Building With Care: 5 Strategies To Skyrocket Productivity .

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Building with Care:5 Strategies toSkyrocket Productivity inHealthcare ConstructionHow to Mitigate the Complexities of Healthcare Projects

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare ConstructionWhat’s Inside?Inside3 Introduction5 Top Challenges for Today’sHealthcare Construction Projects7 5 Productivity Strategies forHealthcare Construction10 4 Technologies that Will ImproveQuality of Healthcare Construction11 Case Study: How DPR IncreasedProductivity to Reduce Project Costs12 References2

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare ConstructionIntroductionHealthcare construction projectsrepresent a significant market potentialfor both contractors and ownersalike. The sector has been steadilyexpanding year over year, with ananticipated 3.5% growth in 2018.1But healthcare is changing. A trend inrecent years involves large, householdnames decentralizing their services.While the industry remains verticallyintegrated, facilities are no longer inone just location–and one form. Beyondjust ambulatory hospitals, the growthof medical facilities is shifting towardsspecialized clinics, microhospitals, cuttingedge laboratories and more, all to betteraddress both the advancements in thefield and patients’ needs. As providerstake a patient-focused approach to thecare they provide, trends in constructionare following a parallel path.As healthcare evolves, owners andcontractors will need to navigate boththe existing and emerging hurdles offacility design and construction. In thisebook, we’ll focus on how trends inhealthcare are impacting constructionand how builders and owners canovercome major challenges to: Improve productivity of construction Enhance efficiency of designs Reduce overall construction costs Maintain quality of construction Provide a complete turnover package Lower facility and operationcosts in the long-term3

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare ConstructionHow Healthcare’s Patient-FocusedApproach Affects ConstructionPatient-focused healthcare means providersprioritize outcomes and experiencesover volume. As a result, healthcareorganizations are investing in ways to becloser to patients and diversifying thetypes of services they provide. In recentyears, this includes a surge in buildingoutpatient care centers. According toPatrick Duke, Managing Director of KLMKGroup, “In the early 1990s, outpatient careaccounted for only 10-15% of hospitalrevenue; today, it’s closer to 60%.”Even where healthcare facilities are settingup shop is evolving. As mentioned, hospitalsare no longer the central “hub” of care andnetworks are increasingly less anchoredto one location. For instance, healthcarecompanies are making key investmentsin real estate that has traditionally beendesignated for retail. In fact, globalcommercial real estate powerhouse, JLL,reports that in some locations, 40% of newretail real estate transactions are for medicalfacilities compared with 2% a decade ago.2As healthcare continues to evolve,construction will need to meet the increasingcomplexities of the patient-centricapproach. To better address patient needs,many networks are relying on evidencebased design or designs that are researchedto understand how they impact patientoutcomes and experiences. The design-ledconstruction approach means teams need tobe in constant communication and ownersrequire full visibility into project progressat every phase of building. Thus, projectdelivery methods in healthcare projects havebeen favoring design-build and integratedfacility design to ensure patient-led designsare implemented at a more rapid rate.40% of newretail real estatetransactions arefor medical facilitiescompared with2% a decade ago.As healthcare systems change and thepopulation ages, communities, companiesand individual patients all rely on theexpansion of facilities to adequatelyprovide care. To address both the changingneeds of patients and challenges ofthe construction landscape, builderswill need the right tools in their arsenal.Therefore, the responsibility falls onproject teams to aid delivery by adoptinginnovative workflows and technology.4

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare ConstructionTop Challenges for Today’s Healthcare Construction ProjectsTo compete for patients, networks areracing to build the latest and greatestfacilities across communities. Beyond newbuild facilities, the industry’s expansion intoretail and other spaces requires existingspaces to be repurposed and extensivelyrenovated. Existing medical facilities alsoare in a constant state of renovation. A“modern” hospital five years ago, couldneed a complete design reconfigurationto accommodate new technologyfrom advancements in the field.A Balancing Act: MaintainingQuality, Performance and CostEven beyond basic construction needs,healthcare projects are significantly morecomplex than other projects. There’s anexhaustive list of elements and variables toconsider when building a medical facility.Likewise, inspections of medical facilitiesare more rigorous compared to otherconstruction sectors. For contractors, thismeans that there is more scrutiny over thequality of their work and little tolerance forerror. Every medical facility needs to meeta different level of standards, cleanlinessand code. Even the location of the facilitymeans a whole new set of regulations,with the potential impact of thousandsof varying federal, state and local codes.Both owners and contractors need toconstantly stay abreast of changingregulations that impact construction.To manage both facility needs andthe regulations of healthcare projects,construction companies are consistentlyaiming to control quality, performanceand cost.QualityHealthcare is a highly regulated industry,and this means more regulations anddesign standards that need to becarefully evaluated and tested throughoutdesign and construction. If contractorsfail to deliver quality work, healthcarecompanies open themselves up toliability and patients could suffer.Failure of inspection or not meeting codecould mean substantial delays, increasedcosts and, alas, unhappy owners. Missinga scheduled opening for a facility by aday, a week or a month could have asignificant impact on both the patientswho need these services but also the profitbusinesses that provide the same services.Therefore, a regular system of checks andbalances is necessary throughout designand construction for quality assurance.5

