Design-build is a natural for health care construction
The design-build project delivery system has been around for thousands of years. And construction management has grown to be more popular and is increasing its presence in private sector construction projects. Yet design-bid-build still is an option that the public sector almost always uses and some private sector clients still continue to believe is the only way to get the best price. For many years, design-bid-build was an obvious choice for construction projects, including health care construction projects. However, there is a change in the thinking in building health care projects. Health care design is adapting to include the design-build and construction management delivery systems. The unique challenges of health care construction have precipitated this change in thinking, and now design-build often is the preferred method for health care construction. Design-bid-build is the traditional method that most people think of and have some experience with in construction. Basically, the owner has a vision and ideas about the needs and budget for the building. That vision is provided to the architect retained to design the building. This worked well years ago when general contractors had a large number of employees in dozens of trades such as carpenters, masons, electricians, plumbers, concrete finishers, finish carpenters, roofers, steel erectors, welders, equipment operators, drywall finishers, painters, etc. An owner would select an architect and then would do a complete set of bid drawings and specifications. The documents were sent to several general contractors for bidding. The general contractor bidders knew the costs and had data and production rates, etc. in house to use to prepare reasonably accurate bids. The drawings were tighter, the bid process was tighter and the results were better. However, there has been a transformation over time in the number of employees and in-house services of general contractors. Today, general contractors that had large numbers of employees in every trade have significantly fewer employees, and often most of those employees are management and general-trade skill people who can do many different things. Architectural firms also evolved by changing from large numbers of architects, engineers and designers to a significantly lower number of these employees. Many times, the engineering is subcontracted to an engineering firm. This creates a fragmented design process that affects the critical coordination stage. This can lead to change orders, cost increases and time extensions. More importantly, this disjointed process can result in an adversarial relationship between the owner, architect, engineer and general contractor. Plans and specifications become very cumbersome and generalized (because of liability concerns), and this makes it difficult, if not impossible, to complete a well-developed accurate bid. This also results in working with a great amount of data and information that arrive at the last hour to the general contractors, including numbers from firms the contractor has never worked with before. It results in the risk of starting a project with unknown team members with mixed and matched scopes of work. The perception that this process is good and the owner is getting the lowest price is inaccurate. Design-build is evolving as the method of choice because it solves many of the problems mentioned above. Although many of the parameters noted above cannot be changed as to where the construction industry is today, they can be managed and processed more efficiently. Design-build puts everyone on the same team from the beginning, and this is an advantage. Typically the leader of a Design-build delivery team is a general contractor and is the single point of accountability for the project. The most effective general contractor uses its overall understanding of the entire process to manage the team and make sure subcontractors are involved in the design. The subcontractors have invaluable knowledge of the realities of their respective worlds. They know what systems and materials are available and which ones are not. They know what new technologies are available and can assist engineers to implement them in a cost-effective manner. Budgets are more attainable because the team has pricing information during the design phase, not after the fact. If something needs to be modified or streamlined, it can be identified while it can be done on paper. This method integrates the old-world method of a master builder with the parameters of today’s construction industry. Scheduling and construct-ability issues are addressed during the design, and efficiencies can be implemented to save money. The perspective of best value is a more strategic way to view the choice of a project delivery system than simply considering the lowest price. When deciding which way to go, the most strategic question to ask is: “What is the best delivery process to use to get the best value for this project? The design-build process reduces adversarial relationships, increases efficiency, decreases cost, provides a single point of accountability and statistically produces less litigation. Glenn Ebersole is a strategic business development/marketing executive and leader.