Integrated Project Delivery

The result of a “LEAN” design & construction approach
by Lois Broadway, AIA

How do we evaluate the resources and techniques necessary to organize our projects for the best results?

How do we apply a collaborative project approach that results in benefits with regard to budget, schedule and quality?

How do we apply the concepts of LEAN production which originated in manufacturing and apply it to healthcare design & construction?

What if integrated project delivery could find a way to eek out additional dollars from the design and construction process that could be re-directed toward direct healthcare benefits such as additional equipment, technology, programs & services, or additional staff?

The traditional healthcare design and construction delivery process is broken. Consider that in the traditional model, the flow of design needs is convoluted, obstructed, and left to numerous opportunities for misinterpretation Consider this example in the design of a surgical suite:

  1. A surgeon requests a specific temperature level and ability to control that level.
  2. that request is passed along to the owner’s representative
  3. who then passes it to the architect
  4. who then passes it along to the mechanical engineer who then design the controls
  5. and submits the design back to the architect
  6. who then passes the revised design along to the general contractor
  7. who then passes the direction along to his HVAC sub-contractor
  8. who must then coordinate with the controls sub-contractor for final performance

How many opportunities for miscommunication and errors to occur exists in this model of the design process? Yet it is a model that we have practiced for many years, and it’s broken.

Consider instead if we were able to bring together end users and trades persons into one room to discuss concerns, industry standards, and means to mitigate issues. This is what they do in LEAN manufacturing when there is a problem on the production line. They stop everything, bring all the problem solvers (the team) together, identify the problem, and they don’t leave until the problem is solved. Short, specific, and produces resolutions.

In a new model of Integrated Design & Construction Delivery, this core team, traditionally thought to be the Owner, Architect, and Contractor, must work to reinforce and optimize their relationship. They must work with candor and a “thick skin”; with enthusiasm to change and improve the process. New models of integrated project delivery agreements for this type of accountability and project responsibility, which covers all of the three parties, reside on the LEAN Construction Institute website at Leanconstruction.org.

A collaborative team of key decision makers can approach integrated design and construction delivery through shared contract commitments, constructability review, delegation of accountability, responsibility for continuous improvement and elimination of redundant efforts and waste. An example of which is to rely on the shop drawing submittals & review for the final detailing of design rather than exerting detailing efforts in construction documents that are duplicated in the submittal process.

Another lesson to learn from “LEAN” manufacturing is to design for tomorrow’s market trends rather than in response to today’s needs. Industry trends lean toward greater consumerism and less availability of resources, services, and expertise. How will that affect healthcare design & services? Demographic trends are toward a wellness/disease prevention & management model rather than today’s symptom alleviation or correction model. How will this trend affect healthcare design & services?

The key to successful integrated project delivery is a collaborative core team of decision makers. These decision makers must have no hierarchy between them, the ability to make informed decisions, and the authority to enforce the decisions made. Shared control of a project offers the entire project greater control. Strong communication skills and a high level of trust is essential within this core team. Consider the example offered about the temperature control within a surgical suite. For the billing rate of each communicator involved in that sequence of communication, the cost is an average of $150 per hour, and if each entity charged an hour of time to process the design request it would cost $1200 to merely communicate the request; not including its actual implementation costs. If all decisive parties were “at the table” at once, with direct communication regarding goals, objectives, concerns & challenges, so much in repetitive communications would be eliminated. Rather than contingencies for the unknown and the need for incentive of shared savings, there would be instead, shared knowledge and shared goals which allow the preservation of contingency.

Building Spaces For Health & Healing

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