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HealthcareInfrastructureResearch

AProgramoftheUniversityResearchInstitute

2015WhitePaperProgram

Title: OwnerOrganizationforSuccessfulProjectOutcomesMission: Themostimportantstakeholder,byfar,intheprocessofshapinghealthcare

infrastructureistheOwner.Andyet,mostOwnersdon’teffectivelyexerttheprojectcontrolsavailabletothem.HowOwnersorganizetheirinternaldecisionandaccountabilitystructureisperhapsthesinglemostcriticalelementinproducingsuccessfulprojectoutcomes.Thisresearchteamhasdocumentedstrategiesproventobeeffective.

Facilitator: D.KirkHamilton,FAIA,FACHA,EDAC ProfessorofArchitecture,TexasA&MUniversity

Introduction

Projectsuccessistheresultofmultiplefactors,includingtheoriginalconceptionofthe

needforaprojectandthesubsequentperformanceofthedesignandconstruction

componentsoftheteam.Especiallyimportant,however,istheOwner’scommitmentand

organizationoftheproject.Healthcareconstructioniscomplex,expensive,andusually

representsasignificantsegmentofanorganization’scapitalinvestment.Predictions

suggesthealthcareconstructioncompletedin2015shouldexceed$1.04trillion(Silvis,

2015).ThiswhitepaperseekstoshedlightonthestrategiesadoptedbysuccessfulOwners

andidentifiestwelvethemesthatconsistentlyarosefrominterviewswithindustryexperts.

Methodology

Twelveexpertswereinterviewedindividuallybytelephonefor45to60minutesbetween

MayandJuly,2015andrecordedusinganOlympusVN-702PCdigitalrecorder.The

recordingswerethenprofessionallytranscribed.Thefacilitatormadenotesduringthe

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conversationsandreplayedtherecordingstoclarifycontentandidentifyquotations.The

followingquestionswereidentifiedbythefacilitatorandusedtoguidethediscussion:

1. Pleaseprovideinformationaboutyourselfandyourexperiencewithmajorhealthcareprojects.

2. TellmeaboutyourexperiencewithdifferentwaysinwhichtheOwnermanagedthedesignandconstructionprocess.Focusespeciallyonthedifferencesthatappeartohavecontributedtosuccessfulprojectsandthingsyouwouldchoosetododifferently.

3. PleaselistwhatyoubelievetobethekeysuccessfactorsassociatedwitheffectivemanagementandcontrolonthepartoftheOwnerwithregardtomajordesignandconstructionprojects.

4. Aretherespecificvalueswithintheorganization,andexpectedfromexternalconsultants,associatedwithsuccessfulprojects?

5. Describetheidealrelationship,basedonyourexperience,betweentrusteesorgovernanceandsuccessfulprojects.

6. Describetheidealrelationship,basedonyourexperience,betweentheC-suite(CEO,CFO,etc.)andsuccessfulprojects.

7. DescribetheidealorganizationalpositionfortheOwner’sprojectleaderandtheirpreferredqualifications.

8. Describeyouridealinternalteamandtheirassociatedexpertiseforprojectdelivery.9. Describeyouridealexternalteamandtheirassociatedexpertiseforproject

delivery.Howaretheexternalconsultantsselected?10. Howdoesthedesignteaminteractwiththeactualandintendedusersofthespaces

beingdesigned?11. Canyoupleasee-mailmeacopyofyourtypicalorpreferredprojectorgchart?12. Inwhatwaydoesasuccessfulprojectteameffectivelycommunicate?13. HowdoestheOwnerknowwhatisactuallyhappeningontheirproject?14. Onsuccessfulprojects,howdoestheinternalandexternalteamrespondto

unanticipatedproblems?15. IsthereanythingelseyouwouldliketotellmeabouttheOwner’sorganizationfora

successfulproject?

Notallquestionswereaskedofeveryparticipant.Additionalinformationnotcoveredby

thequestionswasgatheredviatopicsofinterestraisedbytheparticipants.Rough

biographicaldataofeachparticipantwasgathered.Theintervieweeswereidentifiedbythe

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AcademyforHealthcareInfrastructureandincludeleadersinthefieldofhealthcare

administration,designandconstruction.Theparticipantswere:

§ JohnBecker,MHA,FACHE,FHFI;Director,FacilitiesDivision,DefenseHealthAgency.

Johnspent29yearsasanArmyofficerwithabackgroundinhealthcareadministration,

facilityplanning,andservedasamedicalevacuationhelicopterpilot.TheArmysent

himtoearnamaster’sdegreeinhealthcareadministrationatBaylor.Heservedasthe

COOofamilitaryhospitalandthenCEOofa400-beddeployablemilitaryhospital.Past

facilitiesrelatedpositionsincludeDeputyCommanderoftheArmy’sHealthFacility

PlanningAgencyandVPofFacilitiesfortheArmyMedicalDepartment.Afterretiringas

aColonel,hewentontobecometheDirectoroftheDefenseHealthAgencyFacilities

Division.

§ WilliamR.Calhoun,Jr.;ViceChairman,ClarkConstructionGroup.Billhasbeenwith

Clarkfor32years.HiscivilengineeringdegreeisfromGeorgiaTech,afterwhichhe

beganinestimatingandpurchasingwithacontractorinFlorida.HemovedtoBethesda

toworkforGeorgeHymanConstruction,whichbecameClarkConstruction.His

assignmentsmovedhimaround,includingconstructionofahospitalinTexas.More

recently,hewasinvolvedinmajorprojectsattheBrookeArmyMedicalCenterinSan

Antonio,andtheWalterReedNationalMilitaryMedicalCenter.

§ PeterR.Dawson,AIA;Sr.VP,FacilitiesServices,TexasChildren’sHospital.Petebegan

hiscareerasatraditionalarchitectandconsultantservinghealthcareclients.30years

agohebegantobeemployedbytheOwner,firstforasinglemajorprojectatHouston’s

MethodistHospital.Hestayedontodevelopasophisticatedprogramoffacility

planning,design,construction,andprojectdeliverytoaddressmultipleprojectsof

differingtypes.Hehastakenthelessonslearnedalongthewaytohispositionwith

TexasChildren’sHospitalandtheirsignificantcapitalprogram.

§ PatrickE.Duke;ManagingDirector,CBREHealthcare.Patrickearnedacivil

engineeringdegreefromAuburnwhileworkingthroughschoolforaconstruction

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managementfirmwithhospitalprojectsinTexasandVirginia.Hewantedtobeonthe

Owner’ssideandlaterearnedamaster’sdegreeinlanddevelopmentfromTexasA&M.

HebecameanOwner’sonsiterepresentativeforalargeprojectinNewJersey.His

smallerfirmultimatelywasacquiredbyCBREandhedevelopedhisspecializationin

healthcare.

§ SamGioldasis,PE;VicePresident,WalkerEngineering.SamhasbeenintheDallas-Fort

Worthareasincecollege,andhashadavarietyofengineeringrolesassociatedwith

hospitaldesignandconstruction.Earlyinhiscareerheservedaselectricalengineerof

recordatChildren’sMedical,andhashadexperienceworkinginfirmsofconsulting

mechanical,electrical,andplumbing(MEP)engineers,MEPcontractors,andcurrently

worksforanelectricalcontractor.Themajorityofhiscareerhasbeeninelectrical

contracting.

§ DougHarper,PE;Sr.ProgramManager,Gilbane.Dougearnedacivilengineering

degreefromVMIandjoinedtheAirForcewhereheservedfor22yearsintheAirForce

HealthFacilitiesprogram.TheAirForcesenthimtoN.C.Statewhereheearneddual

master’sdegreesinconstructionmanagementandbusinessadministration.Doug

workedonthe2005BaseRealignmentandClosure(BRAC)medicalfacilitiesplanning.

Hislastmajormilitaryassignmentwasthe$1billionrecapitalizationoftheSanAntonio

MilitaryHealthSystem.HejoinedGilbanein2015.

§ BrianHolmes;Sr.VP,FacilitiesDevelopment&RealEstate,TexasHealthResources.

BrianearnedadegreeincivilengineeringandenteredtheNavyCivilEngineering

Corps.HislasttourofdutyinvolvedrenovationoftheNavalHospitalinCorpusChristi,

Texas.WhenlefttheNavy,hebecameaprojectmanagerforthePresbyterianHealth

SysteminDallas,whichhasevolvedthroughmergersandacquisitionstobecomeTexas

HealthResources,amajorregionalsystem.Brian’srolehasevolvedtobecomethe

leaderofthesystem’sfacilityandrealestateactivity.

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§ JohnKouletsis,AIA,EDAC;VP,NationalFacilitiesServices,KaiserPermanente

HealthPlan,Inc.Johnisalicensedarchitectwhobeganhiscareerwithhealthcare

projectsinprivatepracticewithmultiplefirms,includingworkinJapan.Hewasinvited

tobecomeaprojectmanageratKaiserandtransitiontotheOwner’ssidein1993.He

becametheStandardsArchitect,puttingtogetherregionaldesignstandardstobecome

NationalStandards.Johnhaseventuallybecomeanationalvicepresidentinchargeof

planninganddesignforKaiserPermanente.

§ JudyQuasney,RA;Director,OfficeofWorkplaceSolutions,attheNationalInstituteof

AllergyandInfectiousDiseases(NIAID)withintheNationalInstitutesofHealth(NIH).

Asaclassicallytrainedarchitect,Judybeganhercareerintraditionalarchitecturalfirms

withintheUnitedStatesandGermany.Since1992,shehasbeenafederalarchitectat

NIHresponsibleforleadingateamdedicatedtorenovationswithintheresearch

hospitalcomplexofNIH.In2003,sheshiftedherfocustoassistNIAIDleadershipwith

developinghighcontainmentlaboratoriesaspartofanationalcampaigntopreparethe

Americanpublicforapotentialbioterrorpublichealththreat.Herexperienceincludes

biomedicallaboratoryplanning,design/constructionandfacilityoperations.Sheiswell

versedinpatientcare,diagnosticandspecialtyareaswithinaresearchhospitalsetting.

