What are the drawbacks to the conventional approach to construction? Historically, the bulk of medical construction has been through the
conventional design-bid-build approach where an owner hires a
fee-for-service architect to design a building, the architect develops
the building program, and the project is ultimately put out to bid.
What are the drawbacks to the conventional approach to construction?
Historically, the bulk of medical construction has been through the conventional design-bid-build approach where an owner hires a fee-for-service architect to design a building, the architect develops the building program, and the project is ultimately put out to bid. Then a contractor is hired to build the project.
As a result, developing a building program has too often been a fragmented effort, with architects leading the way, engineers in charge of some activities, contractors in charge of others, and the balance left up to fate. With today's technological advances, designing and building ambulatory surgery centers has become very complex. This process is fraught with pressures and uncertainty, and in many instances characterized by cost and schedule overruns, which also makes it expensive: There are no cost guarantees with the design-bid-build approach.
Such shortcomings are becoming more and more unacceptable in all industries, but they seem to be more intolerable in healthcare. Economic pressures are forcing healthcare providers to reexamine every aspect of operations, staffing ratios and energy consumption. The push is definitely on to find the most patient-friendly, efficient and cost-effective way to do business and provide healthcare on a day-to-day basis and, as a result of the above mentioned pitfalls, many owners have recently turned to the designbuild concept of building program development.
What is design-build?
The design-build format integrates the design, engineering and construction segments of a project into a team approach, with all team members being in the same boat and rowing in the same direction. With the sophistication of today's medical facilities, a team should minimally be composed of the following technical disciplines: architectural; mechanical; electrical; plumbing; civil; structural; and construction. Good communication between these team disciplines is paramount. The left hand must know what the right hand is doing at all times. All technical disciplines must be involved and have input into the development of design/build projects from the outset.
What are the advantages?
This integration has proven to reduce construction costs and save owners both time and money – a true single-source design/build firm will offer an owner a guaranteed cost to develop the owner's project as a result. The designer-builder will be the owner's single point of contact throughout all stages of the project's development process. The owner will have one firm to communicate with, depend upon and hold accountable for complete project development. There will be no finger-pointing during the construction process. If the design/build firm makes an error or an omission, the company will correct it with absolutely no additional cost to the owner.
The design/build concept of consolidating these design and construction segments in one format is nothing new, though: When a king or pharaoh wanted to build a new palace, stadium or temple, he would simply go to an individual called the master builder, who was the architect, engineer and contractor all rolled up into one. Many great architectural and engineering feats, like the pyramids, the Great Wall of China and the Taj Mahal were developed by the master-builder through a design-build system. This trend is, in some respects, actually going back to the future.
Mr. Wodoslawsky is an architect and the vice president of BBL Medical Facilities.