Back to the Future

Traditionally, developing a building program has been a fragmented effort, with architects leading the way, engineers in charge of some activities, contactors in charge of others, and the balance left up to fate. With today’s technological advances, designing and building ambulatory surgery centers (ASCs) has become very complex. This process is fraught with pressures and uncertainty, and in many instances characterized by cost and schedule overruns, which also makes it expensive.

Such shortcomings are becoming more and more unacceptable in all industries, but they seem to be more intolerable in healthcare. Economic pressures are forcing healthcare providers to re-examine every aspect of operations, staffing ratios and energy consumption. The push is definitely on to find the most patient-friendly, efficient and cost-effective way to do business and provide healthcare on a day-to-day basis.

Historically, the bulk of medical construction has been through the conventional design-bid-build approach where an owner hires a fee-for-service architect to design a building. The architect develops the building program, and the project is ultimately put out to bid. Then, a contractor is hired to build the project. However, there are no cost “guarantees” with the design-bid-build approach; and as a result of the above mentioned pitfalls, many owners have recently turned to the design/build concept of building program development. This format integrates the design, engineering and construction segments of a project into a team approach with up-front cost “guarantees.”

The design/build concept of consolidating these design and construction segments in one format is nothing new, as at one time it was the traditional method. When a king or pharaoh wanted to build a new palace, stadium or temple, he would simply go to an individual called the “master builder,” who was the architect, engineer and contractor all rolled up into one. Therefore, today’s trend of developing projects with a design/build approach is in some respects — going back to the future.