A synergistic approach to green building delivery, lean principles and building information modeling in the design of healthcare facilities

Healthcare facilities are among the most challenging types of buildings to plan, design, construct, and operate. Tools and techniques that enable information flow, such as Building Information Modeling and decision support systems, are needed to help project teams in the early phases of healthcare projects. To be effective, these tools and techniques must enable critical functions of design teams and also be aligned with the best practices in green healthcare facility delivery. These practices include the use of integrated project delivery methods, the active engagement of numerous stakeholders on healthcare projects through integration functions, the application of lean principles and considerations for the life-cycle use of the facilities. A synergistic approach for the integration of these tools provides a multiplier in terms of their benefits, and has the potential to provide more than the sum of the individual parts. This research examines the synergistic approaches present in healthcare building delivery in terms of greening attributes, lean principles and BIM (GLB) during the programming and design stages of projects to improve the overall understanding of the connections and overlaps. This goal is pursued through observations on multiple LEED certified hospital case study projects which led to the development of detailed descriptions, properties, concepts and categories associated with occurrences of the synergistic approaches. Another goal of this research study has been to assess how GLB synergies influence critical value streams that have life-cycle, operational and clinical outcome implications in healthcare facilities. This approach helps to support and underscore the need to make planning and analysis investments in such synergies that will result in an improved ability of project teams to maximize their impact. The findings provide detailed descriptions and analysis of twenty-one synergistic approaches, along with the emergent categories and connections. A conceptual model has been developed to assess the existence of the synergies, and show interactions that affect sustainable outcomes. Conceptual themes have been identified through content and pattern-matching analysis between green attributes, BIM and lean, and these include: (a) seek continuous improvement by sharing of information and knowledge; (b) eliminate waste; (c) create designs of longterm life-cycle value; (d) recognize interdependence; (e) respect social interactions and trust relationships in designs and within projects; (f) design product, processes and information together; (g) create an environment for communication, collaboration and transparency; (h) focus on end-users and specify what creates value from the end-user perspective; (i) evaluate performance metrics. The combination of developing descriptive synergistic approaches to healthcare building delivery in terms of GBL principles, categories of similar properties pertinent to how healthcare projects structure their work, such as (1) design analysis, simulation and selection (product specific); (2) process and information workflow (process specific); (3) team characteristics and organizational management (people specific), and the conceptual model that identifies relationships makes this research critical to furthering our industry's understanding of the mechanisms behind green attributes, lean principles and Building Information Modeling, and how project teams can make better use of them to improve project and clinical outcomes.