Complex Healthcare Facility Management and Lean...
Transcript of Complex Healthcare Facility Management and Lean...
Guest EditorialHERD VOLUME 3, NUMBER 2, PP 3-6 COPYRIGHT ©2010 VENDOME GROUP, LLC
HERD Vol. 3, No. 2 WINTER 2010 • HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 3
“Health care projects are very complex,
and extensive planning is required to
deliver them. Hundreds of participants,
thousands of products and systems, and
tens of thousands of decisions must be
orchestrated on the path to � nal comple-
tion” (Burgun, Sprague, Stein, & Atkins,
2008, p.119). Healthcare construction
may create conditions that are dangerous
to a hospital’s patients, sta� , and visitors;
therefore, it is essential to include in the
process provisions for infection control;
risk assessment; life safety; protection
of occupants during construction (in-
cluding planned or unplanned outages,
movement of debris, tra� c � ow, clean-
up, and so forth); plans for disruption of
services; measures to be taken to train hospital
sta� , employees, visitors, and construction per-
Complex Healthcare Facility
Management and Lean
ConstructionSarel Lavy, PhD, and José Fernández-Solis, PhD
sonnel; and commissioning processes.
Still, this list represents just a few of the
factors that must be considered while
constructing, expanding, renovating, or
restoring a healthcare facility.
In general, the management team of
any construction project should pay
careful attention to items such as con-
struction contracting, project manage-
ment, value engineering, construction
methods, project controls, scheduling
and estimating, workforce supervision,
construction equipment, construction
safety, technology, and commissioning.
However, because healthcare construc-
tion deals with unique and very com-
plicated structures and systems (e.g., nuclear,
electromagnetic, gases, radiation, chemical, and
concentrated gases), these items assume higher
levels of importance and criticality for the success
of a project.
Sarel Lavy, PhD
Author Affi liations: Sarel Lavy and José Fernández-Solis are both
Assistant Professors of Construction Science at Texas A&M University in
College Station, TX.
José Fernández-
Solis, PhD
Guest Editorial
4 WWW.HERDJOURNAL.COM ISSN: 1937-5867
Owners of new healthcare facilities are very con-
scious of the three items that dominate project
delivery components: cost, time, and quality. In
addition, they are aware that healthcare technolo-
gy and processes are evolving at an ever-increasing
speed. � erefore, they require � exibility and tend
to postpone � nal Program of Requirements deci-
sion making to the last minute to avoid chaotic
changes to the program (Ward, Liker, Cristiano,
& Sobek, 1996). As a result, once a decision is
made, there is an incentive to bring the project
to successful completion as soon as possible at
the lowest cost with the best quality and technol-
ogy available. However, these owners are quickly
coming to the realization that any attempt to
drive down costs and time and also increase qual-
ity is futile, because it frequently results in more
costly projects. A traditional construction project
delivery dictum states that any two of these items
can be achieved, but not all three (Dinsmore &
Cooke-Davies, 2005).
Recently, healthcare owners have begun teaming
up with designers, contractors, subcontractors,
suppliers, and vendors (stakeholders in the sup-
ply chain) who provide Lean construction proj-
ect delivery services, and they have found that
by focusing on minimizing the waste on a proj-
ect, they can achieve all three: reduced upfront
cost, reduced project delivery time, and increased
quality (Koskela, Howell, Ballard, & Tommelein,
2002). � e waste at hand is not only material and
information waste (caused by con� icts, errors,
and omissions detected with the use of building
information modeling, nth-Dimension comput-
er-assisted design, and computerized models),
but also waste from planned weekly activities that
do not occur for various reasons (e.g., “Will try,”
“Will do my best,” problems with other projects,
con� ict with other trades). Studies have shown
that in the United States a typical project has an
average plan percent complete (PPC) of approxi-
mately 54%, which is very good compared with
other countries (Cain, 2004). What this means
is that in any given project construction week,
approximately 50% of the activities planned are
carried out correctly and under strict time lim-
its. Lean construction projects have been able to
achieve an average of 80% PPC (Abdelhamid,
El-Gafy, & Salem, 2008). � e di� erence between
54% and 80% PPC is attributable to all kinds
of direct/indirect, hidden/obvious, excused/
not excused, evitable/inevitable waste. Achiev-
ing a higher PPC is not an easy feat, because it
requires impeccable performance among other
drivers (Ballard & Howell, 1998). It cannot be
enforced by the schedule, nor by contracts, but
by involving the last planner (the one doing the
work) in the actual execution process (Koskela et
al., 2002).
