The healthcare design and construction picture has been muddied by uncertainty over the new healthcare law. Hospital systems are in a bind, not knowing what levels of reimbursement to expect. Building Teams serving this sector will have to work even harder to meet growing client demands.

March 01, 2012

3. Apply Lean principles and integrated project delivery

Patient room at Mercy Medical Center Merced. Using Lean principles, the IPD-based Building Team of RBB Architects and McCarthy Construction Cos. saved the owner $3,725,000 in structural construction costs and $542,000 in MEP costs on the eight-story acute care tower. The team even helped the hospital pick up a $120,000 rebate from the local irrigation district. 

Lean principles, as espoused by the Lean Construction Institute (, probably have their greatest following in the healthcare sector. Nearly half (47%) of architects responding to a survey of attendees at last fall’s Health Design Conference agreed that “Lean practices, where teams analyze processes and improve operational efficiencies before designing a new facility,” will be prevalent over the next couple of years. Fifty-four percent of healthcare providers said preference for IPD is growing; 83% of architects agreed.

The case of Mercy Medical Center Merced, a 196-bed replacement hospital in Merced, Calif., underscores the potential of Lean and IPD in controlling construction costs while meeting client demands for high-quality design.

When Mercy’s parent firm, Catholic Healthcare West (now Dignity Health), decided to consolidate two existing campuses into one facility, it called upon RBB Architects (designer), McCarthy Building Cos. (GC), and Harris & Associates (PM-CM) to manage the project using Lean, IPD, and a hybrid form of design-assist with the California Office of Statewide Health Planning and Development (OSHPD).

The Building Team took a year and a half just in pre-planning and preconstruction.

Strict protocols were put in place to guide construction delivery. Schedule revisions had to be signed off by all subcontractors and the client. Weekly progress meetings, chaired by McCarthy, used short interval scheduling to monitor and control short-term site activities. 

The firms had to commit to hands-on participation by their principals. The client required continuity of the design-assist team leaders who were working with OSHPD.

The 267,000-sf acute care facility opened in 2010 at a construction cost of $167 million and total project cost of $248 million. Patient room size was capped at 1,400 sf, compared to an industry average of 2,150 sf, according to RBB Architects. Construction cost per bed was held to $850,000, vs. an average $1.4 million per bed for the region—a savings of 30%. Change orders were kept to less than 1%. Incremental permitting enabled construction to get started a year early; the project was delivered 60 days ahead of schedule.

As part of the IPD agreement, the Building Team is currently conducting a four-phase post-occupancy evaluation, which has already unearthed a few problems. Hospital staff complained that the storage space in patient rooms was too small. An upholstery fabric was found to be less stain resistant than anticipated. Manual shades in patient rooms were noisy and hard to operate; the Building Team vowed to “advocate more fiercely” for motorized shades in future projects.

Considering the size and complexity of the project, these problems seem relatively minor.


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