Robert Biggio
Health care projects are among the most complex in construction, and it can be particularly challenging to ensure development progresses smoothly, on budget and on time. Inefficiencies in the construction industry, combined with the emergence of new technologies and increased expectations for better quality and cost controls, have created a need for a collaborative approach to design and construction.
This is why Boston Medical Center (BMC), the largest safety-net hospital in New England, embraced the integrated project delivery (IPD) approach for its primary inpatient facility project, an integral part of its $300 million clinical campus redesign, and the first full health care-related IPD project in Massachusetts.
The traditional construction approach involves designers and contractors working in silos, increasing the risks of miscommunication and the need for revisions. In contrast, IPD involves key stakeholders – the architect, engineer, contractor and client – working together to optimize the project outcomes. Together they decide on the scope and budget and the project’s funds are centralized, with all stakeholders working from a common pool containing their fee. That fee pool is at risk throughout the project, motivating everyone to remain aligned to the common goals, and offering a strong incentive for all the stakeholders to work within the budget.
BMC’s four-year endeavor, which began in 2014, is intended to consolidate the medical center’s 2.5 million-square-foot campus by about 300,000 square feet, while transforming it into Boston’s greenest hospital. The redesign, which will rehabilitate some facilities and build new ones, will merge BMC’s two campuses and result in a more easily navigated, patient-friendly and efficient campus that will save close to $25 million a year in facility-related overhead costs.
Through its campus redesign, BMC is on track to cut its greenhouse gas emissions 50 percent by 2020, a goal twice as aggressive as that of most other hospitals in Boston. The hospital’s efforts to go green include air system upgrades, insulated windows, solar panels and an innovative biodigester that composts food scraps from the kitchen. The hospital is also in the process of building a combined heat and power plant on campus that would allow it to generate electricity more efficiently.
From my perspective, the IPD approach was made for projects of this kind. Having the architect and contractor on board during the design phase has been critical for BMC. In fact, a project of this complexity would not have been nearly as successful if we had used traditional methods for project delivery. Some key lessons learned from the project include the following:
Team chemistry and communication is essential. While IPD is becoming more accepted and prevalent, it requires a sophisticated team to manage its inherent challenges. Because of the collaborative nature of IPD, building the best delivery team, by selecting the right partners, should be a priority to ensure effective collaboration, minimize costs and maximize project productivity.
Location matters. As part of the IPD, consultants working on the project should be colocated onsite for the length of the contract to encourage collaboration. At BMC, we have a dedicated 9,000-square-foot space where 14 construction trailers are currently serving as the home base for nearly 90 contractors, engineers, architects and project managers overseeing the redesign project. This colocating has had a significant impact on collaboration and teamwork around the campus redesign project.
Seek buy-in from stakeholders. Involving the BMC medical staff early on in the design process was especially important for us, since the physicians were able to bring specialized clinical and patient care expertise to the equation, and their buy-in and support of the project has been crucial to its success. The team also found it helpful to engage the Patient Family Advisory Committee and the Boston Center for Independent Living for feedback during the design process, to ensure all patient needs were met during the design and construction phases.
While there is still work to be done on the redesign, it is clear the project would not have been as successful had we used a traditional approach. In our case, the IPD approach benefited the project immensely in terms of managing financial constraints and streamlining the redesign process, and it matched well with the culture of collaboration and innovation at BMC.
Ultimately, there is no singular best methodology for project delivery. But putting the project first, enabling others to succeed and not positioning for individual business interests should be the gold standard. And collaboration is the first step in that direction. Adopting the IPD approach can be the answer to ensuring exceptional collaboration in construction projects for hospitals and beyond.
Robert Biggio is the vice president of facilities and support services at Boston Medical Center.
