensive OSHPD field-enforcement resolutions.

Moreover, with BIM integration, contractors can contribute early to the BIM “virtual” information pool, allowing for designer incorporation and immediate regulatory review. This is contrasted with the pre-BIM historical “preconstruction services,” when the trade contractors often found themselves unable to contribute to the constantly evolving design stew, and thus relegated to incorporation of trade variables at the jobsite. That is when regulators would discover discrepancies between plans and built reality.

Palomar Medical Center West

CO Architects uses BIM from the earliest conceptual study forward. The PMCW project, specifically, was therefore virtually three-dimensional from the start, and information-laden with parameters for analysis and tracking. When BIM is further utilized in the context of an integrated project delivery model, CO Architects and its engineering consultants provide early and continuous access to the BIM files for all participating parties, including regulators.

For the PMCW project, a 360-bed tertiary care facility, we brought together a team of engineers with an equal commitment to BIM. The ability of BIM and an integrated team to begin to benefit the regulatory enforcement process came with the implementation of a pilot OSHPD plan-check process for the project's structural engineering, as devised by OSHPD and KPFF, the structural engineers of record.

The pilot process involved simultaneous provision of structural “segments,” (i.e., design criteria, loads, gravity systems, etc.) and supporting analysis to OSHPD for conditional review and approval, paralleling development of the ultimate formal plan-check submittal (figure 2). As mentioned, the resulting formal plan-check period was compressed by as much as nine months. Critical to the success of the “pilot” process was the ability of the entire BIM-integrated design and construction team to maintain their design commitments and design resolutions—in other words, plans did not change and regulators were clued in from the start.

The pilot process involved simultaneous provision of structural “segments” and supporting analysis to OSHPD for conditional review and approval

In a second BIM-based initiative, the BIM-based coordination and detailing of the project has been sequenced to allow for the inclusion of the trade contractors' and product manufacturers' sequencing, detailing, and configuration practices (figure 3), as well as preferences, into the design engineer's formal plan-check documents. The intended effect is that the eventual permitted plans will have incorporated and, by doing so, eliminated the construction phase regulatory agency inspection variables and interpretations that result when trade and manufacturer practices are field-introduced.

BIM-based coordination and detailing of the project has been sequenced to allow for the inclusion of the trade contractors' and product manufacturers' sequencing, detailing, and configuration practices, as well as preferences, into the design engineer's formal plan-check documents


Because of the inherent complexity of the hospital building type, its design process, and the regulatory environment, the healthcare design and construction marketplace can benefit greatly from the use of BIM in an integrated project delivery method, and can recognize even greater reward through the use of BIM in the context of the regulatory review process. BIM can function as the collaborative tool by which the regulatory agency team members are integrated into the process so as to minimize the negative dollar and time impact of design and construction redo work. There is certainly potential within BIM to eventually support the code enforcement role digitally and virtually as a participating and contributing team member and user of the model.

While there are many bridges to cross to that time, it is my firm belief that BIM integrated teams (inclusive of a regulatory agency) who are able to work in an environment of transparency and trust can realistically anticipate a future of better quality buildings, more successful dollar and time controls, and more equitable team relationships. HD

Thomas W. Chessum, AIA, is a Principal at Los Angeles-based CO Architects. Contact him at

tchessum@coarchitects.com or visit



Want to express your opinion? To comment on this article, visit http://www.healthcaredesignmagazine.com and click on Current Issue.