§ BruceRaber,MAIBC,MRAIC;VP,PracticeLeaderHealth+Wellness,Stantec.Bruceis

aCanadianarchitectwhohasspecializedinhealthcaredesignsince1988.Heisthe

PracticeLeaderforStantec’sinternationalpracticeinHealth+Wellnesswhichincludes

over800architects,engineers,designers,plannersandstrategistsinmultipleofficesin

Canada,theUnitedStatesandoverseas.MuchofBruce’slargestandmostcomplex

projectshavebeenCanadianPublicPrivatePartnership(P3)efforts,asinthemajor

$600millionNorthIslandHospitalsprojectfortheVancouverIslandHealthAuthority.

§ JohnH.Rich,MHA;SeniorVP(retired),IntermountainHealthCare.Johnearneda

master’sdegreeinhospitaladministrationfromUCLAandwenttoworkasafacility

andsystemplannerwithIntermountainHealthCare(IHC).HecontinuedwithIHCin

multiplerolesovertheyears,includingstintsastheadministratorofacoupleof

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hospitals,timedevelopingthehealthmaintenanceorganizationnowknownasSelect

Health,andstartingtheIHCphysiciandivision.Hespentthelastyearsofhiscareeras

theseniorpersonresponsibleforfacilityplanninganddevelopment.

§ StephenWooldridge,PhD,PE,FACHE;VP,IntegratedRealEstate&Facilities,MedStar

Health.StevewasintheROTCincollegeandbecameanofficerintheArmy’sMedical

ServiceCorps.Servingasamedicalplanner,hebecameoneofthefirstbrigade

engineersinamedicalbrigade,wherehewasinvolvedinthereplacementWomack

ArmyMedicalCenteratFt.Bragg.Afteradoctorateinconstructionengineeringand

managementfromMIT,heoversawmedicalfacilitiesinEurope,andleadershipofa

clinicinGermany.Returningstateside,hewasinvolvedwiththeinsurancesideof

militaryhealth,deployedtorunacombathospitalinIraq,andreturnedtocommand

theArmy’sHealthFacilityPlanningAgency.SteverecentlyretiredasaColoneland

joinedMedStarasavicepresidentwithfacilityresponsibility.

§ Facilitator:D.KirkHamilton,MSOD,B.Arch,FAIA,FACHA,EDAC;Professorof

ArchitectureatTexasA&MUniversity.Kirkteacheshealthcaredesignatthegraduate

level.Hisacademicresearchisabouttherelationshipofevidence-basedhealthfacility

designtomeasurableorganizationalperformance.Heisafoundingprincipalemeritus

ofWHRArchitects,andhasreceivedtheLifetimeAchievementAwardfromACHA.Heis

co-editorofthepeer-reviewed,interdisciplinaryHERDJournal.Hismostrecentbooks

includeRigor&Research-InformedDesign:ADecade’sAdvocacy(2013),Designfor

CriticalCare:AnEvidence-BasedApproachwithco-authorMardelleShepley(2010),and

Evidence-BasedDesignforMultipleBuildingTypeswithco-authorDavidWatkins(2009).

ParticipantswereselectedbyJoePowell,theExecutiveDirectoroftheAcademyfor

HealthcareInfrastructure.Eachsemi-structuredinterviewwasconductedusingthe

methodsdescribedinJamesSpradley’sTheEthnographicInterview(1979),andanalyzed

usingthemethodologydescribedinKathyCharmaz’sConstructingGroundedTheory

(2006),whichinvolvesthecodingofinterviewcontentandthecategorizationofthese

codesintothemes,untilsaturationisachievedandnonewconceptsareraised.Usinga

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methoddescribedas‘memberchecks’byYvonnaLincolnandEgonGubainNaturalistic

Inquiry(1985),theparticipantsweregiventheopportunitytocommentonandeditthe

interviewtranscripts,themesthatemergedfromtheirinterviews,aswellasgivenan

opportunitytoreviewandcommentonadraftofthepaper.Aconferencecallallowedthem

todiscussadraftdocument.Thefollowingisasummaryoftheopinionsexpressedbythe

participants.

Discussion

OrganizingforProjectSuccess:ADozenPrinciplesandSomeObservations

Acollectionofconsistentthemesemergedfromtheinterviewswiththeseindustry

experts.Thegroupproducedagroupofcompatiblesuggestionsandhadnodisagreements

orminorityreports.

Differentorganizationsmaydefineprojectsuccessintheirownway.Theclassic

statementof‘ontimeandinthemoney’referstobudgetandschedulesuccess.Realsuccess

maybemoreoftenrelatedtodeliveryofthedesiredscopeatthedesiredqualitylevel.

TexasChildren’sPeteDawsonsuggestedthatstrivingforadependableoutcomeisdistinct

fromtryingtodefineasuccessfuloutcomeinthefaceofshiftingprioritiesand

circumstances.

JohnKouletsisofKaiserPermanenteidentifiedseveralindicatorsofprojectsuccess.

Itwillbeonorbelowbudget,anddeliveredonscheduleorearly.Moreimportantly,he

said,thefinishedprojectwill“alignwiththeorganization’sstrategicvision,fulfillorexceed

theintendedscope,meetorexceedtheneedsandaspirationsofthekeystakeholders,

enhanceworkflowefficiency,allowfortheprovisionofthehighestqualityofcareprovided

atanaffordableprice,andoperatedatthelowesttotalcostofownership.”Itwouldbe

“flexibleandadaptabletofuturechanges”intechnologyanddeliverymodels.Sucha

projectwouldbean“outcomes-baseddesign”thatdeliveredshorterlengthsofstay,no

hospitalacquiredinfections,noworkplaceinjuries,andhighersatisfactionscores.Hewent

ontosuggestsuccessmaybeindicatedbytransformativeexperiencesforpatients,families,

clinicians,andstaff.

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JohnBecker,theHealthDefenseAgency’sDirector,offeredsomethoughtson

definingsuccessfulprojectoutcomes.Plan,developandoperatetherightfacilities–

“appropriateandfiscallyresponsibleinfrastructuretomeettheMilitaryHealthService

(MHS)readinessandmissionrequirements;”rightquality–“assureworld-classstandards

aredevelopedandappliedtoprovideasafe,reliable,timely,responsive,andefficientMHS

environmentofcare;”andrightresourcing–“balancerequirementsandresourcesto

optimizeMHScostandtimeinvestmentinfacilitylifecyclecapitalmanagement,

operations,andsharedservicesinfrastructure.”

Dawsontalkedaboutputtinginplace“acontrolstructuretoeffectivelymanagethe

projectscope,budget,andschedule”onbehalfoftheowner.Heindicatedthatcapital

projectsconsistofsevensteps:1)pre-designorplanningwhichotherscallstrategic

planningandfunctionalspaceplanning,2)fundingordevelopmentofthebusinesscase,3)

design,4)bidorpurchase,5)construction,6)occupancy,and7)close-out.

Figure1:CapitalProjectManagementProcess

AdaptedfromDawson&TexasChildren’sHospital

Anumberoftheparticipantsdiscussedanefforttostrategicallyalignthevision,

merits,andanticipatedoutcomeoftheprojectinternallywithintheleadershipteamofthe

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OwnerpriortocommencementofPre-Design.Thiseffort,calledStep0,establishesthe

opportunityforinternalendorsementfromallfacetsoftheOwner’sorganizationtoensure

alignmentandsupportfortheproject.DuringStep0,withintheOwner’sorganization,

projectprioritiescanbedefinedaswellasestablishingoperationalandorganizational

boundarieswhichcannotbereadilyillustratedbymerelyfunding,scope,ortime

parameters.Theconcept,especiallyforgovernmentprojects,iscriticaltoensure

transparencytoallinterestedparties.Throughcarefulreviewofstrategicalignmentand

congruencewiththeorganization’shealthdeliverymodel,Step0setsthefoundationsfor

commencementofPre-DesigninStep1.

Figure2:DemandSignalProcessforEnterprise-LevelReview

Courtesy:JohnBecker&DefenseHealthAgency

JudyQuasney,DirectoroftheOfficeofWorkplaceSolutionsfortheNIHInstituteof

Allergy&InfectiousDiseases,pointedouttheneedforthissortofearlyeffort,andBecker

providedFigure2abovetoexplaintheDHAreviewprocesswhichprecedesdetailed

planning.Gettingintothebudgetstreamoflargeorganizationsorgovernmententities

requiresconsiderableformulationandthesettingofthoroughgroundwork.PatrickDuke,

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managingdirectorofCBRE’shealthcarepractice,providedFigure3belowtofurther

explainoneversionofaStep0whichhisorganizationdescribesasstrategicmasterfacility

planning.

Figure3:StrategicMasterFacilityPlanning

Courtesy:PatrickDuke&CBRE

Kouletsisandothersfeelthatapostoccupancyevaluation9to12monthsafter

beneficialoccupancyshouldbean8thstep.Itisdifficulttogetmaximumbenefitfromthe

potentiallessonsuponcompletionofanymajorprojectwithoutsomesortofinternalor

independentexternalreviewoftheresults.Itmustbenotedthatsourcesofpostoccupancy

feedbackoftenhavenotparticipatedinestablishingtheprojectprioritiesordidnot

providedesigninput,andthustheirsubjectiveevaluationmustbefilteredthroughthis

newlens.Ifperformedforthepurposeofresearch,anindependent,third-partyreview

removesmostofthepotentialforbiasinthereport.Whenthedesignteamevaluatesits

ownwork,thereisapossibilityofbiasaboutthebuilding’sperformance.

Evaluationofaprojectafteroccupancycanprovideimportantfeedbackthatcan

benefitsubsequentcapitalprojects,andifshared,canbenefitthefield.Shepley(2011)calls

it‘healthfacilityevaluation’andnotestheshiftfromthelanguageof‘post-occupancy

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evaluation’tobuildingperformanceevaluation(Preiser,2002).Buildingperformanceisan

importantaspectofevaluationwhentheOwnerisconcernedaboutoutcomes.Quasneyhas

providedFigure4belowwhichdescribesaStep8asOperationalReadiness.

