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July 29, 2021

Alternative delivery benefits health care in Washington

  • Soaring prices of providing and receiving care challenge how facilities are built, operated and maintained.


    Health care is at the forefront of local and national discussion more than ever before. Growth of the health care industry has accelerated and is in a constant state of flux due to rapid advancements in technology, medical equipment and evolving discussions surrounding care equity. While community and public health is vital to our survival, the soaring prices of providing and receiving care present numerous challenges in how facilities are built, operated and maintained.

    The question is, how do we deliver exceptional health care design and construction at the lowest cost, the fastest way possible, while ensuring safety, quality and budget do not suffer?

    OAC Services shows a passion for health care by using alternative delivery methods that cultivate relationships between the owner, contractor and design team early on — which OAC believes is the best way to improve project delivery. Through more collaborative teaming practices, OAC is able to streamline design and construction, identify and mitigate risk, and deliver environments that aid in patient recovery.

    Photo by Barta Pictures [enlarge]
    Mason Health Clinic in Shelton is connected to Mason General Hospital.

    Given the specialized nature of health care design and construction, alternative delivery is truly an ideal contracting method. By following state of Washington statutes (RCW 39.10), a public building owner can apply to use design-build and general contractor/construction manager (GC/CM) contracting methods that the private sector has been deploying successfully for years. In lieu of awarding public works contracts in lump sum to the lowest responsible bidder, owners may elect to follow RCW 39.10 and proceed with a more collaborative method that engages the design team and builder early in the process.

    Health care owners can work with an alternative delivery expert, like OAC Services, to publicly procure an architect and general contractor to design to a target budget, phase and plan; and execute work that implements the most stringent infection control standards, prevents impacts to ongoing operations, and ensures patient, staff and caregiver satisfaction.

    Alternative delivery methods thrive when owner, contractor and designers are engaged as a team. These unique methods are used to accelerate project delivery by allowing the contractor to provide feedback during the design phase before the start of construction. Through early investigating of existing conditions, estimating various design options, and working directly with the health care system’s facility engineers, IT professionals, environmental controls staff, materials management, nurses, medical planners and others, the general contractor and architect can provide a more accurate budget, design and overall experience.

    OAC has provided guidance to owners on 47 GC/CM projects and 27 design-build projects, totaling more than $2 billion. Over the years, OAC has helped improve project delivery by serving on the Washington Project Review Committee from its inception in 2007. OAC has found the design-build and GC/CM delivery methods have been the most effective on several of its recent health care projects.

    “The GC/CM method allows public owners to bypass many of the pitfalls and challenges associated with the traditional design-bid-build delivery method,” said Brent Wilcox, OAC’s senior project manager on the newly constructed Mason Health Clinic at Mason General Hospital in Shelton.

    “The complex nature of the Mason Health Clinic, being connected to the hospital on two levels, was made easier through the GC/CM being brought on early in the process,” he said. “Doing so allowed the hospital to plan for this connection and phase the work in a way that would minimize disruptions to ongoing operations.”

    The project included a new 60,000-square-foot medical office building and significant site improvements, including expanding the south main parking lot and two newly developed parking lots on the campus’s north side. OAC guided MGH through the GC/CM application and approval process, which allowed the contractor to be brought on earlier and saved over $2 million in project costs. The project’s success, combined with the collaborative culture that exists at Mason General, resulted in Mason General’s pursuit and approval of Public Body Agency Certification, which enables the health care system to utilize GC/CM contracting on future projects without having to regain approval from the state’s Capital Projects Advisory Review Board.

    Word of the collaborative nature of the Mason General project spread over to Port Townsend’s Jefferson Healthcare. Much like MGH, Jefferson Healthcare is looking to expand and tie into an existing 24/7 hospital. OAC was engaged to support and guide the Jefferson team through progressive design-build approval with the PRC.

    “We are submitting our application in August and look forward to a presentation in late September,” said OAC senior project manager Patrick Miller. “This will be Jefferson Healthcare’s first DB project and they are really looking forward to a more positive project experience than traditional design-bid-build.”

    OAC encourages owners to align themselves with a true partner for their contractor, someone who understands their needs and challenges, and will help guide them through the process as an advocate. Bringing on a contractor earlier has multiple benefits over the traditional DBB method. It allows public owners to make more informed decisions early on, reduces waste, reduces change orders, and is far superior from a scheduling standpoint.

    Early general contractor engagement can also result in early procurement, mock-up coordination, prefabrication opportunities, and fewer change orders. On projects with intricate phasing or complexities, the value of having the contractor on board during design cannot be overstated. Design-bid-build projects often have little to no preconstruction phase with a contractor, meaning no time to plan.

    OAC recently worked with King County to gain progressive design-build approval on the county’s upcoming Harborview Medical Center Maleng Building project.

    “This progressive method will allow the complex ownership team to engage a design-builder through a public process that evaluates the team based on qualifications, best value and best fit,” said Melissa Teichman, OAC Services vice president of health care. “Once selected, the DB partner will immediately engage in collaborative partnering and programming sessions with the owner to solidify team goals and desired outcomes.”

    Teichman also noted a success story at EvergreenHealth on a GC/CM project in EvergreenHealth’s Family Maternity Center.

    “Aldrich + Associates, our GC/CM, was able to get in early to investigate existing systems and utility routings and create detailed phasing documents in their bid packages,” she said. “This enabled greater accuracy during budgeting and bidding, which will lead to efficient communication, quality control, and safety during construction. All of this benefits the community at large as we can maintain ongoing operations and offer the best possible patient care at EvergreenHealth’s Kirkland campus.”

    The moral of the story is that we cannot afford to waste time. The old adage that time is money certainly rings true — but in the case of health care, time could save a life. Alternative delivery is not a passing fad and the word collaboration is something we should all strive to honor. We encourage you all to research your state’s procurement regulations and talk to an owner, design professional, or contractor and ask how much they enjoyed their last project. Was it successful or was it painful? What does success look like to you?

    Callum Roxborough is a journalist by heart and AEC marketing specialist by day; with over a decade in the industry and a passion for community improvement, he is helping OAC improve the experience of building while OAC’s clients improve lives.

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