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Complex Healthcare Facility Management and Lean Construction

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 HERD VOLUME 3, NUMBER 2, PP 3-6 COPYRIGHT ©2010 VENDOME GROUP, LLC Guest Editorial

Complex Healthcare Facility

Management and Lean
Construction
Sarel Lavy, PhD, and José Fernández-Solis, PhD

“Health care projects are very complex, sonnel; and commissioning processes.
and extensive planning is required to Still, this list represents just a few of the
deliver them. Hundreds of participants, factors that must be considered while
thousands of products and systems, and constructing, expanding, renovating, or
tens of thousands of decisions must be restoring a healthcare facility.
orchestrated on the path to final comple-
tion” (Burgun, Sprague, Stein, & Atkins, In general, the management team of
2008, p.119). Healthcare construction Sarel Lavy, PhD any construction project should pay
may create conditions that are dangerous careful attention to items such as con-
to a hospital’s patients, staff, and visitors; struction contracting, project manage-
therefore, it is essential to include in the ment, value engineering, construction
process provisions for infection control; methods, project controls, scheduling
risk assessment; life safety; protection and estimating, workforce supervision,
of occupants during construction (in- construction equipment, construction
cluding planned or unplanned outages, safety, technology, and commissioning.
movement of debris, traffic flow, clean- José Fernández- However, because healthcare construc-
Solis, PhD
up, and so forth); plans for disruption of tion deals with unique and very com-
services; measures to be taken to train hospital plicated structures and systems (e.g., nuclear,
staff, employees, visitors, and construction per- electromagnetic, gases, radiation, chemical, and
concentrated gases), these items assume higher
Author Affiliations: Sarel Lavy and José Fernández-Solis are both
levels of importance and criticality for the success
Assistant Professors of Construction Science at Texas A&M University in
College Station, TX. of a project.

HERD Vol. 3, No. 2 WINTER 2010 • HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 3
 Guest Editorial
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. Therefore, they require flexibility and tend
to postpone final 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). The waste at hand is not only material and
information waste (caused by conflicts, errors,
and omissions detected with the use of building
information modeling, nth-Dimension comput-
er-assisted design, and computerized models),
4 WWW.HERDJOURNAL.COM ISSN: 1937-5867
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,
conflict 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). The difference 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).
The 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
first to see the advantages in the design, construc-
 HERD VOLUME 3, NUMBER 2, PP 3-6 COPYRIGHT ©2010 VENDOME GROUP, LLC
tion, and maintenance of healthcare facilities
using advanced project delivery techniques and
processes, because they tend to own, operate, and
maintain these facilities.
The link between competency, profit, 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. Therefore, 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
financial—for the improvement of performance
and the productivity of built facilities (Atkin &
Brooks, 2000; Nutt, 1999). Thus, successful fa-
cility management depends heavily on cost and
efficiency (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) identified the major areas of
healthcare facility management in the United
Kingdom as strategic planning, customer care,
market testing, benchmarking, environmental
HERD Vol. 3, No. 2 WINTER 2010 • HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL
Guest Editorial
Healthcare facility management
can be considered one of the
key elements for the successful
delivery of healthcare services.
management, and staff development. Rees (1997,
1998) found that the healthcare sector tends to
integrate noncore services (risk management,
energy efficiency, 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 effectiveness of providing healthcare
service.
Clearly, healthcare facility management is to some
extent different from any other sector or type of
building management, such as office 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 effect of decisions made in the ear-
ly design stages on subsequent medical outcomes,
among others—contributes to the notion that
5
 Guest Editorial
healthcare facility management is an area that re-
quires more investigation and study. This 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.
This 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.
References
Abdelhamid, T. S., El-Gafy, M., & Salem, O. (2008, Fall). Lean
construction: Fundamentals and principles. Journal of the
American Institute of Constructors, 8–19.
Aherne, J., & Whelton, J. (2010). Applying Lean in healthcare—
A collection of international case studies. Florence, KY: Pro-
ductivity Press.
Alexander, K., Atkin, B., Brochner, J., & Haugen, T. I. (2004).
Facilities management innovation and performance. New-
York City, NY: Spon Press.
Atkin, B., & Brooks, A. (2000). Total facilities management. Ox-
ford, UK: Blackwell Science.
Ballard, G., & Howell, G. (1998). Shielding production: Essen-
tial step in production control. Journal of Construction Engi-
neering and Project Management, 124(1), 11–17.
Bertelsen, S. (2003). Construction as a complex system. In
Proceedings of the 11th annual meeting of the International
Group for Lean Construction, Blacksburg, VA.
Burgun, J. A., Sprague, J. G., Stein, M. A., & Atkins, J. B.
(2008). Introduction to health care planning, design, and
construction, 2nd ed. Chicago, IL: American Society of
Healthcare Engineering.
6 WWW.HERDJOURNAL.COM ISSN: 1937-5867
View publication stats
Cain, C. T. (2004). Performance measurement for construction
profitability. Indianapolis, IN: Blackwell Publishing, Wiley-
Blackwell.
Dinsmore, P. C., & Cooke-Davies, T. J. (2005). The right proj-
ects done right!—From business strategy to successful proj-
ect implementation. Indianapolis, IN: John Wiley and Sons.
Douglas, J. (1996). Building performance and its relevance to
facilities management. Facilities, 14(3/4), 23–32.
Fernández-Solís, J. L. (2008). The systemic nature of the con-
struction industry. Architectural Engineering and Design
Management, 4(1), 31–46.
Gallagher, M. (1998). Evolution of facilities management in the
health care sector, Construction Papers, No. 86, (pp. 1–8).
Ascot, United Kingdom: The Chartered Institute of Build-
ing.
Gelnay, B. (2002). Facility management and the design of Vic-
toria Public Hospitals. In Proceedings of the International
Council for Research and Innovation in Building and Con-
struction (CIB) Working Commission 70—Facilities Man-
agement and Maintenance Global Symposium 2002 (pp.
525–545). Glasgow, Scotland: CIB.
International Facility Management Association. (2009). Defini-
tions of facility management. Retrieved April 13, 2009, from
http://www.ifma.org/what_is_fm/index.cfm
Koskela, L., Howell, G., Ballard, G., & Tommelein, I. (2002). The
foundations of Lean construction. In R. Best and G. de Va-
lence, (Eds.), Design and construction: Building in value (pp.
211–226). Oxford, United Kingdom: Elsevier, Butterworth-
Heinemann.
Lavy, S., & Shohet, I. M. (2004). Integrated maintenance man-
agement of hospital buildings: A case study. Construction
Management and Economics, 22(1), 25–34.
Miller, D. (2005). Going Lean in healthcare. White Paper 7, In-
novations Series 2005. Cambridge, MA: Institute for Health-
care Improvement.
Nutt, B. (1999). Linking FM practice and research. Facilities,
17(1/2), 11–17.
Rees, D. (1997). The current state of facilities management in
the UK National Health Service: An overview of manage-
ment structures. Facilities, 15(3/4), 62–65.
Rees, D. (1998). Management structures of facilities manage-
ment in the National Health Service in England: A review of
trends 1995–1997. Facilities, 16(9/10), 254–261.
Ward, A., Liker, J. K., Cristiano, J. J., & Sobek, D. K. (1996,
Spring). The second Toyota paradox: How delaying deci-
sions can make better cars faster. Sloan Management Re-
view, 43–61.