Review Process Impacts

California healthcare construction costs are among the highest in the nation, with $2.5 million as the average cost per bed for new hospitals. That’s why healthcare leaders in California are now utilizing a program called Phased Plan Review for more than 70 projects at 50 hospitals throughout the state.

 

What is Phased Plan Review? In California, most healthcare projects must go through a rigorous review process with the Office of Statewide Health Planning and Development. The traditional process is a continuous cycle of state reviewer comments and architect responses on the completed construction documents, which can take up to two years. 

 

Sometimes these reviews result in a complete reworking of a hospital design. To save time and decrease the potential for project escalation costs, a committee of hospital, design and OSHPD representatives came up with a collaborative streamlining of the OSHPD review process that also incorporates a lean project delivery approach to decrease waste and increase value.

 

The resulting PPR process starts with OSHPD reviews at the outset of the project. The architect submits milestones on a set schedule agreed upon by the design team and OSHPD, which is referred to as the PPR matrix. Review is under way soon after each segment or increment of the project design is completed instead of looking at documents as a whole.

 

The design team can quickly respond to OSHPD’s comments when that portion of the project is fresh, while also preparing the next agreed-upon package of drawings and materials. As a result of PPR, the time from design to construction to occupancy is expected to be about 12 months less than that of a comparable project going through the traditional OSHPD review process.

 

 

HGA Architects and Engineers recently used PPR to help expedite its work at Clovis Community Medical Center in Clovis, Calif., a large and complex project that involves the addition of a new bed tower and expansion of the diagnostic and treatment platform, as well as infrastructure upgrades.

 

Through this project experience, HGA’s designers can offer the following tips and observations that can contribute to the success of any complicated project that requires reviews and approvals:

 

 

An owner and its design team must understand and consent to some key caveats before utilizing PPR. Since changes to OSHPD-approved project components are a deal breaker for PPR, the owner must agree to not make any changes to portions of the design that have already been reviewed and approved via PPR by OSHPD. Issues are worked out prior to implementation documents, saving time and rework.

 

Another agreement is that the design team must be willing and capable of dedicating staff resources to up-front design work on tight schedules. They, and OSHPD, must be prepared to work hard and fast to keep up with the milestone review schedule. The timeframe for reviews needs to be negotiated early with OSHPD so that expectations are clear.

 

It is recommended to build in buffers to absorb schedule delays. Ultimately, both the owner and design team must be in agreement about the value PPR will bring to the project, and understand its implications in regards to keeping schedule commitments, making decisions and sticking with them, and following through on promises, as well as continuous communication and collaboration.

 

 

As part of the first PPR milestone at Clovis Community Medical Center, HGA submitted a package that addressed structural and Fire Life Safety (FLS) design approaches to OSHPD. These two segments usually create the most need for rework and resubmission on a project. By first receiving OSHPD’s approval of the design approach for structural and FLS, many of the other design components moved ahead on a faster schedule.

 

For easy reference and continuity, the FLS plans should be kept with the architecture drawings. Additionally, alternate methods of compliance must be determined and approved early in the process.

 

 

Planning and working toward a reasonable number of submittal milestones helps maintain a more aggressive schedule. Conversely, compiling too much information into one phase can result in the need for more review time.

 

Smaller, more frequent submittals enable OSHPD to complete reviews in a timely manner. Submittals must be complete and offer sufficient information and reference drawings necessary for decisionmaking. This proactive preparation results in more productive and complete feedback, resulting in less rework and waste. 

 

To be successful with PPR, the team must be cohesive and adept with multi-tasking. While one milestone is being prepared for submittal, responses to comments on previously submitted milestones are also expected. 

 

Utilizing online logging to track progress helps keep the team informed and coordinated. Continuity of team members throughout the project helps increase the team’s affinity and builds trust, as well as increasing efficiency and keeping project knowledge alive and accessible. All team members are responsible for being up-to-date on the intent of submittals and keeping abreast of project comments and responses to questions.

 

 

As with anything that is new, there is fine-tuning and continuous learning taking place for the process improvement of PPR. Consideration of conceptual approvals on areas such as duct wrap, fire dampers and structural systems are being discussed.

 

Overall, the learning and adoption of PPR will be built on a framework of openness and willingness to listen to new ideas, as well as patience and respect for team members as everyone becomes more familiar and adept with the process.

 

The PPR process is forging a new path founded on determination, positive attitudes and skilled collaboration that is resulting in significant changes in the way healthcare projects are reviewed and approved. Certainly, it illustrates a philosophical shift and a welcomed change in the healthcare design industry.