You can manage construction risks.

A construction project is about the riskiest thing any company does in the normal course of business. Hundreds of things can go wrong, dozens will. But officers who analyze and manage every other sort of risk often ignore construction risk as if it were uncontrollable. The truth is, it can't be eliminated, but it can be controlled. Construction is not a product but a confusing and often exasperating service. A group of experts--architects, bankers, consultants, contractors, engineers, users, city officials--coordinate the activities of an army of suppliers, laborers, designers, subcontractors, and inspectors. The job of the company officers is to coordinate the coordinators; to make prompt, informed decisions as the work progresses; to take and retain project responsibility at the highest level; and to analyze and manage the entire process in the following seven stages: 1. Study the types and phases of construction risk. 2. Assess the risks of the company's particular project. 3. Match these risks with the in-house capabilities. 4. Define a building strategy. 5. Pick the right kind of contract. 6. Choose a contractor. 7. Monitor construction. Analyzing risk is largely a matter of assessing the complexity of the building, the site, the financing, the schedule, and the special uses and problems of the project. This analysis then drives the choice of contract and contractor. The range runs from low-cost providers, lump sum contracts and very little teamwork at one end of the spectrum to highly differentiated construction companies, guaranteed-maximum-prince contracts, and consultative coordination at the other.

Merging facility and financial planning: a new approach.

This article seeks to help hospital administrators and boards (especially planning and finance committees) balance facility and financial aspects of a construction project by planning for each concurrently. It recommends that the process start with formal strategic plans, and that facility and capital plans be advanced interactively, thus maintaining flexibility to ensure that the hospital's objectives can be met within manageable financial limits. The authors suggest that the project thus delivered will be the most effective and efficient project possible within defined constraints. And, once planned, the project will be ready for implementation--false starts will be eliminated.

Trends in hospital planning: tools for the next decade.

This article observes that the team of specialized professional disciplines needed to deal with the technical complexity in health care architecture has become fragmented. This has lead to an aesthetically boring and uninspiring architecture. The author's "dynamic" approach to the facility development process suggests a reintegration of disciplines as a first measure for improvement. As a second consideration he discusses technological advances in the state-of-the-art of pre-architecture (planning, programming) and design which could allow architects to more adequately address aesthetic and environmental needs of patients and workers in health care facilities.

Commissioning.

Commissioning, or "starting up," a new facility is described in this article as the management of change. The authors make a strong case for commissioning to be a strategic issue addressed by professionals on the project team almost from the beginning of project design. The paper makes a useful distinction between engineering commissioning (the energized system) and operational commissioning (the human system); and they address both in highly specific terms.

Managing construction at Greater Bakersfield Memorial Hospital.

The management of major expansion projects often exceeds the in-house capabilities of hospitals. This article describes how Bakersfield Memorial Hospital in Bakersfield, California, used a construction management (CM) firm to handle its $40 million expansion project. The CM, as the owner's representative, ensured that the project was completed on schedule with changes from the original design made at minimal cost and with adequate documentation to provide legal protection for the hospital should cost disputes arise.

Planning, design, and building for health services.

Robert Douglass discusses why and how this issue was compiled and notes that, regardless of the state of the health care industry (i.e., in a mode of expansion or retrenchment), health facilities will always change, and construction will be a fact of life. Educating health care executives about the health facilities development process (with all its individual but interrelated components and phases) is important in order to assist these executives in minimizing risk and achieving success in their own projects. He also gives the reader an "executive overview" of the health facilities development process, outlines several key factors for administrative control in virtually every health facility project, and offers specific suggestions for executive leaders seeking excellence in health facility development.

How to be a good consumer (both buyer and manager) of programming services.

This article provides a straightforward and clear introductory explanation of programming, the process of developing a formal statement of the requirements of a facility project. It offers recommendations on process management, includes examples of programming "products," and cautions about potential pitfalls. A health care executive is typically faced with one or more facilities projects (new construction and/or renovation) during his or her career. The development of facilities projects is cloaked in an aura of horror stories and old wives' tales, interspersed with caveats and jargon. One key step in a successful facilities project is the development of a "program"--planners' jargon for a formal description of project requirements. This article is intended to provide future health care executives with an understanding of, and an insight into, the development of a program. It is not intended to develop a rigorous programming methodology, but, rather, to define programming, describe its attributes and uses, provide an overview of how programming should be accomplished, and caution the new executive about some pitfalls.

The design process or, how not to be afraid of building.

The excitement and fun of the design process is described in this article. The author makes a strong case for the active involvement of users throughout the formative stages of a project (i.e., from "kick-off" through schematic design and design development). Design techniques involving on-site work sessions ("squatters") and interactive gaming are discussed. The discussions of architect selection and cost control during design are of particular importance.

Construction documents.

Contractors base their bids on construction documents and use them as their daily "nuts and bolts" guide in constructing the building. They are the owner's legal instrument to insure that the building they want is constructed as they intended. This article defines and examines the vital significance of construction documents. Of particular interest is the discussion of owner and architect responsibilities during the construction documents (CD) phase, contractual agreements on these responsibilities, and how to minimize potential problems.