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare ConstructionPerformanceHealthcare is a highly competitiveindustry, and medicine continues todevelop at a rapid rate. For owners, bothlocation and speed-to-market are vitalto staying relevant and profitable. As anexample, momentum in telehealth canpotentially render a dedicated diabetesclinic practically obsolete overnight. Thisplaces pressure on contractors to step upto deliver facilities quickly, as well as tobuild with the intention that reconstructionmight be needed shortly down the road.Adding to the challenges of quick speedto-market builds and renovations isthe complicated design feedback loop.Owners need to balance both the needsof its patients with the various facilitystakeholders involved. Ninety-five percent3of facilities report that both clinical andnonclinical staff are included in the designprocess, even before breaking ground. If notmanaged and streamlined correctly withtechnology, communications can be severelydisjointed and cause crippling overruns.CostThe bulk of healthcare facility costs primarilystem from long-term building management.Healthcare owners are responsible forthe brunt of these costs as they are morelikely both owning and operating facilitiesvs. in commercial construction wheredevelopments usually build and handoff.Generally, operating margins of hospitalsare low–2-3% is considered an industryaverage.4 However, many hospitals endup losing money. With such low margins,owners need to manage the operationcosts of their centers effectively. But onaverage, 30% of initial data created duringdesign and construction is lost by closeout.5The data drop-off makes it difficult tomanage costs efficiently in the long-termwithout a complete view of facility history.Furthermore, healthcare structures areoften in a constant state of upgrade orrenovation. As advancements are made,and new technology emerges, facilitiesneed to adapt and evolve. This challengeincreases facility costs over time. Tominimize long-term redesign costs, initialfacility designs should have flexibilityin utilization so that when changesmaterialize the cost burden is minimal.On the whole, the large bulk of healthcarecosts can be attributed to labor–on average,staff wages and benefits contribute to60-70% of total costs.6 To balance laborcosts, facilities need to be designed foroptimal efficiency of staff. Designs should becarefully evaluated and optimized with staffproductivity in mind as it has the potentialto make a major impact on the bottom line.Operating margins of hospitals are low–2-3% is considered an industry average6

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare Construction5 Productivity Strategies for Healthcare ConstructionBecause there are countless movingparts involved in building or renovatinga healthcare facility, it’s challenging toidentify the areas that can be improvedfor maximum impact. To overcome thehurdles of building in the sector andprovide the most ROI, it requires animprovement in construction productivity.This means streamlining communications,standardizing workflows and refiningprocesses with the help of technology.Adopt the Right TechnologyThe healthcare industry is already usingthe latest and greatest technologies inits facilities–it’s time the field catches up.Most importantly, it’s critical that the entireproject team–from project manager toforeman–can seamlessly collaborate fromanywhere. Adopt a platform that’s easyand reliable enough to use for all on yourteam–from industry veterans to jobsitenewcomers–for quicker project delivery.Here are five strategies project teamscan implement to start improvinghealthcare construction productivity tobalance quality, performance and costs.Ensuring quality of projects is a fieldcentric process. Since the bulk of dataduring construction comes from the field,workers need to access and markupproject documents at a moments notice.With the right software in the hands offield workers, quality can be monitoredand executed at every step of the job.7

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare ConstructionGo LeanLean construction is gaining popularityin the healthcare sector. The practicefocuses on decreasing waste andincreasing efficiency whenever possible,making it an ideal method to speed upproject delivery. Eliminating unnecessarywaste in construction and operationsincreases staff efficiency as well as safety.For owners, this means more measurableoutcomes and even risk sharing in thedesign and construction process.Lean also complements otherconstruction methods well-suitedfor healthcare projects. For instance,integrated project delivery (IPD) is highlycollaborative. When used in tandem withLean construction principles, waste andinefficiencies are drastically reduced,and project teams are better aligned.Finally, modular construction is onemethod Lean enthusiasts are adopting.Going modular poses major opportunitiesfor healthcare construction primarilybecause it comes with a more flexibleapproach to construct facilities. Forinstance, consider a cancer treatmentfacility which typically has a 3-5 yearbusiness plan. As it does not line up withthe typical 30-50 year building lifecycle,modular construction could be effectivewhen the treatment center needs to beredesigned shortly down the road.Utilize Visualization TechnologyConsidering the amount of designfeedback needed to build your averagemedical facility, the more accuratevisualization can be, the better. In allconstruction projects, incomplete anduncoordinated design documentsalmost always lead to change ordersand rework. Therefore, visualizationthrough applications like BIM providesa more complete view of projectdesigns and needed changes.One added benefit of data visualization forhealthcare projects is the ability to maximizespace and efficiency. Especially, in theremodeling space, visualization technologyallows design teams to reconfigure complexspaces like operating rooms. Nonetheless,visualization tech is still relatively untappedin the healthcare sector. Currently, only17% of hospitals use simulation software.7Currently, only 17%of hospitals usesimulation software.8

