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

HERD Vol. 3, No. 2 WINTER 2010 • HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 3

“Health care projects are very complex,

and extensive planning is required to

deliver them. Hundreds of participants,

thousands of products and systems, and

tens of thousands of decisions must be

orchestrated on the path to � nal comple-

tion” (Burgun, Sprague, Stein, & Atkins,

2008, p.119). Healthcare construction

may create conditions that are dangerous

to a hospital’s patients, sta� , and visitors;

therefore, it is essential to include in the

process provisions for infection control;

risk assessment; life safety; protection

of occupants during construction (in-

cluding planned or unplanned outages,

movement of debris, tra� c � ow, clean-

up, and so forth); plans for disruption of

services; measures to be taken to train hospital

sta� , employees, visitors, and construction per-

Complex Healthcare Facility

Management and Lean

ConstructionSarel Lavy, PhD, and José Fernández-Solis, PhD

sonnel; and commissioning processes.

Still, this list represents just a few of the

factors that must be considered while

constructing, expanding, renovating, or

restoring a healthcare facility.

In general, the management team of

any construction project should pay

careful attention to items such as con-

struction contracting, project manage-

ment, value engineering, construction

methods, project controls, scheduling

and estimating, workforce supervision,

construction equipment, construction

safety, technology, and commissioning.

However, because healthcare construc-

tion deals with unique and very com-

plicated structures and systems (e.g., nuclear,

electromagnetic, gases, radiation, chemical, and

concentrated gases), these items assume higher

levels of importance and criticality for the success

of a project.

Sarel Lavy, PhD

Author Affi liations: Sarel Lavy and José Fernández-Solis are both

Assistant Professors of Construction Science at Texas A&M University in

College Station, TX.

José Fernández-

Solis, PhD

Guest Editorial

4 WWW.HERDJOURNAL.COM ISSN: 1937-5867

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. � erefore, they require � exibility and tend

to postpone � nal 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). � e waste at hand is not only material and

information waste (caused by con� icts, errors,

and omissions detected with the use of building

information modeling, nth-Dimension comput-

er-assisted design, and computerized models),

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,

con� ict 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). � e di� erence 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).

� e 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

� rst to see the advantages in the design, construc-

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

HERD Vol. 3, No. 2 WINTER 2010 • HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 5

tion, and maintenance of healthcare facilities

using advanced project delivery techniques and

processes, because they tend to own, operate, and

maintain these facilities.

� e link between competency, pro� t, 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. � erefore, 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

� nancial—for the improvement of performance

and the productivity of built facilities (Atkin &

Brooks, 2000; Nutt, 1999). � us, successful fa-

cility management depends heavily on cost and

e� ciency (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) identi� ed the major areas of

healthcare facility management in the United

Kingdom as strategic planning, customer care,

market testing, benchmarking, environmental

management, and sta� development. Rees (1997,

1998) found that the healthcare sector tends to

integrate noncore services (risk management,

energy e� ciency, 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 e� ectiveness of providing healthcare

service.

Clearly, healthcare facility management is to some

extent di� erent from any other sector or type of

building management, such as o� ce 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 e� ect of decisions made in the ear-

ly design stages on subsequent medical outcomes,

among others—contributes to the notion that

Healthcare facility management

can be considered one of the

key elements for the successful

delivery of healthcare services.

Guest Editorial

6 WWW.HERDJOURNAL.COM ISSN: 1937-5867

healthcare facility management is an area that re-

quires more investigation and study. � is 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.

� is 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.

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