Figure4:EnhancedCapitalProjectManagementProcess,withSteps0&8

Courtesy:JudyQuasney

Itisreasonabletosaythattheparticipantsinthisprocessfeelstronglythatthe

Ownermustbeorganizedaroundaclearandconsistentprocessthatcanbemanaged.The

Ownerwillneedanorganizationalstructuretomanagethecapitalprojectteamwithits

multipleinternalcomponentsanditsexternalconsultants.

Theparticipantsrecognizethattheremaybemultipleeffectivewaystoorganizethe

overalldesignandconstructionteam,justastherearemultiplecombinationsofinternal

andexternalmembersoftheseteams.Someorganizationswillhavemoreinternal

resourcesformanagingcapitalprojectsthanothers.Thecombinationsofteammembers

mayvaryfromoneprojecttoanother.Thereportingrelationshipsmaybedifferentwithin

somedesignandconstructionteams.DukeprovidedthefollowingFigure5asageneric

organizationstructureillustratingoneversionofpossiblereportingrelationships.

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Figure5:TypicalOrganizationChartforaMajorCapitalProject

Courtesy:PatrickDuke&CBRE

Acollectionofguidingprinciplesemergedfromtheinterviewsandgroup

conversations.Thethemeslistedbelowasprinciplesrepresentthecombinedopinionsof

theparticipantsaboutthedesignandconstructionprocess,asexpressedduringthe

interviews.Afewrelevantobservationsarealsoincluded.

Principles

Principle1: Visiononthepartoftheownerisshared

TheOwnermusthaveavisionfortheproject.Differentvisionsfortheschedule,

economy,andqualityoftheproject;andofthecaredelivered,value,ordesiredoutcomes

oftheprojectshouldproducedifferentprojectresults.Aprojectvisionisthereforeneeded

toclarifytheintentionsoftheownerbeforeanyworkonspecificdesigncanbegin.Itis

importanttonotethatwithamulti-headedowner,theownermaynothaveasinglevision

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andthevisionscould,andoftenare,inconflictwithoneanother.Theseissuesmustbe

resolved,atleastonaconceptuallevel,beforetheprojectcaneffectivelymoveforward.

Makingknowntheexpectationsanddesiresofkeyplayersinthedeliveryofthe

projectisofcriticalimportancesothatpropermomentum,supportandoverallfocuscan

bemaintainedbytheOwner’steam.Thedesignconsultantsandtheconstructorsneedto

beclearaboutwhatprojectsuccesslookslikefromtheirrespectiveperspectives.Unless

theseexpectationsforsuccessareclear,andthereisgeneralagreementthattheyare

achievable,theprojectwillbehamperedfromamisalignedOwner’steam.

Kouletsisdeclaredthat“TheOwner’svisionmustbeinwritingandopento

adjustmentastheOwnerandotherteammembersencounterchallengesandopportunities

intheproject.”HeseestheOwner’svisionasalivingdocumentthatisrefinedastheproject

evolves.Itwillgrowandadaptastheprojectgoesthoughrealworldadjustmentsand

changes.Manythingsmaychangeduringthecourseofaprojectimpactinghowthecore

visionisachieved.Dawson,however,wishestowarnagainstacceptinganOwner’sfailure

tomaintaindisciplineandrigor,whichcanleadtounsuccessfulprojectoutcomes.The

OwnerandentireteammustunderstandthatthevisiondefinedatStep0willguideall

decisionsastheprojectencountersinevitablerealworldcomplicationsandconflicts.This

isonekeytoeffectiveprojectdelivery.

TheOwner’svisionmustbeclearandexplicitlyunderstandable.Thevisionofthe

Owner’sleadershipshouldbestatedsimplyinafashionthatleavesnoroomformultiple

interpretations.JohnRich,retiredfromIntermountainHealthCare(IHC)hassaid“aproject

isnobetterthanhowwellitsownerarticulatesit,becauseiftheycannotarticulateit

accurately,precisely,andhavedefinitevisionaboutit,itwon’tcomeoffthepreciseway

thattheOwnerenvisioned.”BillCalhounofClarkConstructiondeclaresthat“theOwner’s

visionmustbeassociatedwithclearmetricsdefiningmeasuresofsuccess.”

TheOwner’svisionmustbeunderstoodbyeveryoneateverylevel.Theowner’s

visionshouldbesharedwitheverymemberoftheteamandmustbeclearand

understandable.Thisvisionwillultimatelyguideprojectdecisionsatmanylevels.Itwill

alsoserveasthe‘truenorth’oftheprojectandshouldbeconsultedfrequentlytoensure

theprojectremainstruetoitsvisionandgoals.Thisisparticularlycriticaliftheproject

encountersdifficultiesthatcouldresultinachangeinprojectscopeorbudgetadjustment.

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Eachsystemhasitsowncomplexitiesandmultiplestakeholderswhoneedtofocusonthe

sharedvisionandgoals.

SteveWooldridge,recentlyretiredfromtheArmy’sHealthFacilityPlanningAgency

andnowaVicePresidentforrealestateandfacilitieswiththeMedStarHealthsystem,

reportedthat“wherewehavethegreatestsuccessisifwecometoacommon

understandingandacommongoal.Thegoalisnotaboutthebuildingsomuchas

appreciatingthatwe’reabouttobringafunctioninghospitalonline.”Hewentontodeclare

that“ifyoucangetalignmentaroundthatsingularideawiththewholeprojectdelivery

team,thatpavesthewaybecausethenyouhaveatruepartnership.That’sreallywhereit

starts.”

Envisioningthefuturebeginswithastrategicplan.Aprojectvisionshouldbein

alignmentwiththeorganization’soverallstrategicplanandcaredeliveryplan.Duke

believesthatorganizationsandsystemsneedto“utilizerealestateandfacilitiesasatoolto

carryouttheirmission,”withthefirststepbeingdevelopmentofasolidstrategicplan.The

masterplanmustsuittheintendedstrategy,andthespecificprojectproposalmustbe

supportedbyawell-craftedbusinessplan.

NIH’sQuasneyworkstogetalltheinternalandexternalpartiesinvolvedinorderto

havesomesharedvisionandacceptanceofwhatistohappen.Sheinvolvesherself“to

makesurethatthevisionandtheagreementbytheseniorleadershipinthestrategic

planningphaseisnotcompromised.”Quasneysaidthevision“needstobecomprehensive

andlasting.”

Bewareofresistancetochange.DougHarper,SeniorProgramManagerfor

Gilbane,pointedouthowindividualsandculturesmayoftenberesistanttochange.If

majorprojectsaresubjectedtonewanddifferentdeliverymethods,orinvolvedwith

significantinnovation,theremaybeopenorhiddenroadblockstoovercome.Sharinga

compellingvisionmayrequirehardworktodriveitdowntothelowestlevelsofthe

internalandexternalprojectteams.

Harperdescribedanexampleinwhichtheleadershipvisionrequiredabigchange,

but“theenterprisejustcouldn’tturnonadime”andresultswerelessthanideal.Becker

tellsusthat“Changemanagementinparticularrequiresintensiveownerinvolvementand

obviouslyeffectscostandschedule.”

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Principle2: Clear,documentedprojectobjectives

Theremustbespecificobjectivesfortheproject.Theinternalandexternalproject

teamshouldhaveexplicitgoalsandobjectivesfortheirwork,withmetricsformostofthe

objectivesthatpermitobjectiveperformanceevaluation.AccordingtoQuasney,“critical

projectdecisionsandmilestonesarethefoundationofmeetingobjectives.”Thedesignand

constructionteamcannotbeeffectivewithoutclearobjectivesthatprovideguidanceabout

whattheOwnerexpectsfromtheirwork.Calhounmentionedtheneedforamajordecision

timelinetoguidetheowneranduserleadership.

Theprojectteammustbegivenclearstatementsofthemeasurableobjectives.

Theobjectivesmustbeprovidedsothatteammemberscanbetreatedfairly,astheywork

toaccomplishthem.“Thisclearlydocumentedscopeofworkandrangeofexpectationsfor

success,”Kouletsisremindsus,“mustbealivingdocumentthattheteamcomesbackto

againandagainduringthecourseoftheproject.”Heremindsusthatitshouldbe

understoodthatitisgoodtohaveanunderstandingthatthedocumentwillberevisitedon

aregularbasissotheentireteamcanverifythattheprojectcontinuestoadheretothe

principlesandobjectiveslaidoutatthestart.“Suchadocumentcanserveasa‘guardrail’

whentheprojectencountersdifficulties.Itwillguidethesettingofnewprioritiesin

responsetoacrisisandhelpdeterminewhatis‘inbounds’andwhatis‘outofbounds’

whenengaginginvalueengineering.”

Theprojectteammustshareacommonlanguageabouttheirobjectives.Harper

describedwaysinwhicheachparticipantmayhavehadtheirownwayofseeingthetask.

Helikenedittodifferentplayersdescribingthesameelephantwhilelimitedintheirview

becausenonecould“backofffarenoughornotlookthroughtheirownstrawtoseethe

wholeelephant.”Eachteammember,bothinternalandexternal,mustcometosharethe

samelanguagethatallowsacommoninterpretationoftheowner’svision.TheOwner’s

leadershipshouldestablishandformallydocumentdefinitionsandguidingprinciplesfor

theprojectasatooltoinformtheteam’sdecisionmaking.

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Principle3: Qualified,experiencedstaff

Leadersmayhavemultiplevariedbackgrounds.Projectleaderscanincludethose

withbackgroundsfromarchitecture,engineering,construction,healthcareadministration,

business,orfrommilitaryservice,amongothers.Someparticipantshavemovedfromone

roletoanother.DawsonandKouletsis,forexample,bothwerearchitecturalpractitioners

workingwithhealthcareprojectsbeforetheytransitionedtotheOwner’steam.Whatis

importantistheirexperienceandjudgment.

Beckerreportedthatthe“biggestfactorinsuccessseemstodependonthepeople

ontheground,theteamandwhotheyare,howtheyworkandbuildtheirteam.”Quasney

declaredthat“leadersneedtodeveloptrustedinterpersonalrelationshipswiththekey

stakeholders.”

