Orlando, FL June 4, 2008
Today’s Landscape…High Probability for a Runaway Inefficient and Obsolete Facilities
Rising Operating Costs Inflation
Auction Rate Bond Crisis Auction Construction Rate Bond Cost Crisis Escalation
Declining Reimbursement
Increased Competition
1
The Vision
2
The Experts Brian Garbecki, P.E.
Tim Strouse
Ð Gilbane – Providence, RI Ð Director Healthcare Center of Excellence Ð Healthcare Design Magazine’s "Top 20 Making a Difference in Healthcare Design" Ð Developed “Healthcare Cost Advisor”
Ð All Children’s Hospital - St. Petersburg, FL Ð Vice President Operations Ð Project Lead on $400M Program Ð Extensive Clinical Background Ð Licensed Captain USCG- Active
Richard Vermeulen, PQS
Kurt Spiering, AIA, HCHA
Ð Vermeulens Cost Consultants – Richmond Hill, ON Ð Principal Ð David B. Perini Jr. Award from the New England Construction Users Council Ð Developed Standard Elemental Format for CIQS
Ð Hammel, Green & Abrahamson, Inc. (HGA) – Milwaukee, WI Ð Vice President and Principal Ð Pioneer in Lean Principles Ð Co-Authored Patient Experience Process Ð “Invisible-Motivational-Inspirational”
3
The Moderator Patrick E. Duke Ð KLMK Group – Richmond, VA Ð Senior Vice President – Regional Manager Mid-Atlantic Ð Expertise in Project Launch Ð Focused Healthcare Experience
4
We’re Here To Help – Session Goals
Goal 1: Understanding a Healthcare Project Budget Goal 2: Provide Suggested Approaches to Establishing a Confident Budget Goal 3: Establish How to Recognize/Control a Runaway
5
Goal 1: Understanding A Healthcare Project Budget
آﻴﺲ,ﻣﻴﺰاﻧﻴﺔ 预算 Haushaltsplan Presupuesto бюджет Budget
6
The Owner’s Understanding A healthcare project budget includes all the costs I will incur to:
Acquire Land (If Applicable) Plan and Design Construct Equip and Furnish Finance Occupy (including one-time operating costs)
7
The Construction Manager’s Understanding Project Understanding What needs to be built… Where will it be built… How will it be built…. When will it be built… Construction costs Labor, Materials, Systems, Market Markups Accurate budgeting through… Early involvement Challenging questions Communicate to Understand
8
The Architect’s Understanding Financing Costs Land Acquisition Construction Cost Hard Construction General Conditions
Other Soft Costs
FF&E Medical Equipment Technology Professional / Administrative Review Fees Moving / Relocation Fees Staff training and participation
Contingencies Design Estimating 9
The Cost Consultant’s Understanding Historical Understanding Understand Benchmarks Understand historical market dynamics
Procurement Determine Strategy Define Scope in Detail Understand Value Equation
Risk Understand Level of Contingency Required Develop Escalation Based on Market Dynamics
10
The Owner’s Rep Understanding • I need to pull all this together! Landscape Architect Medical Equipment
Interior Design Engineers
Financing
Legal Legal
Construction
Legal
Medical Technology
Insurers
Design
Healthcare Owner
Department Task Forces Medical Staff
Signage/ Graphic
Permits
Insurance
Specialty Consultants
Subcontractors Safety Maintaining On-Going Operations
Focus Groups
11
Suppliers
Goal 1: Understanding a Healthcare Project Budget
A Healthcare Project Budget includes all costs to plan, design, construct and occupy the project. How the costs are accounted for is up to the Owner. A common understanding of the Healthcare Project Budget must be reached by all Team Members at the onset. Budgets should not be published without consensus of the Project Team
12
Goal 2: Provide Suggested Approaches to Establishing a Confident Budget 100 Degree of Impact on Cost (%)
75
Highest Ability to Make Changes
Cost of Making Changes
Cost of Construction ($)
50 25 0
Lowest Project Launch
Design Project Delivery Process
13
Construction
Define Goals and Understand Capital Constraints Establish a Vision for the Facility Establish Guiding Principles Know Funding Sources and Categorize by Level of Confidence Understand Timing of Financial Commitments Balance Routine Capital Needs with Project Scope Align Expectations with Level of Funding Continuous Reinforcement of Vision, Guiding Principals
“All Children’s replacement hospital and medical office buildings will set industry standards and be recognized as the national benchmark for pediatric facilities for the next 40 years.”
