What The Private Sector Can Teach The VA About Hospital Construction
In my years here at Healthcare Design, I’ve always noted the appetite our readers have for details of government healthcare construction projects—and for good reason. I’ve heard it said that “as the government goes, so goes the rest of healthcare.”
So it’s interesting to find news today that government auditors are calling into question the Department of Veteran Affairs’ oversight of major hospital construction projects—interesting in terms of the implied mismanagement, of course, but also because it sounds like there are construction strategies the VA could stand to learn from its healthcare design colleagues in the private sector.
According to news reports, in testimony to a House panel, it was said that projects—specifically, medical centers in Las Vegas; Orlando, Fla.; Denver; and New Orleans—are taking on average three years longer to complete than scheduled and costing an additional $366 million per project more than anticipated.
In fact, Rep. Mike Coffman, R-Colo., who chairs a House subcommittee, said the VA’s oversight of major construction projects fails to meet industry standards and went as far as calling it "dysfunctional."
While a number of factors were cited as contributing to delays—for example, major changes to project scope—the Government Accountability Office (GAO) specifically notes in its report the VA’s inability to deal with design changes in a timely manner. The agency found that modifications to design made during the construction phase of projects commonly took up to six months or more to be finalized, as opposed to the weeks-long timeframe the GAO supports.
The GAO also highlighted issues on the Orlando project, where changes to equipment were made so many times that construction had to be suspended, recommending that medical equipment planners be brought into the design process much earlier.
Also suggested was better defining construction management staff’s roles and responsibilities, especially identifying decision-makers, so there’s more clarity on projects for general contractors as well as design and engineering firms.
They're issues the industry at large has discussed, and addressed, for some time, especially early integration of project team members. And from my perspective in talking to sources, this is largely happening across the board. So when changes have to be made—whether to scope or the nitty-gritty like equipment—potential issues are brought to light earlier and a collaborative environment nurtures quick decisions.
But we also know too well another truth to hospital construction: If you make a major change to the project, like shifting from a clinic expansion to a standalone medical center (which happened on the Las Vegas project), it’s going to take more money and more time.
The auditors acknowledged this, too, noting that some delays and costs overruns simply couldn’t be avoided. And while avoidance may not be an option, better management certainly is. And it sounds like the VA is conceding to that, too, creating a construction-management review council.
According to an article in the Orlando Sentinel, Glenn Haggstrom, who heads the VA’s construction division, said lessons learned from the Orlando project—which is the furthest along of the four—will be applied to others, specifically to better coordinate with construction firms and to increase its own project oversight to avoid design errors (like the continuous re-design to account for all those medical equipment changes).
While the VA and other government agencies will surely remain leaders in innovating healthcare delivery, technology, and design, it may be time to look across the divide to public sector peers for more efficient approaches to delivering the facilities that support those innovations.
What’s your take on the VA report? Share your thoughts in the comments below or email me at firstname.lastname@example.org.