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare ConstructionImprove Data Collection inDesign & ConstructionAfter construction ends, the real work forowners in the healthcare space begins.Just to break even, facilities have tobe meticulously managed. The moreinformation that owners have about theproject’s history, the more empoweredthey are to make changes that minimizeoperating costs. Nevertheless, manyowners are provided with insufficientdata in their turnover package to makeinformed decisions. It’s estimated that 15.8billion is lost annually due to inadequateinteroperability in the capital facilitiessegment.8 10.8 billion of that costs fallsto owners just to catch up, recover andreplicate the bad data they are left.When given a full set of design andconstruction data, owners can makebetter decisions about their facilitiesmanagement. With a more accuratepicture of the project’s entire history andbackground, owners can address issuesmore effectively and reduce operationscosts in the long-term. Construction teamsthat use technology that helps themcapture a complete set of data from thedesign, construction and closeout phaseswill improve the turnover package theyprovide. This means more satisfied ownersand repeat business for contractors.Standardize WorkflowsQuality is one of the critical pillars ofsuccessful healthcare construction.To help ensure optimal quality is met,setting standards is essential. Already,many healthcare facilities are alreadystandardizing hospital designs like telehealthcenters and operating rooms. Currently,around 65% of hospitals are adoptingconstruction standardization throughouttheir facilities.9 Modular construction is onemethod to achieve design standardizationas a huge cost-saver. As an example,standardizing operating room layout andequipment can boost efficiency, allowingsurgical staff to streamline procedures.With the right software, project workflows,templates and processes can also bestandardized to improve quality control ofconstruction. By ensuring field workers knowexactly how to execute on a project, eachstep of the way, there’s less concern fromproject managers and owners about meetingcodes and passing inspections. Project-widestandardizations also help to keep workersas efficient as possible as little room if leftfor critical steps to fall by the wayside.9

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare Construction4 Technologies that Will Improve Quality of Healthcare ConstructionBIM and VRBIM paired with virtual reality (VR)technology are powerful tools to enhancedata visualization. With these innovations,construction teams can simulate andconsider facility design and operationalvariables, such as patient flow andphysician and staff workflow for ultimateefficiency. For contractors that needto coordinate with end-user groups tosolidify the layout, VR can provide animmersive element that 2D designs lack.Nurses, pharmacists and other staffmembers can “walk-through” designs,before they’re built, to understand howthe layout impacts their efficiency. In turn,users can give meaningful feedback onhow they will actually utilize the space aswell as if there are better alternatives.Implementing BIM on healthcareprojects is also useful in maximizingspace in a redesign environment.Finally, utilizing the tech on projectsensures more data is collected througheach phase of construction.Integrated Data Management andBusiness Intelligence SystemsAccess to the right data on healthcareprojects is critical to its success–duringand after construction. To make themost out of the data that’s collected onprojects, builders in the healthcare sectorshould look to adopt data managementsystems. With the right implementation,these can be integrated into theirbusiness intelligence systems that collect,integrate and analyze critical companydata. This integrated and deeper diveinto data can be used in every phaseof construction; from maximizing spaceand efficiency of designs to providingevidence to make informed decisionsabout how to reconfigure space when aremodel is eventually needed. Integrateddata with design software will allowowners and builders to make betterchoices in construction that will impactoverall facility costs in the long-run.Collaboration SoftwareWith the need for speed-to-market builds,healthcare construction teams cannotafford to rely on disjointed communicationprocesses. Therefore, it’s necessary tocentralize communications. Collaborationsoftware will ensure the whole projectteam stays on the same page and canfollow project standards. The right softwareallows whole teams to easily collectinformation, manage issues and deliveron tasks as one cohesive team. It notonly keeps contractors and subs on trackbut gives owners full project visibility.Field Inspection SoftwareField inspections can be a stressful part ofthe job for those building in the healthcaresegment. Nonetheless, field inspectionsoftware allows for better oversight ofquality, directly from the field. In additionto ensuring codes and standards aremet, field inspection software streamlinespunchlists for more efficient project closeout.Since software can capture an electronicrecord of all field activities, owners willhave a complete set of data at closeout.10