Leadersshouldhavehadexperiencewithhealthcarecapitalprojects.Experience

withlarge,complex,capitalprojectsforhealthcareorganizationsisanimportantcriterion

forpersonsaskedtotakeleadershipresponsibilityforamajordesignandconstruction

project.Harperobservedthat“peoplecometoaprojectwithwhattheirpastexperience

hasbeen.”Eachteammemberwithaleadershiproleshouldhavetherelevantexperience

necessaryforthemtomakeconfident,responsible,andtimelydecisionsattheirassigned

levelwithintheproject’sorganizationalstructure.

Itisusefultodocumentrolesandresponsibilitiesforallmembersoftheproject

team.Itisnotuncommontohavealargenumberofplayers,especiallyontheowner'sside,

whohavelittleornoexperienceinthedesign,construction,andcommissioningofa

significantcapitalproject.Insomecases,theowner'sleadershipteammayhave

insufficientknowledgeofthecapitalprojectprocess.Theteamshouldnotmoveforward

untiltheseteammembershavebeenthoroughlybriefedontheirrole,responsibilities,and

decisionrightsontheproject.Itissurprisinghowoftenkeymembersoftheteamarenew

totheprocess.

Internalstaffmustbeasskilledandexperiencedastheconsultantteam.Bruce

Raber,theHealth+WellnesspracticeleaderforStantec,commentedthattheowner“needs

tohavestaffthatareasgood,honestly,asourstaff,orasgoodasthecontractor’sstaff.”The

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Owner’steammembersneedexperience,alongwithtechnicalskillsandinterpersonal

skills.

Raberfirmlybelieves“thebiggertheproject,themoresophisticatedandskilledthe

Owner’sorganizationhastobe.”Dukepointedoutthatthefacilitymanagementprocessis

notacorebusinessfunctionofthehospital,andthat“theworstthingpossibleisiftheytry

tooperatethemlikeahospitaldepartmentratherthanabest-in-classdesignand

constructionprojectmanagementgroup.”

Dukepointedoutthattheinternalstaffmustbeempowered,andmustbe

compensatedatmarketrates.Iftheeconomyisstrong,experiencedandqualifiedinhouse

staffmaybeluredawaybyoffersfromindustry.Keepingexperiencedstaffanddeveloping

experienceinnewemployeesinthefaceofloomingretirementsisanissueofsome

importance.Itisgoodtorememberthatinexperiencedorineffectivestaffanywhereinthe

team,whetherowner,designer,orconstructor,cancauseprofounddysfunctionintheteam

andthreatentheviabilityoftheproject.

Internalleadersmusteducatetheowner’snon-designandconstruction

leadership.Internaleducationisrequiredforanorganizationtobecomehighperforming

withitscapitalprojects.Dawsonsaid,“Youhavetodemonstrateveryeffectivelyto

individualswhoarenotparticularlywellversedinunderstandingthecomplexitiesofa

facilitiesprojectdeliveryprogram,andmayactuallyhavesomestrongmisconceptions.”

Internalpoliticscannegativelyimpacttimely,effectivedecisionmaking.

Dawsonwentontodeclarethat“itisessentialtoestablishanempowered

hierarchicalprojectclientstructure,withdesignatedroles,authorities,and

accountabilities,thatcanberelieduponfordecisions,commitments,andkeyinformation

atalllevels.”Rabermadethepointthattheowner’sleadershipmustbeabletoactas

passionate,committedchampions.

Principle4: Astableofpre-qualifiedconsultantsandcontractors

Knowndesignandconstructionconsultantswithrelevantqualificationsare

preferred.Whilenewrelationshipsandcombinationsofexternalconsultantsare

inevitable,andoftendesirable,theabilitytoworkagainwithindividualsandcompanies

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thathaveperformedtogethersuccessfullyinthepastisvalued,especiallywhenthepast

workwaswiththeclientmakingthecurrentselection.

Dukesuggestedthatwhenselectingateam,“theownerneedstohaveaclear,

transparent,andconsistentprocess.”Collectingqualificationsfromcandidatefirmsis

helpfulinnarrowingaselectionlist,andthoughtfulexaminationofthequalificationsand

referencesforthespecificindividualsproposediscrucial.Theprivate,non-governmental

ownerhasgreaterleewaytodefinethecriteriaforselectionandprocurementinanyway

theydesire.Governmentalprocurementmayhavemoreregulatoryboundaries,butcan

includecreativeandinnovativeproposals.

Althoughdifficult,selectingindividualsfortheteamthathaveastronghistoryof

workingtogetherisfrequentlythedefiningcharacteristicofprojectsuccess.Althoughtwo

firmsmayhavealonghistoryofworkingtogether,ultimatelyitisabouttheindividualson

theteamfarmorethanitisaboutthespecificcompaniesparticipatingintheteam.

BrianHolmesofTexasHealthResourcesexplainedthat“itisveryhelpfultohavea

generalcontractorandanarchitectwhoarefamiliarwiththefacilityandbecome,forall

intentsandpurposes,anextensionofourstaff.”Thesefirms,together,mayserveovertime

onallprojectsforasinglecampus.Holmesdescribesawaytokeepaddingnewcompanies

tothepool.“Wecontinuallytrytorefreshthegroup,”hesaid,“byregularlyintroducing

newpeopleonprojectsthatmaybealittlelessrisky,sotheycangetmorefamiliarwiththe

campus.We’reinfusingnewbloodbecauseifwedon’t,thenourcoststendtodriftupward.

We’vegottocontinuallybringinhungrysubcontractorstokeepeverybodyhonest.”

Holmesrecognizesthatthebigcontractoronthebigjobmaynotbeabletosecure

competitivebidsforthesimultaneoussmallerproject,sotheybringinsmallercontractors

forsmallerjobs.“Wegettoknowpeople,anditkeepseverybodyelsehonest.”These

smallerprojectswouldbehandledbythesameinternalprojectmanagerresponsiblefor

thecampus.“Everybodyneedstoknowtheycanbereplaced,”hedeclared.

RichdescribedtheIHCinterviewprocesswhichincludedafulldayattheofficeof

theshortlistteams.IHCconsistentlyusedastableofexperiencedfirmspre-qualifiedbythe

system,fromwhichlocalunitscouldmakeaselection,oftendecidingonthebasisof

perceivedculturecompatibility.Calhoun,whobelievesindetailedinterviews,describesa

selectionprocessinwhichtheprospectiveconsultantteamisgivenaproblemtosolve

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duringtheinterview,providinginsightintothewaytheteamworks,andacceleratingthe

learningcurverelatedtoworkingtogether.

Evaluationcriteriashouldextendbeyondlowestfirstcostandshortesttimeline.

Theowner’sdecisionaboutcontractorselectionshouldofcourseincludecostand

schedule,buttheparticipantswereclearthatlimitingevaluationtothesecriteriaisshort

sighted.Alltoooftentheclaimisthatabidoffersthebestvalue,butinrealityitisonlyif

thebidislow.Beckerrecommendsthat“thelevelofacceptablequalityinmaterialsand

constructionshouldbeaknownfactor,alongwiththelowesttotallongtermcostof

ownership,andthedesiredlevelofsustainability(LEEDCertification,Silver,Gold,or

Platinumlevel).”Theownershouldbecertainthattheproposalsaddresstheproject

objectiveswithmeasurablecommitments.Beckersuggeststheexpressionoftheowner’s

brandisjustonefactortobeconsidered.

“Ithinkalotofsuccessofthejob,”Calhouncontended,“startswiththeprocurement

andtheevaluationfactorsused,andthebehaviorsthoseevaluationfactorscompel.”He

pointedoutthatselectionsthatonlyconsiderlowestfirstcostcompelbehaviorsnotinthe

owner’slongtermbestinterest.“Youwantaprocurementprocessthatcompelsthe

behaviorofopenness,ofdecisionmakingonthebestperceivedvalue,notjustlowest

price.”Hemadethepointthatbestvaluefortheowner,asameasureoflifecyclecost,is

rarelycalculatedandusedtocomparecompetingproposalsintheworldoflowestfirst

cost.

Choosingefficientsystemscanlowertotalcostandtotalcostofownership.Calhoun

saidtheconstructionprocurementcommunityisnotsetuptoaskthiskindofquestion.

Kouletsisrecalledthewarningthat“ifyouwantitcheap,you’llgetitcheap.”

Evaluationcriteriashouldincludesubjectivefactors.Whenmakingevaluations

ofproposalsfromcandidatesforthedesignteam,ortheconstructionteam,notallfactors

canbemeasuredobjectively.Thepersonalchemistrybetweenproposedteammembers

andtheowner’sstaffcannotbemeasured,forexample,butitcanbesensed.Thereare

intangiblefactorsthatmayhaveaprofoundinfluenceupontheteam’sperformance.

Calhounbelieves“subjectivefactorsandpastperformancearesuperiorpredictors

ofsuccessfulprojectoutcomes.”Hesaystheyaremoreimportantfactorsinteamselection

thanfirstcost,orfee.

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Increasingly,reportsKouletsis,KaiserPermanenteislookingatoperationalquality

asbenchmarksforsuccess.Onsomeprojects,successcriteriamightbeoperationalin

nature,suchas,fewerslips/trips/falls,orareducedrateofnosocomialinfectionsinthe

newbuilding.Theseoutcomesmaybeinfluencedbytheselectionoftheteam,yetthelink

fromteamselectiontooutcomesmaynotbeobviousduringtheinterviewprocess.

Principle5: Standardsthatsimplifydecisionsanddonotstifleinnovation

Standardssimplifysomedecisionsandreducevariation.Standardsshouldhelp

setthelevelofqualityorperformancethatisconsideredtheminimumacceptabletothe

projectteamortheowner.Standardsfortypes,sizes,configuration,equipment,andso

forthcansimplifythedecisionprocess.Thefullscalemock-upprocessallowslarge

numbersofusersandconsultantstorefinethespecificsforstandardizedspaces.According

toDuke,standardsforthedesignandconstructionprocesscanactasa“clearplaybook”

followedbytheinternalteam,andprovidedtotheexternalteamsothattheycanbe

“oriented,integrated,andeasedintotheprocess.”