� e preceding examples come from projects that
have used the Lean construction approach—a
methodology implemented by the typical con-
struction team on typical complex construc-
tion projects (Bertelsen, 2003; Fernández-Solís,
2008). Interestingly, slightly more than 50% of
the projects using Lean construction initiatives
since 2000 have been in the healthcare sector
(Aherne & Whelton, in press; Miller, 2005).
Owners of healthcare systems were among the
� rst to see the advantages in the design, construc-
Guest EditorialHERD VOLUME 3, NUMBER 2, PP 3-6 COPYRIGHT ©2010 VENDOME GROUP, LLC
HERD Vol. 3, No. 2 WINTER 2010 • HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 5
tion, and maintenance of healthcare facilities
using advanced project delivery techniques and
processes, because they tend to own, operate, and
maintain these facilities.
� e link between competency, pro� t, and the
way property is managed has been discussed in
the literature (Douglas, 1996). Facility man-
agement seems to deal with the management
of noncore company assets (Alexander, Atkin,
Brochner, & Haugen, 2004), which includes a
very long list of responsibilities, among them the
cost of occupancy, maintenance and operations,
function and use, environmental health, comfort,
and many others. � erefore, it can be concluded
that facility management is multidisciplinary,
because it aims to combine all aspects related to
the people, places, processes, and technologies of
an organization (International Facility Manage-
ment Association, 2009). Another perspective
holds that facility management is the practice
that integrates decisions across the major areas
of concern—physical, human, functional, and
� nancial—for the improvement of performance
and the productivity of built facilities (Atkin &
Brooks, 2000; Nutt, 1999). � us, successful fa-
cility management depends heavily on cost and
e� ciency (Lavy & Shohet, 2004).
Healthcare facility management can be consid-
ered one of the key elements for the successful
delivery of healthcare services (Gelnay, 2002).
Gallagher (1998) identi� ed the major areas of
healthcare facility management in the United
Kingdom as strategic planning, customer care,
market testing, benchmarking, environmental
management, and sta� development. Rees (1997,
1998) found that the healthcare sector tends to
integrate noncore services (risk management,
energy e� ciency, cleaning, and security) under
the umbrella of facility management. All of these
sources and examples reinforce the understand-
ing that the growth and continuing development
of the facility management profession also will
increase the e� ectiveness of providing healthcare
service.
Clearly, healthcare facility management is to some
extent di� erent from any other sector or type of
building management, such as o� ce buildings,
or educational or industrial facilities. Healthcare
systems tend to plan, build, own, operate, and
maintain their own facilities; as a result, they are
more concerned than developers of other types
of buildings about the service life, systems, and
components of their buildings. A unique com-
bination of factors—patients and personnel with
whom hospitals must be concerned; the fact that
some of these patients are on life support and
therefore vulnerable and dependent; the massive
infrastructure that supports daily, ongoing opera-
tions; and the e� ect of decisions made in the ear-
ly design stages on subsequent medical outcomes,
among others—contributes to the notion that
Healthcare facility management
can be considered one of the
key elements for the successful
delivery of healthcare services.
Guest Editorial
6 WWW.HERDJOURNAL.COM ISSN: 1937-5867
healthcare facility management is an area that re-
quires more investigation and study. � is can be
accomplished by joining forces in collaboration
with academicians, who understand research pro-
cesses and methods, together with practitioners,
who bring experience and knowledge of the pro-
cesses involved in managing these unique, com-
plex, and multifaceted facilities.
� is special issue of the Health Environments Re-
search & Design Journal contains research studies
about the complex issues of healthcare construc-
tion and facility management. Manuscripts were
submitted and reviewed by some of the best re-
searchers in the world specializing in these areas,
and we are pleased to provide the results to our
readers.
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