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare ConstructionCase Study: How DPR Increased Productivityto Reduce Project CostsIn 2012, DPR Construction beganworking on a new, 100,000 squarefoot hospital tower replacement forSan Francisco’s Chinese Hospital. Thenew building contains four operatingrooms, numerous floors of patientrooms, and diagnostic imaging spaces.As an alternative to San FranciscoGeneral Hospital, the non-profit ChineseHospital primarily serves the surroundingimmigrant community. Therefore, it wasimportant to the team to meet projectmilestones and deliver the project onschedule as well as below budget.Due to dispersed project teams, it initiallylooked like a challenge to communicateand distribute all the project documentssuch as drawings, submittals, markups,photos, issues, and RFIs and more.As foreman and others in the fieldencountered issues, they needed a fastway to document and share detailsto find a resolution. Furthermore, asa California hospital, the project fellunder the jurisdiction of OSHPD, whichrequires a hard copy set of drawingsbe kept on site for the duration of theproject for easy access by the OSHPDfield staff and inspector(s) of record.Keeping a paper set on site iscumbersome, takes up space, andrequires countless hours of effort tomaintain. With these challenges inmind, the DPR team chose PlanGrid asthe solution to digitize, maintain anddistribute information across multipleparties and locations. Subcontractors,vendors and Office of StatewideHealth Planning and Development(OSHPD) could receive the sameinformation as quickly as DPR receivedit from the client and design team.addition to drawing, specification, and RFImanagement, the team used PlanGrid todocument issues in the field. This helpedto streamline communication between theoffice and field, especially with a drawing,photograph and location as a reference.By using PlanGrid to communicate andshare information with different teamsefficiently, DPR drove considerable costsavings for the project. The Chinese Hospitalproject involved about 350 change ordersand 140 bulletins. DPR estimated thatPlanGrid saved them two hours per changeorder, which added up to 1,000 total hourssaved during the project on change ordersalone. PlanGrid allowed DPR to dedicatemore time to productive work, instead ofwasting time chasing down information.Because PlanGrid allowed for quick sheetuploading and an almost immediatedistribution of documents throughtablets, the team recognized the benefitsof using PlanGrid immediately. In11

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare ConstructionReferences[1] AIA Releases Construction Forecast for Remainder of 2017-18[2] Despite uncertainty over healthcare reform, healthcarereal estate remains an attractive investment[3] Feedback drives health facility design processes[4] How the Affordable Care Act Affects Healthcare Construction[5] Operational Readiness: Bridging the Gap BetweenConstruction and Operations for New Capital Assets[6] 4 Steps to Overcome Challenges in Healthcare Construction[7] 9 Takeaways from the HFM Healthcare Construction Survey[8] Inadequate Interoperability: A Closer Look at the Costs[9] Health care designers focus on efficiency12

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare ConstructionSee a Live Demoor give us a call at 1 (415) 429-1227PlanGrid’s Construction ProductivitySoftware is the easiest and most costeffective way to get substantial return onyour investment in construction mobileapps. By using PlanGrid you will: Complete projects faster: 90% ofproject costs occur in the field and notin the office. This includes wasted timeand project delays. With PlanGrid, youcan reduce wasteful trips to the trailerand time delays, while eliminating costlyrework. PlanGrid also allows for fastercollaboration and communication. Reduce costs: PlanGrid allows you tooptimize productivity in the field, whicheliminates time waste that causes projectoverruns. By completing projects earlyor on time with PlanGrid, contractorswill benefit from reduced costs. Win more bids: The best way to bidmore competitively is not just to trackcosts so you can provide more accurateestimates — it’s to improve your overallproductivity. PlanGrid’s ConstructionProductivity Software will allow youto increase productivity so you canreduce costs and win more bids.Try PlanGrid for FreeApp StoreGoogle PlayWindowsThere is a reason why PlanGrid is not only the#1 construction app, but also the highest rated.With PlanGrid construction productivity software,you can streamline document management,access all project information from any device,and seamlessly collaborate within teams.13

Used on more than 1,000,000projects around the world, PlanGridis the first construction productivitysoftware that allows contractors andowners in commercial, heavy civil,and other industries to collaborate,collect, and share project informationfrom any desktop or mobile devicethrough the entire project lifecycle.PlanGrid increases project efficiency bystreamlining document management,providing construction teams witheasy access to all project informationfrom any device, and enablingseamless collaboration within teams.Guide Author:Grace EllisContent Marketing Specialist, PlanGridConnect with PlanGrid 2018 PlanGrid, Inc. All Rights Reserved.United States 1 (415) 963-4088www.plangrid.comAustraliaAUS 1800 316 406www.plangrid.com/auUnited Kingdom 44 (0) 20 3695 0292www.plangrid.com/gbCanada(800) fr

Building with Care: 5 Strategies to Skyrocket Productivity in Healthcare Construction Go Lean Lean construction is gaining popularity in the healthcare sector. The practice focuses on decreasing waste and increasing efficiency

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