Standardscanbeinavarietyofareas.Organizationsmayhavestandardsata

system-widelevelforthingsliketheelectronichealthrecord,thefoodservicemodel,local

andregionalclinicallaboratoryservices,orlaundryoperationsthatgoverndecisionsfor

individualprojects.Theremaybestandardsforroomsizes,equipmentlayouts,allowable

furnitureandfinishes,aswellasprotocolsforwhomayhaveanoffice,andwhomaynot.

Manyoftheequipmentandfurnituredecisionsmaybeassociatedwiththesystem’s

purchasingagreements.Standardsmaybeinplaceforthequalityofpreferredmechanical

andfiresafetysystemsorotherimportantengineeringcomponents.AnOwnermayhave

projectdeliverypreferencesthatstandardizeprojectcommunication,submissions,and

approvals.

Standardsmaybeprioritized;somearemoreimportantthanothers.Some

standardsareessentialwhileothersshouldsimplyserveasguidelines.Following

standardsbasedondifferingvalues,orinappropriateinthespecificcircumstance,requires

judgmentonthepartofprojectleadership.RichreportsthattheIHCsystemexamined

generalprinciplesofstandardsandbasiccomponentsthatlentthemselvesto

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standardizationandalthoughapprovedbytheboard,theywerenotconsideredautomatic.

Standardswereflexibleenoughtoallowforlocaladaptation.

Dukesaid“youcan’tstandardizeeverynutandbolt”onaproject.Hesuggested

Ownersevaluatewherethemostriskliesintheabsenceofastandard.Harpersaidthatthe

“Owner’svisioneventuallygetsboileddownintoprojectdocuments.Wecanlosesomeof

theowner’sfocuswhenweboiltheproblemdown”fordocumentation.Insomecases,

standardscandefendagainstlossoffocus.

Standardsmustnotbeallowedtobecomestaleoroutdated.Standards

documentsneedtobecontinuouslyreviewed,updated,andimproved.Theymustbe

documentscapableofadaptationandrespondingtonewprojectrequirementsor

conditions,asinthecaseofchangingtechnologyormedicalpractice.Itiscritically

importantthatthestandardsarealwaysinstrictalignmentwiththeowner'svisionand

objectives.Thosestandardsthatdonotalignmightbeeliminated.Dukerecommendeda

personorsmallgroupdedicatedtoreviewingandrevisingtheorganization’sstandards.

Externalconsultantsmightalsobeaskedtoperformareviewofthestandards.

Principle6: Hierarchicalcommandstructurefortheteam

Complexprojectsoftenrequirecomplicatedteamstructures.Eachmemberofthe

teamshouldrecognizetheauthoritywhichdirectsthecourseofthework.Thehierarchy

withineachfirmorcompanyengagedtoworkfortheownermustbeclearandunderstood.

Theowner’sorganizationmusthaveaclearstructureforguidingtheprojectfromthe

trusteestotheadministration,andontotheprojectdirectortowhomtheexternalteam

reports.DawsontellsustheOwnerneeds“atopdowngovernancestructureinvolvingthe

differentconstituenciesinaparticularproject.”Kouletsistellsusthat“creatingabrief

documentthatstatestherolesandresponsibilitiesofeverymemberoftheteamiskey.

EveryoneshouldunderstandtheRACIdiagram(ResponsibilityAssignmentMatrix)forthe

project.Itshouldbealivingdocument—changingasnecessaryoverthecourseofthe

projectandastheprojectteamencounterschallenges.”

Multi-headedownerswithoverlappingresponsibilitiesmustclarifylinesof

authorityfortheteam.Projectswithcomplexownershipstructures,suchasgovernment

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orsystemprojectswheredifferentplayersonlyhaveportionsoftheOwner’srole,mustbe

abletoproviderationalwaysfortheexternalteamtomakesenseofthewayinwhich

instructionswillbereceivedanddecisionswillbemade.Dukesuggestedtheneedfora

steeringcommittee.HolmesdescribedhowTexasHealthResourcesviewstheworkfora

particularhospital.“Theauthoritytospendthemoney,theauthoritytodoanythingonthe

project,toapprovechangeorders;theentireauthoritystructurefortheprojectdoesn’tgo

throughthelocalhospital,”hesaid.“Representativesofthehospitalanddepartmentsare

treatedascustomers,andwetakethatveryseriously.”Wooldridgedescribedhowa

governmentprojectmayrequireacollectiveleadershipteamasaresultofthecomplicated

contractualauthorityofthemultipleentitiesinvolved,but“everyseniorexecutivewantsto

knowwhothego-topersonis,andtheywantoneperson.”

Organizationseachneedanidentifiedsinglepointofresponsibility.Calhoun

suggestedthatthemostimportantsuccessfactorisforeachorganizationwithintheteam

tohavearesponsiblepersoninaleadershipposition.“Eachteammember,”hedeclared,

“musthaveoneindividualwiththeauthority,theexperiencenecessarytomakeinformed

andtimelydecisions,andtheattitudethatrecognizestheneedtomaketimelydecisions.”

Whenthepersondoesn’thaveauthoritytomakeadecision,anditinvolvesabureaucracy

thatrequirestoomanyapprovalsandjustifications,Calhounsaid“thecostsgoupandthe

relationshipdisintegrates.”Richdeclaredthat“itisownerdecisionmaking,morethanany

otherfactorthatdelaysthecourseofaproject.”

Contractorsareaccustomedtoahierarchicalstructure.Subcontractorspreferto

receiveordersfromasingleperson;recognizingachainofcommandwithasinglepointof

responsibility.Conflictinginstructionsfrommultiplesourcescreateconfusionandcanlead

toproblemsanddelays.SamGioldasis,VicePresidentofWalkerEngineering,speakingfor

subcontractors,said“thehierarchyisinplaceforareason.Wecan’thavemultiple

masters.”Calhounconcurred,saying,“Wehavetobecarefulthatwedon’thavemultiple

headsgivingmultipleorders”tothesamesubcontractors.Thesubneedstobelievethe

persongivingtheordersisempowered,andwillnotbecountermanded.

IftheOwnerskipslevelsofauthoritytomakedirectrequestsofthesub,problems

canarise.Ignoringthehierarchyoftheprojectstructurecanleadtoconflictandconfusion.

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Principle7: Timely,effectivecommunicationiscrucial

Teamcommunicationisfundamentaltoprojectsuccess.Complexprojects

demandconstanteffectivecommunicationamongthevariouselementsoftheinternaland

externalteam.Rapidresponsetomessagesisexpected,andrapidturnaroundforrepliesto

requestsforinformationordecisionsisrequired.Messagesmustbesimultaneouslycopied

toallconcernedsothattimeconsumingstringsofsequentialmessagescanbeavoided.

Everyoneshouldbeawareofprojectstatusandemergingissuesatthesametime.

ThisisespeciallytruewhentheOwnerisa‘multi-headed’entitywherecommunicationand

decisionmakingprotocols,andacceptabletimeframesfordecisionmakingmustbecrystal

clear.Quasneyremindedthat“wheneverthere’sahandoff,there’salwaystheriskofsome

vitalinformationorintentiongettinglost.”

Raberpointedoutthat“goodcommunicationcreatesgoodworkingrelationships

betweenpeople,”andwentontosaythat“thebettertherelationships,theeasieritisto

resolveproblems.”Wooldridgesuggestedthatthereshouldbedailyorweeklyhuddles

involvingallthecontractentities,andbi-weeklysupervisorylevelmeetings,“Atamonthly

orquarterlylevel,”hesaid,“webringintheexecutiveteams.”Whenitisworkingwell,the

participantscansittogetherandhave“open,candidissuediscussionswithouthavinga

control.”

Itdoesn’tworkwhereoneormoreoftheentitiesputsafilteronshared

information.Wooldridgecommentedthatsometimesthiscommunicationtransparencycan

beenhancedbyoutsidefacilitation.

Someaspectsofcommunicationshouldbecontrolledatspecificlevels.Open

communicationdoesn’trequireanoverload.Fullandtimelycommunicationcanbe

subvertedbypassingonunnecessarychatter.

Holmesindicatedthatinformationmustbecontrolled,sosomeupperlevelplayers

getinformationthathasbeen“boiledandcondensed”toexplainthestatusofschedule,

budget,andkeyissues,including“thekeydecisionsweneedfromyou.”Hesaid,“Thisis

likemakingsausage,andyouhavetokeepthesausagemakinghidden.Youcan’thave

peoplewhodon’thaveastrongstomachobservingthis.”

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Principle8: Constantattentiontocostandschedulecontrol

Budgetandscheduleareuniversalfactorsbywhichprojectsaremeasured.It

comesasnosurprisethattheexpertsinterviewedwereunanimousinrecognizingthat

everyprojectrequirescontinuousmonitoringofbothbudgetandschedule.Dawsontellsus

that“therearethreebasiccomponentsofeveryproject,consistingofscope,budget,and

schedule.Oneofthosemustbedesignatedasthemostimportant,andthusbecomesthe

primarydriverforallprojectdecisions.Theothertwowillfollowinadeclaredorderand

aresecondary.”Dukedeclaredthattheprocessofbudgetandschedulemanagementshould

be“visibletothehigher-ups,”andtransparentaboutthemetricsused.Managementbest

practicesuggeststhatthemultipleprojectmanagersonvariouspartsofthedeliveryteam

should,basedontheirrelevantexperience,beabletoanticipatewhatisyettooccur,and

plantoavoidpotentialproblems.

MedStar’sSteveWooldridgeconsideredthetoolofanintegratedmasterscheduleas

awayofforcingaprocessinwhich“eachofthoseactorsateachofthoselevelsmustcome

togetherandworkthroughthenuancesofassemblingamasterschedule.”Dukepointed

outthattherearenowcollaborativeprojectmanagementsoftwaresystemsthatmayhelp

thecoordination.

