Construction Cost and Schedule Strategies for Optimal Results

Healthcare and Life Sciences have been – and will continue to be – some of the most complex, dynamic construction segments on the market. Expectations for facilities are constantly being redefined as these sectors continue to grapple with a host of tests – shifting reimbursements and project funding, new market entrants, consumerization, and of course, the COVID-19 pandemic.

Just as these segments are being reshaped, so too should our thinking of the design and construction process. In Part 1 of this five-part series, we'll explore strategies for greater cost and schedule outcomes through:



Whether your building program calls for the construction of an ambulatory surgery center, expanded medical office building, or the renovation of a hospital suite, the demands on today’s healthcare owners and managers are immense. Facilities are increasingly complex; layers of regulatory compliance are required, schedules for construction projects are routinely accelerated, and budgets are ever-tightened. The COVID-19 pandemic has also brought its own unique set of issues, further amplifying the need for a transition to more cooperative project delivery methods led by nimble project teams.

Reduce Waste, Maximize Efficiency & Increase Value Through Project Team Integration

Strategies that promote early contractor involvement, qualification-based selection, cost transparency, and full-team collaboration (client, design team, contractor, sub-consultants, and targeted end-users) are proven to produce greater outcomes than those with lower levels of group cohesion. Thus, a full-team integration involving conscientious planning, continual design and process improvement, and leveraging the right tools ensures collective expertise results in value realized.

Involving critical participants in the earliest project planning phase, before advancing beyond schematic design, allows the team to collectively harness the talents and insights of individual members and avoid typical project pitfalls.



A linear design-bid-build approach often pits design intent against budget as complexity and scope scale upward. The result can often be an overly value-engineered, diluted end-product or a budget-busting scenario. The integrated delivery process optimizes the often-competing objectives of cost, quality, and schedule through close collaboration.

Making Data-Derived Decisions

From simple napkin sketches with cost-per-square-foot pricing to detailed budgets based on full plans and specs, an experienced contractor who is engaged early can serve as a critical resource for determining how much to invest and where to invest for maximum impact.

Constructability, building methods, materials, codes/regulations, and local practices can be fully investigated and challenges fleshed out. Clients are thus provided with detailed scopes and bid estimates to make the best data-derived decisions for their project.

Digging into the Details

Maintaining the ability and flexibility to align goals and resources requires knowing the right questions to ask.

Is your facility intended to serve as business-occupancy space, housing offices and exam rooms, or will it be more medically-intensive space (i.e., house extensive imaging services)? If it’s the latter, higher air change requirements, increased floor-to-floor heights, and more robust fire protection should be expected. Thicker columns, added shielding, and increased mechanical and electrical loads must also be considered.

Experience with renovation and adaptive reuse projects have shown us that long-term flexibility should be worked into the planning scenario. Costly impacts can be negated in the future if, for instance, a modular structural column layout can provide for simple, less costly changes when department structure and/or workflow requires alteration.

With proper planning between construction, design, and owner team members, such issues can be fleshed out early, lessening the odds of long-term repercussions.

Precise Coordination for Precise Budgets

Cost savings can also be realized through highly-detailed systems coordination. For instance, interstitial space constraints are a perennial concern. While the interstitial space between floors is often larger in healthcare and life science facilities than other buildings by necessity, it is usually filled to capacity with additional medical-specific systems (medical gases, isolated exhaust ducts, additional plumbing, etc.).

Precise coordination between the different disciplines (mechanical, electrical, plumbing, structural, life safety, and fire protection systems) through combined models ensures costly in-field conflicts and clashes are avoided.

MUSC Health and Modern Minds | Charleston, SC


Time is money, and well-executed, accelerated project scheduling can be a rewarding way to save costs and stay ahead of challenging market demands. A host of scheduling strategies can be implemented throughout the project lifecycle to reduce waste, improve efficiency, increase collaboration, and achieve maximum value.

Milestone scheduling provides for the identification of major events along the critical path (e.g., imaging equipment installs), while pull planning increases overall accountability and collaboration as the focus of workflows is based on downstream demand. Just-in-time delivery for pre-manufactured solutions or owner-installed equipment provides for proper on-site sequencing. Permitting, a particularly important component for healthcare (and a topic we'll explore in Part II), can be easily streamlined by engaging local and state officials in the process, thus decreasing the time between design and permitting.

Saving Time Without Risking Quality or Consistency

From medical head walls in hospital spaces to modular wiring systems for outpatient facilities, pre-manufactured solutions assembled offsite in a controlled area help drive speed, quality, and consistency. The uniform installation also reduces the risk of rework and improves implementation of future updates and maintenance.

The exact placement of pre-manufactured building components can be determined in advance with watchmaker precision and the highest level of robotic accuracy through model-based digital layout technology like QuickMark Layout.

Technical Integration Without Compromise

A fast-track schedule with technical scopes managed under one source (i.e., the contractor) considers all systems throughout each subcontractor’s scope of work. Early coordination identifies potential conflicts in design, manages for dimensional clearances, and ensures optimal installation times. With this consolidated effort, simultaneous work between the core-and-shell construction and buildout can help the tenant occupy the facility more quickly.

Staying Informed and On Track

Analytic software such as Procore® brings the office, field, designers, and owners together on one open platform. By storing accurate, real-time information in an easy-to-navigate, cloud-based format, project leaders and field teams can make better decisions faster, eliminate delays, increase efficiency, and reach ribbon cutting with nearly zero punch.

4. Integration of Virtual Technology

Realigning the planning process and integrating virtual design and construction (VDC) with project control applications provides nearly limitless opportunities to resolve design, constructability, and logistical challenges while also quickly exploring schedule, cost, quality, and operational efficiency impacts. Achieving balance – using the right applications for the right project – is crucial.

Enhancing Collaboration with the Right Platforms

Preconstruction visualization, model coordination between disciplines, and enhanced planning through applications such as Revit, Navisworks, and Edgewise create coordinated, efficient workflows that eliminate costly in-field rework and provide for an accelerated construction process. Further integration with facilities management platforms delivers to clients the ability to efficiently and proactively manage building systems.

Likewise, cloud-based collaboration and project control platforms (BIM 360 Glue, Revizto, Procore, etc.) provide unified access to project data, streamlining approvals, design, and construction operations.

With ample communication and an integrated delivery process, efficiency and value are maximized through all phases of design, fabrication, construction, commissioning, closeout, and facility operations.

Modeling for End-User Experiences

When building information models (BIMs) are paired with virtual reality (VR) and augmented reality (AR) technology, data visualization and accelerated decision making are powerfully enhanced.

For example, 3D planning capabilities with VR afford physicians, nurses, and other healthcare professionals the opportunity to virtually “walk” their spaces to better understand layouts, room finishes, workflows, on-stage and off-stage spaces, and overall usability of equipment placement.

Not surprisingly, immediate experiences and on-demand reconfigurations in the virtual world also come at a significantly lower cost than physical mock-ups.

In Parts II through V of this series – coming soon – we'll navigate the regulatory roadmap, delve into the intricacies of adaptive reuse and renovation projects, and finally, detail sustainability and infection mitigation measures which promote better healing through better constructed buildings.

You've got the basics of our approach to healthcare construction; get in touch with one of our experts to learn more. Email us directly or visit our portfolio pages to see more healthcare project experience.

Created By
Choate Construction