Healthcare Design's New Paradigm Shift
Interactive Design Process, Collaborative Design Approach, Integrated Project Delivery, BIM, 3P, and Lean production process … so many new terms in the world of design and construction. What does it all mean? How will it affect and change my business that I’ve been “practicing” for the past too many years to mention?
I recently discussed these changes with an expert in the field of transition and innovation. We started our discussion talking about change that happens over the course of 100 years—from farming to the industrial age—then talked about change that happens over the course of a generation—from horses to trains to automobiles—then talking about change that occurs over the course of modern innovation—from the first cell phone shaped like a brick to my new smart phone that only a 13-year-old can program!
Stop and consider how our own industry is changing. The influences of healthcare reform; cost of healthcare at 18-19% of our gross national product; interactive and BIM software; and the blurring of the lines between owners, contractors, architects, and engineers are all changing our industry within the short lifespan of a single project delivery. What if the integrated project delivery model, along with use of BIM software, and a new process of extracting design needs from the end user could find a way to wring out additional dollars from the design and construction process? What if those dollars could be redirected toward more healthcare benefits in the way of additional equipment, technology, programs, services, and staff?
Would we be able to turn the tide of rising healthcare costs?
Could we reevaluate operational flow and process models to improve the healthcare industry and the design and construction industry, by reducing errors, assuring better coordination, and standardizing our documentation practices? Would we be able to turn the tide of rising healthcare costs? Do we have any other choice?
This paradigm shift is happening piecemeal throughout our industry. In recent years, nearly all our healthcare design work has been in some format of integrated and collaborative process, using a revamped Lean design process, which shifts the focus from the A/E design to the “team” design, where the team is defined by the owner, architect, engineers, general contractor, and prime MEP sub-contractors. Collective “ownership” of the design challenge and the solution is an empowering tool.
This paradigm shift reminds me of my second love—sports (of course architecture/ healthcare design is my first love!). The shift reminds me of the differences between baseball and football.
In the traditional model of design/bid/build, you’ve got some star pitchers and hitters, and other assorted defensive team players who stand around waiting to react to a hit that comes in their direction. Everyone has a job to do on the field, and my view is that in baseball, one or two stars can make an appreciable difference. In baseball, one or two players can shine above the rest, and carry a franchise to the championship.
In the Integrated Project Delivery/collaborative design new world order, it is an environment of “all for one and one for all,” more like football. Sure, as an outsider, one might see it as a few star players—the Tom Brady’s, Peyton Manning’s, or Adrian Peterson’s of the game. Ask any one of them, and they would tell you that if not for their hard-working unsung heroes of the offensive line, there would be no star player. In football, each of the 11 players on the field has an assignment to carry out at the moment the ball is snapped. Each assignment is vital to the success of the game. All five offensive linemen must work in unison to move the line forward and create a pocket so that the quarterback has time to look down field and throw, or the running back and his blocking fullback have time to make a hole and run up field. Wide receivers and tight ends must distract the secondary defenders so the play has time to develop. Just one blown assignment, and the play may fall apart. The success of reaching the end zone is not accomplished by one star player, but by many players doing their assignments with precision and no wasted effort.
It is the same way in our industry when we employ Lean concepts, use BIM software, and implement an Integrated Project Delivery. After each “play,” we regroup in the “huddle” and discuss what’s happening on the field, where help is needed, and where weaknesses are observed.
Each team member in the IPD process is given a design assignment. We are all working in the same BIM document, each working in the same design volume, seeing each others’ work, operating in real time, detecting conflicts, and enhancing coordination. Estimating and constructability review is ongoing during design. The process as a whole assures the owners that they are receiving a better coordinated design, a project that is “buildable.” The collaborative and interactive design process and IPD make every effort to bring the right people together at the right time, to provide appropriate input in a timely manner with decision-making authority, and to bring constructability, conflict detection, construction coordination, and construction cost-estimating all together. This is how you win a football game!
We have adopted BIM as our documentation tool of choice for all healthcare design projects, and our recent experiences with IPD and other forms of collaborative and interactive design process has proven to save time, and resulted in better coordinated design and construction, with more satisfied clients and long-lasting relationships between architect, engineers, general constructors, and prime sub-contractors. We are convinced this is the way of the future of all healthcare design and construction.