Developingreliablebudgetsbeginsearlyintheprocess.Dukesaid“itallstarts

withanorganizedcapitalsubmissionprocess”thatincludeshowprojectrequestsare

submittedandatransparentprocessbywhichtheyareevaluatedforapproval.Theremust

beclarityaboutthecriteriabywhichaprojectisselectedforfunding.Beckerdescribed

changingfromaplanningmodelforthemilitaryinwhichservicecomponentsprepared

extensivedocumentationforprojectsthatstoodlittlechanceoffullfundinggiventhe

volumeofprojectsandalimitedbudget.Thewastedtimeandefforthasbeenreducedby

revisingthesubmissionprocesstobestreamlinedandsimplified,allowingprojectstobe

givenanenterprisereviewbeforedetailedplanningtoensurealignmentwithMilitary

HealthSystemstrategicinitiativesandidentifyfacilityperformanceparametersbefore

investmentoftheextensiveplanningeffortrequiredtoseekformalapproval.“We’retrying

tobemoreagile,”hesaid,“andspendlessmoneyupfrontuntilwereallyknowit’san

importantrequirementthatseniorleadershipwantstofund.”

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KaiserPermanentetypicallyhasaplaceholderbudgetuntilthecompletionof

SchematicDesign,atwhichtimethebusinesscase,includingtheultimateprojectbudget

andscheduleisfinalizedandapproved.KouletsisreportedthattheconceptofTargetValue

Design(Zimina,Ballard&Pasquire,2012)is“onewaytoreducethelikelihoodofthe

traditionalanddevastatingdesign-estimate-redesign-estimate-redesign-estimate‘cycleof

death’.”Thereisalsothenotionthatthedesignteamcanbegivenspecificcosttargetsfor

allmajorConstructionSpecificationsInstitute(CSI)lineitemsasawayofdesigningtothe

budget.

Accurateestimatingismandatory.Itisnotpossible,Richobserved,tohave

confidenceinthescopeandbudgetwithouthighlyreliableestimatingfromtheearliest

stageofaproject.Suchestimatingcanbepartoftheexternalprojectteam,usuallyfromthe

chosencontractor,orfromaprofessionalestimatingconsultanttotheteamandtheowner.

Controllingbudgetandscheduleisaneverydayactivity.Discoveringwherea

projectscopestandsagainsttheintendedbudgetandscheduleisnotanactivityrestricted

totheproject’smajormilestones.Eachmemberoftheprojectteamhasaresponsibilityto

considercostandscheduleimplicationsofalldecisionsalongtheway,fromproject

initiationthroughcompletion.Ifattentiontocostcontrolispartofeachdecisionalongthe

way,therewillbefewersurprises.Calhounpointedoutthat“timeisakiller,”andthatlack

oftimelydecisionscanfester,causingincreasedcostandothermajorissues.

Acontractormustcontinuouslymanagetheschedule.Theinitialscheduleissubject

tonumerousunexpectedforcesthatrequireadjustments.Gioldasispointedouthowthe

intendedscheduleissubjectto“uncountedthingsthatchange,”sothatweeklymeetingsof

thesuperintendentandallofthesubcontractorsmust“constantlymodifyandkeepthat

scheduleasalivingdocument.”

Understandingoftheroleofusersandcontrolovertheirrequestsisvital.While

theinputfromusersofthespaceissought,desirable,andimportant,itmustbetimely.

Calhounobservedthatwhentheprojectisnearingcompletion,itmaybe3-5yearsafterthe

medicalequipmentwasselectedandspecified.Userrequestsforlatermodelsandnewer

equipmentcannegativelyimpactthecompletionschedule.Theremustbeaconsistent

policyannouncedearlyintheprocessonhowthisissuewillbeaddressedandtheusers

needtohavesharedaccountabilityforbudgetandschedule.Inoneexample,theowner

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declaredasixmonthmoratoriumonchanges,requiredthestafftooccupyand‘shake

down’thespace,andsaresultcollectedfewerchangerequestsattheendoftheperiod.

“Whereyoucancreatesomeaccountabilityintheusergroup,”Calhounargued,“youhave

everybodycollaboratingtosolveissues.”

Controllingbudgetandschedulerequiresearlyandconsistentinvolvementof

theconstructionelementsoftheteam.Earlycontractorinvolvementshouldmeanthat

thedesignerscanincorporatepricingandconstructabilityinformationfromthestartand

stayclosertothetargetbudget.Holmesidentifiesproblemsinateamifheseesdesign

workfollowedbypricingthatforcesredesigntoreducecost,andfurthercyclesofdesign-

pricing-cutting.“That’sasignalformetoeithergetinvolvedorstartquestioningthe

projectmanagementbecausethatteam’snotworking.”

Formany,valueengineering(VE)hastakenonnegativeconnotations.While

costcontrolismandatory,thewayitisaccomplishedmakesadifference.Insomemodels,

theprogrammanagerisgivenastrongfinancialincentivetoreduceprojectcost,withno

requirementtoretainvaluefortheclient,andinvariablyunproductive,adversarialconflict

ariseswithmembersofthedesignteam.Insomecasesprojectqualitysuffersunreasonably

andsomeoftheowner’sobjectivesremainunmet.

Asharedsavingsmodeloftendoesnotgivetheownerfullvalueofthesavingsand

incentivizesthecontractortomakeanyandallcuts,regardlessofultimatevaluetothe

owner.Changingtheincentivesfromprovidingmaximumvalueforeverydollarinthe

budgettofindinganywaytoreducecostsignificantlyaltersthewaythedesignand

constructionteamperforms.Holmesdescribedacomplexprojectwithabroad-based

sharedsavingsstructureandsays,“I’mnotsureI’deverdothatagain.”

Ahotteam-coldteammodelofferssecondopinionsfromtrustedpartners.

IntermountainHealthCarehaslongusedastableofpre-qualifiedfirmsforbothdesignand

construction.Becausetherearemultipleapprovedfirmsineachcategory,IHCcanselect

oneasthe‘hotteam’engagedtoproducetheproject,pairingthemwitha‘coldteam’only

responsibletoreviewthedesigndevelopmentplansandofferalternatives(Rich,2010).

Atareviewworkshop,hotandcoldrepresentativesfromthearchitects,mechanical

engineers,electricalengineers,structuralengineers,civilengineers,andcontractorsarein

thesameroomwiththeowner’steamforlengthymeetingstocarefullyexamineliterally

27

hundredsofalternativesandtheirfinancialandoperationalimpacts.Alternatesare

examined,andhighpriorityoptionsarefullydevelopedbythediscipline-basedgroups

suitabletobefullyestimated.Ultimately,some50-100alternativeswouldbeincorporated

intotheproject.Becausebothfirmsareontheacceptedlist,andwillbepairedinother

waysnexttime,thereisnoincentivetotreatthereviewasanadversarialprocess.

IntermountainHealthCarehasfoundthemethodtobe“aneffective,orderlymethodto

optimizevalueandreducecost”(Rich,2010,p.135),whichhasproducedsavingsof8%on

acapitalexpenditureof$1.3billion.JohnRichnotedthatthisseemstobeuniquetoIHC,

butbelievesitcouldworkasaneffectiveevaluationprocessforanysystemorproject.

Principle9: Everyoneinthesameroom

Asprojectplanningisoccurring,anddecisionsaremade,everyonemustbe

presenttoparticipate.Leadershipanddecision-makersfortheowner,designconsultants,

theconstructionteam,andimportantadvisorsmustallbeinthesameroom.Theymust

hearwhatishappeningatthesametime,andbeabletofullycontributetotheexchange.All

voicesontheteammustbeheardasimportantdecisionsareconsidered.Wooldridgesaid

“that’showyoucansortoutwhoneedstodowhat.”Iftheprocessleavesoutkeyplayers,

anddirectionissentoutfromapartialgroup,therealwaysexiststhepossibilitythatthe

bestdecisionmaynothavebeenmade,andinsomecases,thesubsequentadjustment

requiredmaymeanconfusionanddelay.

Dukereportedthat“ourbestprojectshavethecoreteam,constructionmanager,

engineer,andarchitectallonboardatthesametime,workingtogethertodevelopthe

design,”withaparallelcostingprocess.Gioldasisfavorablydescribedearlyinvolvementof

contractorsandsubcontractorsinwhichkeysubtrades“areoftenselectedbeforethefirst

lineisdrawn.”

Harpertalkedabouthaving“thearchitectonthebuilder’sside”asameanstohelp

thecontractorunderstandthedesignconstraints,butcautionedagainstasituationin

whichthearchitect/engineeristreated“likeanothersubtobepushedaround.There’sgot

tobeapartnership,”hedeclared,“regardlessofthecontractualrelationshiporthe

acquisitionstrategy.”

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Dukebelievesmanagingtherisksonamajorprojectcannotbedoneinday-to-day

managementmeetings.“Therehastobeaseparateanddedicatedprocess,”hesaid,“anda

meetingcadenceestablishedtomanagethesegamechangers.”Thebigroomconcept,

accordingtoKouletsis,ismorethanjustgettingallthekeyplayerstogetherformajor

decisionmaking.Co-locatingtheowner'steam,thedesignteam,thegeneralcontractorand

thesubsisenormouslyhelpful.Itisoftenthedaytodayconversationsandthemillionsof

tinydecisionsthathelpwithteamcohesionandgooddecisionmaking.

TheLEANprocessencouragesthebigroomdecisionmodel(Jørgensen&Emmitt,

2009),butgettingeveryonetobetogetherformajordecisionsandguidingprinciplesis

usefulforanyprojectdeliverymodel.Gioldasissuggestedthatmostlargeprojectsare

beingdoneinsomeformalorinformalvariationofaLEANprocess.Rabernotedthatmost

bigprojectshavejointprojectofficesfortheteammembers.Beckerreportedthat“solving

theproblemisnotsequential.We’llcallallofthestakeholderstogetherandhaveproject

folksonthephone.”Calhounsaidthatregardlessofprojectdeliverytype,hewouldprefer

togatherallplayersfortheplanning,andthatitresultsin“ahugeimprovementtothe

outcomes.”

