The paradigm for the delivery of construction projects is undergoing a cultural shift, and nowhere is this change more evident than in the healthcare market. The evolution began in the early 90s as project delivery methods started moving away from a culture of command and control to one of trust and collaboration. This is largely due to the convergence of several separate, yet interconnected, concepts which have since become commonplace. So what are they and how have they come together to change an industry?

Experience-Based Design (EBD) and Innovation Teams focus strongly on capturing and understanding patients’ and caregivers’ experiences, aligning people with their behaviors to deliver the best building solution. So what does that mean and how is that collaborative? EBD is like Target Value Design and Pull Scheduling; it starts with the desired end result (the ideal experience) and works backward through the design process to craft the experience that the building should elicit, rather than just the systems and processes. This is accomplished through the use of Innovation Teams, comprised of designers, owners, staff, patients and the community who collaborate to discover that ideal patient and staff experience.

Target Value Design (TVD), like Experience-Based Design, starts with a desired outcome and works backward from there. In this case, TVD begins by setting a “not-for-a- penny-more” conceptual budget or Allowable Cost based on historical costs and best practices. As design progresses, the budget is continually tested against the allowable cost to ensure that the project never goes over budget. Value Engineering becomes a more meaningful exercise to correct cost overruns than the “cut and slash” exercises of past. Value-added cost information and alternatives are provided through close collaboration between architects, engineers, managers and key subcontractors and vendors. The outcome is a budget that is reliable and free from unpleasant surprises.

Pull Scheduling is the product of direct collaboration between the tradesmen who actually perform the work instead of a mandate coming from a single construction manager. It has been said that all schedules are forecasts and forecasts are mostly wrong by nature; thus, the farther out you forecast, the more wrong you will be. Think about it. Pull Schedules, conversely, are created by foremen or other responsible parties working backward from established milestone dates, creating opportunities for preceding activities to occur, thus “pulling” the work forward. Push-style scheduling forces work to be done without regard for appropriate timing or the optimal manpower required to complete the tasks. Pull scheduling relies on collaboration and the promises made by individual stakeholders, not the command of a project manager or superintendent.

The Future is upon us. We will continue to evolve and find more meaningful ways to collaborate and engage all stakeholders in the construction process. Experiences, budgets and schedules are only the tip of the iceberg. Relational Contracting, Building Information Modeling and Sustainability will take collaboration to new and never before seen levels. A transformation of the design and construction process is underway; we cannot deny it and in the “new economy” we can’t do without it.

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