Eaton says another way to keep construction costs downwhile helping to keep overall volume upis for hospitals to do more planning and to involve more players sooner in the process.
It really comes down to making the right decisions early, he says. The design-bid-delivery modelwhere the facility is totally designed and then put out to bid without builder inputis tailing off.
Now, he says, everyone is getting involved from the beginning, even equipment suppliers and major subcontractors, and design tools that offer three-dimensional images of a project are being used to help visualize the finished project. Other cost-cutting moves involve constructing modular sections of walls or piping off-site.
Eaton explains that fabricating these pieces in advance and in a controlled environment allows for better quality control, can reduce installation time, and enhance work-site safety related to hoisting and installing the material and assembled components.
Opportunities differ on specific projects, but there is certainly potential on most projects for this to be of value on several fronts, Eaton says. But he also warns that a great deal of on-site planning and verification needs to be done to minimize the opportunity for mistakes.
At a program on integrating information technology into healthcare-facility design sponsored by the Greater Chicago Chapter of the Healthcare Information and Management Systems Society in January, Bob Pratt, principal designer of the Pratt Design Studio in Chicago, also mentioned how integrated design teams are incentivizing people to work together who previously were working separately and sometimes even as adversaries.
Under this model, Pratt explained that the money usually set aside for contingencies or change orders could be put in a bonus pool to reward people for getting a job done on time and on budget.
Garbecki agrees that this trend of including more parties in the early stages of planning is definitely growing.
Our preferred delivery model is getting involved early because it helps us understand the goals and objectives, Garbecki says. Were raising questions that are enabling us to identify the scope so things dont become surprises later on.
Planning is especially important with some of the more complex projects in the works that involve major renovations that are being done without any interruptions in healthcare delivery.
Well see an increase in the need for that type of work, Garbecki says. I think well be seeing more downtown projects where you build a new parking garage, build an addition on the old parking lot, and then connect it to the existing building.
Garbecki says Gilbane is working on a project like this at Ascension Healths 320-bed St. Vincents Medical Center in Bridgeport, Conn. The $140 million expansion project involves building a new 600-car parking garage on the site of an existing surface lot; expanding the current 13,000-square-foot emergency department to more than 43,000 square feet; and building a new four-story, 125,000-square-foot wing that will house a new cancer center, part of the emergency department and a conference center. In addition, the medical centers main lobby, ambulatory service facilities and cardiology center will be remodeled.
Michael Canniff, St. Vincents project manager, says the project is expected to take three and a half years, but was preceded by a year and a half of planning and almost a year of make ready projects to prepare sites for construction. This included relocation of utilities, asbestos removal and underpinning the foundations of existing buildings, which involved excavation of soil and replacing it with concrete.
Other complexities include instituting valet parking for patients during construction and shuttling 300 employees to work from an off-site parking area.
Canniff says the largest challenge involves keeping the emergency department operating while renovations and construction take place. Construction on the new wing began last fall and is scheduled to be completed in fall 2009. When thats done, work will begin to get the emergency departments older section up to speed, and that will involve renovating one-half of the section at a time. This phase of the project is expected to be completed by late fall of 2010.
The garage is now 60% finished, Canniff says, and will be occupied in September, and the renovations of existing facilities are just getting started.
Another complicated project Eaton cites is taking place at the University of Texas M.D. Anderson Cancer Center in Houston where nine floors are being added on top of the 12-story Albert B. and Margaret M. Alkek Hospital.
According to the university, the project will add 478,000 square feet at a cost of $293 million, and the hospital will grow from 512 staffed beds to room for 867.
Levine says how much money will be available for projects of this type and healthcare construction in general could depend on the outcome of the presidential election and how its results hold the potential for universal healthcare.
He explains that 60% of a hospitals revenue and 95% of its profit may come from private payers, and universal coverage could change the revenue ratio to 40% private and 60% public, which Levine says could lower profitability and leave far less operational money available for construction projects.
On the other hand, universal coverage would lead to hospitals being stuck with far fewer unpaid bills and reducing uncompensated-care costs.
If all charity care went away, that would more than make up for the change in ratio, Levine says.