Conventional Engineering is Failing Health Care Building Owners

By Michael McLaughlin, Executive Vice President, Southland Engineering

Too often, health care building owners do not get the results they expect from engineers and builders. In fact, only 30 percent of capital projects meet owner expectations in terms of budget and delivery date, according to the Lean Construction Institute. That means conventional engineering approaches fail to meet owner expectations 70 percent of the time. But it doesn’t have to be this way – there’s a proven approach that more consistently delivers the results owners rightly expect: a right-sized, optimized solution and efficient process that remains in-line with costs presented to and approved by executive boards. We are talking about a different kind of approach – one that redefines the expectations of a modern engineering firm. This type of engineering redefined is something every health care building owner should consider before starting any capital project.

What is engineering redefined?

The creation of a single, optimal technical solution that simultaneously addresses the expectations of cost, constructibility and maintainability is engineering redefined. It begins with a keen understanding of the impact engineering decisions have on a health care project. These impacts are vast, encompassing everything from mitigation of infection risks to managing a hospital’s ongoing energy and operating costs. Almost every outcome on a project relates back to decisions made by engineers. Far too often, engineers either fail to consider that impact or are missing the knowledge, resources or the trust to positively impact the project’s outcome. When engineers make a conscious choice to do these things, they start to redefine engineering through a more connected approach.

The concept sounds simple, but it takes great effort and a sincere desire to understand details and make timely decisions. A connected approach to engineering is anchored in an engineer’s ability to gather and assess conflicting information, and dig into the details with subject matter experts to develop solutions that are truly optimal. This process, referred to as connected engineering, can require multiple iterations with various stakeholders – but once it is complete, the decisions are lasting and impactful.

A better approach leads to better results

A connected engineering approach requires engineers to expand their influence. This means going beyond engineering fundamentals into topics such as construction estimating and budgeting, cost management, construction planning, labor productivity, economics, total cost management, and more specifically for health care facilities, topics such as patient care models, emerging medical technology and certification by the Joint Commission on Accreditation of Healthcare Organization (JCAHO). Understanding the fundamental drivers in each of these areas allows engineers to make more informed decisions and truly impact the outcome of the project.

To understand how this looks in practice, let’s consider the use of 100 percent outside air systems for hospitals. Once a favored mechanical system for a health care environment, the energy crisis of the 1970s scrutinized the use of outside air and considered it to use too much energy. Standards and codes were then changed to reduce the amount of outside air used for building ventilation to save energy. Nearly a decade later, the result was an epidemic of “sick building syndrome” cases, with too little outside air identified as a primary culprit. Fortunately, the codes and standards were revised to improve the indoor environment of buildings, but the 100 percent outside air system was permanently branded as an “energy hog” and “too expensive” in the HVAC world.

But that is no longer the case. Improvements in energy recovery devices and control systems, enhanced energy modeling capabilities and a deeper understanding of construction and operating costs have proven otherwise. When designed appropriately, 100 percent outside air systems can actually reduce energy consumption when compared with a traditional recirculating system – and, it can cost less to install and maintain. It doesn’t stop there –  a 100 percent outside air system is more flexible to adapt to future hospital changes, contributes to the sustainability of the facility, and is considered beneficial for both patients and staff.

Employing a connected engineering approach, modern day engineers are shedding old paradigms and forging new ones by combining the core needs of a health care environment with fundamental engineering knowledge, modern day analytical tools, insight and understanding of construction cost and operational efficiency. And when applied to health care mechanical systems, 100 percent outside air systems have been re-established as a favored mechanical system for a health care environment.

Connected engineering leverages technology

Connecting technology improves reliability and expedites the decision-making process. Advanced simulation tools such as computational fluid dynamics and advanced energy modeling, coupled with historical data, real time building data analytics and building information technology are just a few ways of harnessing the power of information to improve outcomes for a health care project.

Consider a case study of a hospital considering the use of displacement ventilation for the patient tower. This advanced approach has the benefits of reducing energy use, lowering first cost and improving ventilation effectiveness. The challenges for this system include acceptance by the local authority having jurisdiction (AHJ) and significant retrofit costs if the system does not perform as expected.

To eliminate the uncertainty, the engineering team engaged the use of computational fluid dynamics (CFD), a computer simulation tool used to validate with precision the temperatures and flow of air or water. Using this tool – along with the input of engineers, architects, facility operators and product manufacturers – the displacement ventilation system was modeled and optimized to peak performance under a wide range of operating conditions. To add further reliability to the results, a mock up patient room was constructed, and tested in a laboratory to confirm the system performed as modeled. The actual results validated the system approach, which ultimately gained the approval of the AHJ. This design had no additional first costs, and has saved the hospital nearly $250,000 per year in ongoing energy and water costs.

Linking applicable technology tools with key subject matter experts is yet another way connected engineering can achieve better outcomes at reduced risk.

Connected engineering links relationships

Engineers must extend and engage in relationships with a wide range of stakeholders, including owners, hospital administrators, physicians, nursing staff, facility operators, and medical equipment providers, as well as architects, contractors, estimators, vendors and a host of other participants to improve decision making. Most importantly, connected engineering requires listening and valuing the input of others to build a level of trust that traditionally has not existed in this fractured industry. When coupled with an effort to expand the individual engineer’s personal knowledge of the work that others do, this results in better outcomes for all involved:

For health care owners: Improve patient outcomes, reduce capital costs, improve energy and operational savings, improve reliability, and increase facility efficiency and adaptability.

• For architects: Eliminate disruptive “value engineering” near the completion of design, obtain reliable input and feedback during the design process, and reduce construction administration costs and change orders.
• For engineers: Achieve better solutions, create impactful results for the patient and staff, improve reliability, improve cost certainty, and reduce construction administration.
• For general contractors: Achieve cost targets, reduce construction durations, reduce construction risks, improve coordination, eliminate scope gaps, and improve jobsite safety performance.
• For contractors: Benefit from construction-ready design and a single model for both design and construction, improve jobsite productivity and scheduling certainty, and enhance safety performance.

Most importantly, connected engineering requires listening and valuing the input of others to build a level of trust that traditionally has not existed in this fractured industry.

In recent years, the health care building industry has worked to improve collaboration among partners by using well-known tools and methods like Integrated Project Delivery and Design-Build and Design-Assist contract models. But these measures are not enough. Engineers must redefine the expectations of engineering. Through a unique approach that connects our engineering decisions to real cost, practical construction, and realistic facility operations, we achieve more. By becoming leaders and modernizing our approach, we can drive the industry forward.

About the Author

As the Executive Vice President, Michael McLaughlin leads Southland Engineering to redefine the expectations of a modern day engineering firm by delivering cost responsible solutions that are innovative, constructible, and maintainable. With extensive experience in the engineering and construction industry, he is able to help Southland Engineering strategically bring engineering services to market and meet its business goals.