Seattle Daily Journal of Commerce

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August 22, 2013

A Special Section of


Contractors can help with health care transition
Skanska USA

Pregnancy center offers one-stop care for new moms

Not all healing gardens deliver as advertised
By MARK EPSTEIN Hafs Epstein Landscape Architecture

Outpatient clinics multiply as big projects dry up

Workplace health clinics are making a comeback
McGranahan Architects

Integrated delivery pays off for Kirkland hospital

How buildings help with patient care

Children's addition built to be safe after an earthquake
Coughlin Porter Lundeen

August 22, 2013

Contractors can help with health care transition

  • Contractors have more tools to save time and money, such as BIM-aided prefab construction and smartphone apps that monitor dust and noise.
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    Skanska USA

    It's possible there has not been a more disruptive time than the present for health care providers.

    The Affordable Care Act (ACA) is a major driver of this trend. New laws will change the way health care systems operate. Ongoing debate over how this will or will not roll out is only increasing uncertainty for health care providers who simply want to provide their communities with the best health care.

    This shift comes amid other significant factors that affect how health care systems work and plan ahead: seniors becoming a larger part of the population, continued fluctuation in energy costs, advancing technology that enables new treatments and procedures, and more.

    Add in the needs of hospitals to adopt electronic medical records -- and have the space to securely store that data -- and it's enough to make you realize these actually are the things keeping hospital administrators up at night.

    As a general contractor, it would be easy to believe those factors just aren't our problems, but that would be doing a disservice to our clients. In fact, we contractors can play a unique role in helping health care providers as they navigate these uncharted waters.

    Photo by Michael Mathers [enlarge]
    Building-information modeling software helped speed construction of MultiCare’s Good Samaritan Hospital patient tower in Puyallup.

    Minimizing disruption

    Health care providers have a bit of a quandary: how to address new facility needs without disrupting existing operations. The trend toward more outpatient clinics is one thing. Improving existing facilities is another.

    Working inside existing spaces to bring in new medical technology presents a number of challenges. There is no reason construction technology shouldn't try to advance to alleviate these issues for owners.

    That was our view with our app, the inSite Monitor. Vibrations, noise and particulate matter from construction can be annoyances in a hospital, or, if not properly controlled, actually do harm to patients.

    The conundrum for hospital facility managers is how to ensure work moves along according to schedule while not harming the existing patient environment. This used to mean hourly tests of air quality, noise levels and more.

    We can streamline that process using a smartphone app that monitors these factors in real time, alerting anyone using the app of levels approaching unacceptable thresholds. This provides peace of mind, but also ensures time on a project is being maximized. This can have positive effects on schedule and costs.

    Getting lean

    Technology is a tool that can help schedule, but increasing efficiency all around has to be a mindset. We've worked on several projects at Virginia Mason Medical Center and have followed their lead in implementing lean practices on our projects.

    Lean principles aim to eliminate or minimize wasted materials, time, labor and more in order to increase overall efficiency, accelerate schedules and drive value for project owners. Essentially, it finds the fallacies in 'we've-always-done-it-this-way' thinking and encourages project teams to take stock of where they can improve.

    These efforts have led to dramatic changes from project startup to project closeout. We had some startup processes that were averaging a month to complete. By putting key project team members in one spot to deconstruct and examine the process, we've decreased the time to three days. For us, that shaves a significant amount of time off a schedule, which is critical for owners in facilities like hospitals, where every minute counts.

    Putting lean practices into play can change the industry. Combining this sort of thinking with new construction methods and technology can lead to entirely new approaches.

    Photo by Lara Swimmer [enlarge]
    Skanska USA says it uses lean practices for projects at Virginia Mason Medical Center to minimize wasted time, labor and materials.

    Revisiting prefabrication

    One construction method that has come back to the fore as a result of merging technology and lean has significant benefits for health care providers: prefabrication.

    Forget the connotations 'prefabrication' has in your mind. With building-information modeling and other virtual design and construction techniques widely adopted, all sorts of building components can be built off-site and quickly installed at top quality.

    In hospitals, we're able to prefabricate everything from heating, cooling and plumbing systems to bathroom pods and headwalls. This has significant advantages for all involved.

    For a contractor, it means less work at heights, greatly reducing fall risks for workers. That safety benefit is significant, but owner benefits are even greater.

    In active hospital spaces, prefabrication means less work on site -- that means less disruption, vibration, noise, and so on. Also, prefabrication can reduce the overall project schedule.

    Aside from the obvious benefits of seeing a building rise faster, scheduling, deliveries and more are streamlined to an off-site location that has space to accommodate them. This means less construction traffic.

    On a normal construction site, that's a convenience. On a health care campus, it can be critical, helping reduce construction impacts for emergency transport and others coming to and from the hospital.

    We recently put some of these methods to work for Swedish Edmonds' new cancer center. Modular construction was selected because it allowed the project to be completed faster than typical ground-up construction methods. We wanted to make sure we worked in a way that helped Swedish achieve its goals -- getting the new facility online and caring for the surrounding community -- as soon as possible.

    With health care reform changing the way providers think about facilities -- everything from what they offer to where they are located -- new technology and construction methods are keeping pace, ensuring communities get the new facilities they need on time. In areas where space is at a premium, prefabrication is offering solutions that benefit all involved.

    Howell is a Senior Vice President for Skanska USA in Seattle.


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