Onerecordedconcernwasthefrequencywithwhichinformationtechnologyisnot

integratedintothedesignandconstructionprocess.CBRE’sPatrickDukeobservedthat

perhapsitisbecausetheconstructionprocessusuallyreportstoaCOO,andtheITsystems

reporttotheCFOorCIO,andthereisnotanautomaticassumptionthattheyshouldhave

earlyinvolvementintheprocess.

Principle10: Everyoneneedstohaveskininthegame

Projectsuccessmustbepersonallyrelevanttotheparticipants.Majormulti-

milliondollarprojectscannotbetreatedas‘justajob.’Quasneysuggestedthat“team

membersneedtoshareownershipofeachfacetoftheeffort.”Thereneedtobeexplicit

tangibleandintangiblerewardsandconsequencesforperformance.Recognized

performanceonasuccessful,huge,complex,costlyprojectshouldhaveimportantcareer

advancementpotentialforinternalandexternalparticipants.Atthesametime,withstakes

sohigh,unsatisfactoryperformanceshouldbequicklyresolved.

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Projectdeliveryisateamsport.Nosingleindividual’sperformanceissufficientto

ensuresuccess.Kouletsisbelieves“Thereshouldbethesensethatthewholeteamsucceeds

orfails,ratherthanasinglepartoftheteamsucceedingorfailing.Allteammembersneed

tobeinvestedinthecombinedsuccessofallotherteammembers.”Alignmentofincentives

isimportantforaligningcollaborativeperformance.

Risksshouldbeallocatedtothepartybestabletomanageorcontrolthem.

Calhounsuggestedincentivesandcontingenciesshouldbeconsideredforidentifiedrisks.

Hedeclaredthat,“Allmajorstakeholdersmustsharesomerisk.”Gioldasisemphasizedthe

needto“createasafeworkenvironment”foreveryoneonthejob.

TheOwner’sroleiscrucial.Kouletsissays“themoretheownerisawareand

acceptstheirownaccountabilityandresponsibilityintheproject,themorelikelythe

projectwillgowell.”Holmesseeksarchitects,engineers,andcontractors“whoaresmarter

thanme,”butsuggestsownerbehaviorscanharmtheproject.“Ifyouwanttoreallyscrew

upaproject,itrequirestheownertoscrewup.It’stheownernotmakingdecisionsontime,

micromanagingandquestioning,andcreatinganenvironmentoffearorretributionwith

thearchitectsandcontractors,sothosepeoplecan’tdotheirjobs.IfIgotothetable

thinkingthesepeoplearetryingtocheatme,orthesepeoplehavetobecontrolledlike

children,thenI’mbasicallyjustlimitingthem,andI’mnotgoingtogetthebestfromthem.”

Principle11:Personalrelationships

Peopleworkingwithotherpeopledelivercomplexcapitalprojects.Team

membersneedtobeskilledatinteractingwithothers.Peoplewithahistoryofworking

togetherandasharedhistoryofprevioussuccesswillfinditeasytocontinuetobuildona

solidrelationship.Newteammembersshouldbeabletofitintoaproductivesetoffresh

relationships.Kouletsissuggestedthat“morethanafirm’shistoryofworkwitheachother,

theindividual’sconnectionstoothersontheteamiscritical.”Discordandcircumstancesin

whichpeoplearenoteffectiveinworkingtogethermustbeavoidedandaddressedifit

arises.

Quasneydescribedamethodinwhichshealwaysmeetswithparticipants

individually“tooptimizeawarenessandunderstanding”beforecallinggroupmeetings.She

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usesintegrationmanagementasawayofbringingtogetherandconnectingteammembers,

andblendingthemintotheproject.Shesaid“itisnotreallyfairtohaveanarchitectcome

inandstartfromscratch,”soshedevelopsaframework“sotheycantargettheirfocusand

talentappropriately,andnotwastetime.It’saboutgettingtherightpeopletalkingand

sharingideas.”

Participantsmustbelieveinthebenefitsofcollaboration.Calhounsuggestedthat

youcan’tgetthemostfromcollaborationiftheorganizations,orthepeoplerepresenting

them,aren’tcollaborativebynature.Harpersaideveryonehas“gottobecollaborativeand

beabletoworktogether.”Heproposedthatadesirableteamtraitisforpeoplewhocan

thinkmorecollaboratively.Gioldasisreportedthat“aprojectofanysignificancestartsoff

withsomesortofteambuildingevent.”Sincetherearealwaysnewfacesonanyproject,

effortstoencouragedevelopmentofpersonalrelationshipscanbeproductive.Wooldridge

remindedthattheremustbecelebrationsoftheteam’swinsalongtheway.

Principle12:Trustiskey

Peoplewhoworktogetherneedtrustwitheachother.Anon-adversarialclimate

isrequiredforcollaboration.Whenonemustrelyontheworkofanother,orthewordof

another,trustisrequired.Harperdeclaredthat“everybodyhastohavetrust.That’sthe

non-negotiablerule…ruleone.Ifyoudon’thavethat,you’renotgoingtogetveryfar.”

Dawsonsaid,“Webelievethereisanaddedvaluewhenworkingwithtrustedpartners.”He

declaredthatcontractorsarepre-qualified“onthebasisofdemonstratedtrustworthiness.”

Maister,GreenandGalford(2000)definetrustworthinessascredibilityplusreliabilityand

thedegreeofintimacyintherelationship,dividedbytheperceptionoftheperson’sself-

interest.TrustgoesoutthewindowwhenIthinkyouareinitforyourself,andnotgenuine

indoingsomethingtoservemybestinterest.

Organizationsmusttrusttheirrepresentatives.Permissionforauthorityand

responsibilitytoexplorenewpathsmustcomefromhigherlevelsoftheorganization.

“Withthecredibilitycomestheopportunitytoestablishofficiallysanctionedproject

managementprocessesandstructures,”reportedTexasChildren’sPeteDawson,in

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describinghisimplementationofamoresophisticateddeliverymodel.Astrustincreases,

thereismoreleewayandcontrolovertheprocess,whichcancontributetogreatersuccess.

Organizationsmusttrustthepartnerorganizationsintheprocess.Holmes

commentedthateveryonesignstheinadequatestandardcontractformsbecause

negotiatingnewlanguagewouldbecomplexandprohibitivewithlawyersrepresenting

eachpartyandchallengingeveryword.Instead,hecontends,thesignedcontractgoesin

thedrawerandisnotseenagain.“Weactuallyputtogetheramuchsimplerteaming

documentonhowtheteamisgoingtoworktogetherintheprocess,andeverybodysigns

ontothat,andthat’sthewaytheteambehaves,”hesaid.“Ifweeverwenttocourt,Idon’t

knowwhatwouldhappen,butthat’sthewayweactuallywork.”Trustisclearlyattheheart

ofthismodel,asitisinworkforthemilitary.Beckertalkedaboutthe“triangleoftrust”

betweentheDefenseHealthAgency,theCorpsofEngineers(orNAVFAC),andtheusersof

thefacility(ServiceMedicalDepartments).

Anescapevalvewhenallelsefailsisatrustrelationshipatthetop.Leadershipof

thevariousprojectteam’scomponentsshouldhavebuiltastrongrelationshipoftrustwith

thepartyorpartiesattheverytopoftheclientorganization.Inacrisis,thistrustmay

rescuearelationshipinjeopardy.

Observations

InadditiontotheareasofbroadconsensustreatedaboveasPrinciples,afew

additionalObservationscanbemade.Thereissomevariationamongtheparticipantsin

termsofuserinvolvement,conflictresolution,potentialevaluationmetrics,andvariations

inthemodelsofprojectdelivery.

Observation:Conflictresolution

Conflictsmustberesolvedquickly,withfairness.Theparticipantsvoicedsupport

forcompletecommunicationtransparency,yetsomefeltconflictsneednotbeairedacross

theentireteam.Calhoundeclaredthat“littleproblemsjustgetbigger,andtheyagelike

32

milk,notwine.”Theinterviewparticipantsspentlittletimeaddressingconflictresolution,

perhapsbecausesuccessfulprojectsencounterfewerconflicts.Itisexpectedthatwherever

possible,thepartieswillrapidlyresolvetheirpotentialconflictsattheirownlevel,without

turningtoarbitrationorinstructionfromabove.Conflictsbetweenusergroupsatone

institutionareresolvedbytheproject’ssteeringcommittee.

Conflictsdonotneedtobewidelybroadcast.Holmessaidthat“wedon’thandle

theminfrontofthecustomer.”Mostissuesarehandledbytheowner’sprojectmanager,

andthegeneralcontractorisheldresponsibleforresolvingdisputeswithsubcontractors.

“Ishouldn’thearit90%ofthetime,”hesaid,“andthehospitalpresidentand

administrationshouldneverhearit.”Gioldasisconfirmedthatmostconflictsareresolved

bythegeneralcontractorwithoutreachingtheowner’srepresentative.

Observation:Userinvolvementindecision-making

Thereisatraditionofinternalandexternalteamsinvolvingtheusersofspace

inthedesignprocess.Theparticipatoryplanningmodelinvolvestheintendedusersofthe

buildingtohelpthedesignteammakedecisionsaboutfunctionandprocess.A

participatoryprocesstoincludethepeoplewhowillultimatelyoccupythespacebeing

designedhasbeenwidelyutilizedsincethe1960s,butlargehealthcaresystems,likethe

MemorialHermannHealthSystemheadquarteredinHoustonhavesoughttoachieve

greaterconsistencyfromonesitetoanother.Therehasbeenashiftinthelevelof

participationofferedtotheendusers.Theparticipantsofferedvariationsintheir

descriptionsofmethodsforinvolvingthelocalorsystemusersintheprojectdecisions.