14
Establish Budget Component Responsibility Matrix Scope, Schedule and Budget
Control Document What line items are applicable? Who is responsible for them?
Ensure Team Members Understand
all Facets of the Budget – Line Items are Interconnected Encourage Team Members to Establish and Manage to Target Values Each Iteration of the Budget Test Should Reference Back to the Control Document for Evaluation 15
Use Effective Cost Modeling Tools Basis of Assumptions Options Analysis Benchmarking Modeling Tools by Clinical Program
Project Cost Results: Building Trade Cost $265.12/SF Conceptual $265.19/SF Buyout
by Building System Schedule / Escalation Impact Construction v Total Project
Costs
$0.07 Variance
16
Designing to a Value
17
Designing to a Value Set Based Design
18
The Reconciliation Process Have the estimates prepared independently Exchange estimates when both are completed Reconcile the estimates against each other Treat this process as a learning tool Do not make the process adversarial
19
Goal 2: Provide Suggested Approaches to Establishing a Confident Budget
Establish a vision and guiding principles and stick to them while understanding your available capital. Establish a cost model with proven tools/information and assign responsibility of elements to Team Members. Ensure there is a process to design to a target and reconcile between all Team Members at each budget checkpoint.
20
Goal 3: Establish How to Recognize/Control a Runaway
21
The Art of Benchmarking Academic Research: Chicago
Pharmaceutical Research: Massachusetts
Academic Research: Pennsylvania
Structure
$44
$41
Enclosure
$50
Interiors
Teaching and Research: Central New York
Weighted Average*
$57
$48
$47
$70
$50
$51
$54
$38
$48
$41
$48
$43
Fittings
$37
$33
$59
$48
$42
Mechanical
$127
$101
$143
$85
$114
Electrical
$42
$26
$50
$39
$41
Site
$12
$26
$26
$7
$15
Markups
$35
$38
$50
$54
$42
Total
$385
$383
$476
$380
$398
Element $/sf
22
The Art of Benchmarking Index plotting construction cost and nominal inflation
Construction costs decline below Trend Line when construction volume falls rapidly and below capacity Federal Reserve has targeted 3% or less inflation per year during this period
Percent Cost Increase
Construction costs rise above Trend Line when construction volume increases rapidly and above capacity 200%
150%
Inflation Trend Line—3.5% year average Construction cost for institutional/lab project Individual project
100% 1986 1988
1990
1992
1994
1996 1998
Year 23
2000
2002
2004
2006
2008
Finding Defects in Design Production Coordinated, intelligent information virtually represented to: Collaboratively design Facilitate construction Assist in maintenance
3D model
Field installation 24
Finding Defects in Design Production Consider Co-Locating Design Effort Involve Prime Subcontractors in Design Production Establish “The Big Room”
25
Internal Audit/Contingency Tracking Ensure monthly auditing with Team Members Set up Contingency Tracking Team Based Approach Goes back to Control Document with Responsibility Matrix Have categories of risks and exposures
Feed and Care Necessary
26
Establish Accurate Reporting Look at Software Solutions for Comprehensive Cost Management Need Flexibility in Reporting for Different Audiences Need reports that identify:
Commitments Expenditures Budgeted Amounts Budget Revisions Risks/Exposures and Potential Impact
Ensure Team Members are connected and Owner Accounting is reconciled
27
Controlling a Budget Sources of Change Changes in THE PLAN… Changes in DESIGN… Changes in the FIELD…. Controlling (Managing) the Changes No SURPRISES… Budgeting (Allowances)… Contingencies Control (Manage) IMPACT of the Change… Recognition Communication Timeliness 28
Goal 3: Establish How to Recognize/Control a Runaway
Monitor your budget using confident benchmarks through design and construction. Understand market forces at work. Control design by co-locating process and harnessing BIM technology. Establish accurate reporting to manage contingency and control changes. Change is not a bad thing, but bad change management is!
29
Final Conclusions – The Top Ten Establish a vision and guiding principles and understand your capital availability Understand all facets of the Healthcare Project Budget and how it will be structured Establish target values for all members to be responsible for Ensure cost model development tools are flexible and interactive Use a reconciliation process at each budget checkpoint
30
Final Conclusions – The Top Ten Ensure accurate reporting that caters to its audience and is flexible Control scope, schedule and budget by fostering close collaboration Actively manage the contingency and make decisions while understanding all risks/exposures Do not leave your benchmarks on the shelf – dust them off! Feed and care for your budget – it is a living and breathing being
31
We Welcome Your Questions
32