Itappearsthattheparticipants’organizationshavetakenstepstoreducethe

variationininputfromusers.TexasChildren’sappoints‘ambassadors’torepresentthe

peerstakeholdersandusergroups.Theybringtopicstothedesigntable,assuretheyare

fullydiscussed,andreturntotheuserstocommunicatedecisionsandtheirreasonsina

transparentprocess.Othershavecommitteesof‘superusers’atasystemleveltorepresent

otherusersatthelocallevel.TexasHealthResourcesretainstheauthoritystructureatthe

systemlevelandtreatstherepresentativesofthelocalhospitalascustomers.

33

Kouletsisremindedusitisalsocriticaltorememberthat,ingeneral,20-30percent

ofthecontentexpertsfromtheOwner'ssidewillneveractuallymoveintothecompleted

project.PromotionsandjobchangeswithintheOwner'sextendedteammeansthat

introducingnewmemberstothevisionandthetaskofchangemanagementisnever

ending.

Observation:Multipledeliverymodelscanbeeffective

Successfulprojectshaveusedseveraldeliverymodels.Multipledeliverymodels

havebeeneffectiveforlargeandsmallprojects,privateorpublic.Theinterview

participantsmentionedexperiencewithtraditionaldesign-bid-buildprojects,alongwith

negotiatedbid,CMatrisk(ConstructionManager),design-build,andtheincreasinglyseen

P3(PublicPrivatePartnership)process.

RabernotedthattheP3processrequiresawell-organizedclient,alongwithwell-

organizedarchitecture/engineeringandconstructionteamstotakeadvantageofthespeed

oftheprocess.KouletsismentionedtwoversionsofIntegratedProjectDelivery(IPD)

includingacontractingstructurelinkingallofthepartners,andanIPD-likestructure

wherethespiritisthesame,butdoneunderamoretraditional“hub”ofcontractual

relationshipswiththeOwneratthecenter.TheHealthDefenseAgency’sJohnBeckernotes

thattheDepartmentofDefenseusesDesign-Build,Design-Bid-Build,EarlyContractor

Involvement(ECI),IntegratedDesign-Build-InitialOutfitting(DBIO),andIntegrated

Design-Bid-Build(IDBB),amongothermodels.CalhounmentionedtheVA’sIntegrated

DesignandConstruct(IDC)method.

Gilbane’sDougHarperdescribedhowdesign-bid-buildhadbeenthe“triedandtrue

method”forthegovernmentinwhichtheOwnerhadmajorinput“tocustomizewhatthey

wanted.”Hecontrastedthatwithdesign-buildwhichprovided“alittlebitmoreprice

certainty,”andsuggestedthatthegovernment’sintegrateddesign-bid-build{IDBB)was

modeledonthecivilianCMat-riskmethod,butthattheFederalAcquisitionsRegulations

(FAR)“didnothavethelanguagetoallowanat-risktypecontract.”Hisconclusionwasthat

design-buildmightbethebesttoolforgovernmentsystems,aslongastheyunderstandthe

levelofadvancedocumentationrequired.

34

Ownershavetrieddesigncompetitionsamongselectedfirmspaidnominalfees.The

NIH’sJudyQuasneybelieves“Aniconicbuildingwhichisdeemedworthyofacreativeflair

isworthacquiringthroughadesigncompetition.”Holmesdescribedprojectsinwhichthe

Ownernegotiateddirectlywithsomeofthesubcontractors.WalkerEngineering’sSam

Gioldasispointedoutthegeneraltendencytobidprojectswhenthereislittleworkand

competitionishigh;andtheoppositetendencytoprefernegotiationwhenworkis

plentiful.

Themajorlessonhereisthatanyoftheseprojectdeliverymodelscanproducea

successfulproject,butCalhouncautionsthat“nooneprojectdeliverytypeisrightforevery

organization.”IPDandP3methods,forexample,maybemoresuitedtolargerprojects.

Responsibilityandliabilityischanging.Holmesrespondedtoaquestionabout

treatingthemechanical/electrical/plumbingsystemsasanidentifieddesign-buildelement

withinaconventionalcontract.“Theideaofhavingdesign-buildMEPisactuallypretty

appealingtomefromanOwner’sstandpoint,”hesaid.Hewonders,however,forwhom

theywouldwork.ThearchitectistodaythekeeperoftheRevitmodelusedbytheentire

team,butHolmesbelievesthecontractorwilleventuallyhavethatrole.Hepointsoutthat

thecontractorhasthecontractualrighttorelyontheaccuracyofthedrawings,yet

“nobodythinkstheyareaccurate.”Holmescontendedthatdocumentationandcontracting

processeshavenotcaughtupwithreality.

Somemethodsofferthepotentialforanemphasisonlifecyclecosting.TheP3

process,asanexample,hasthepotentialtobeseenasthetotalcostofownershipsinceit

includesanoperationalcomponentforaperiodaslongas30years.ClarkConstruction’s

BillCalhounbelievesthereispotentialforgreatvaluewhentotallifecyclecostis

considered,andishopefulthatgovernmentalOwnerswilleventuallychangethe

legal/financialconstraintspreventingselectionbasedontotalcostofownership.

Observation:Owners’deliverymodelsarenotstatic

ContinuousimprovementandconstantchangeisnormalformostOwners.The

participantsdescribedmultipletypesofchangeintheirevolvingprocesses,andmultiple

reasonsforchange.TexasHealthResources’BrianHolmesdescribedtheinfluenceofnew

35

technologiesfordocumentingprojects,including3-Dmodelsthatallowfordiscoveryof

systemconflictsbeforetheprojectreachesthefield.

Deliveryisanimportantmeasure.Stantec’sBruceRabersaid,“Deliveryiskeyfor

everybody.TheOwnerwantshisbuilding.Thecontractorwantstogetoutoftherequickly.

Andthearchitecturalanddesignstaffwanttogettheirworkdoneandgetoutwithout

losingmoney.”Ifitgoesright,everyoneishappy,hesaid.“Ifitgetsdonewrong,thereare

lotsofunhappypeopleformanyyears.”

Observation:Evaluationmetrics

Youcan’tmanagewhatyoucan’tmeasure.Thedifferentorganizations

representedbytheparticipantshavedifferentmetricsfortrackingandmanagingaspects

oftheircapitalprojects,yettheyallmanagetoaddresskeyissuesofimportancetotheir

ownprojectdeliverystructure.Beckertellsusthat“codifyingtherolesandresponsibilities,

havingopentransparentcommunication,andhavingprojectperformancemetricsinplace

thatgetreportedandreviewedonarecurringbasishaveenhancedourabilitytodeliver

theprojectthatwethoughtwewerebuying.”Hedescribedputtingprocessesandmetrics

inplacetoinstillaccountabilityateachlevelofthecomplexorganization.Developmentofa

consensusmodelforprojectevaluationmetricsisaworthytaskforfuturemanagersand

theirexperiencedconsultants.

Conclusion

ThiswhitepaperaddressesthefutureoftheOwner’sroleinprojectorganizationfor

healthcaredesignandconstruction.Thetwelveparticipants,whoareeachrecognized

leadersintheindustry,werequiteconsistentintheirresponsestothevariousquestions.

TheOwnerplaysacentralroleintheproject’ssuccess.JohnKouletsisreportedthatinthe

Kaiserexperience,“ThemorethattheOwnerisawareandacceptstheirownaccountability

andresponsibilityintheproject,themorelikelytheprojectwillgowell.“

36

• AnOwner’svision,goals,andobjectivesmustbeclear,welldocumented,and

fullysharedateveryleveloftheprojectteam.

• Asetofexpectationsforqualityandstandardsorguidelinesthathavenot

becomeoutdatedorstalehelpguidetheplanning,design,andconstruction

process.

• TheOwnermusthaveanexperiencedsetofinternalleaders,orhirethem

externally.

• TheOwnermaywishtoworkconsistentlywithagroupofpre-qualifiedfirms

andcompaniesthathaveahistoryofstrongperformance,whoeachoffer

specificexperiencedindividualswithprovenperformanceasprojectleaders.

• Theassembledteammusthavedirectincentivesforeveryone’sperformance,

andallmustrecognizethattheorganizationssucceedorfailasagroup;notas

isolatedplayersinacompetitivesetting.

• Asuccessfulprojectwill,ofcourse,haveaccurateandreliableestimating,

usuallyfromaqualifiedexternalconsultantorteammember.

• Constantmonitoringofcostandschedulewithtimelyandtransparentfeedback

totheteamisrequired.

• Theparticipantsstatedtheirpreferenceforahierarchicalstructureof

responsibilitiesinwhicheveryonetakesdirectionfromasingle,unambiguous

source.

• Theprojectorganizationalmodelrequireseffectiveandtimelycommunication.

• Rapidcommunicationisahallmarkofourtime,andisrequiredtokeepaproject

movinginitsplannedtrajectory.

• Avaluablemethodforacceleratingqualitydecisionmakingistoensurethatall

theappropriateplayersareintheroomatthesametime,soallperspectivescan

beconsideredasdecisionsaremade.

• Eachcomponentofthelargerprojectteamiscomposedofindividualswhomust

continuouslyinteractwithoneanother.Theirpersonalskillsassociatedwith

humaninteraction,facilitation,andconflictavoidancewillbeimportant.

37

• Teammembersshouldhaveintegrity,beempathetic,understanding,and

genuinelycareforothersassociatedwiththeproject.

• Intheend,trustandrespectamongstindividualswhomustworktogetheris

crucialtoprojectsuccess.

Theparticipantsdevelopedaconsensusthattheseelementsmaybetheminimum

requiredforprojectsuccess,butdidnotruleoutotherpossibleconsiderations.Further,

theyfounditimportanttostatethattheseprincipleswerenotrestrictedtolarge,complex

capitalprojectsforhealthcarefacilities.Theycanbeshowntoplayavitalroleonsmaller,

lesscomplexprojects,aswellasprojectsfromotherindustries.

Projectsuccessisneitherrandomnoraccidental.

Successrequireshardworkonthepartofmany.Successrequiresthefullfocusand

consistentattentionoftheexperiencedplayersovertheentirecourseoftheproject’s

duration.WorkingtogethertoachievetheOwner’svision,thoughdifficult,canbe

enormouslysatisfyingwhensuccessisrealized.

38

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