The bottom line at Nashville, TN-headquartered HCA, the nation’s leading provider of healthcare services, is much more than making “sense” of dollars earned and dollars spent. It’s about doing the right thing – making a difference in the care and improvement of human life.
Although physicians, nurses, technicians, and support staff provide the visible face of HCA’s commitment to delivering high-quality, cost-effective healthcare to its many communities throughout 23 states; London; and Geneva, Switzerland, there’s a whole team of behind-the-scenes professionals whose dedication to this same mission is accomplished by outfitting the organization’s locally managed facilities – 180 healthcare (67 million square feet) and 200 office buildings (12 million square feet) – with best-in-class operations, equipment, and materials. Each location’s director of plant operations (DPO) takes his or her cue from a centralized Design, Construction, Equipment, Corporate Facility Management, Engineering, ADA, and Bulk Purchasing “core” (known internally as HCA Design and Construction). Here, under the direction of Vice President Tom Gormley, this small but extremely cohesive team combines a cross-pollination of knowledge, experience, and idea competencies to ensure that clarity of objectives, talent, and diligence result in long-term, high-performing facilities throughout the HCA portfolio.
This holistic approach didn’t happen overnight; nearly 8 years in the making into today’s well-established integrated partnership, it began as an interface between similar (facilities-related) but disparate groups. “We wanted an [organizational structure] that rolled everyone together and avoided the ‘silo’ effect where each department had a sole focus,” recalls Gormley. “Now, for example, Equipment people include nurses and lab technicians and those in Construction include engineering and construction management professionals. Today’s structure is so effective because these diverse groups work toward the same goals for the end product – what a facility will look like, how it will support [the company’s] overall goal of quality and cost-effective healthcare, how it will be maintained, and the life-cycle cost.”
For existing facilities, each hospital maintains its autonomy as an independent profit center and legal entity, while HCA Design and Construction provides corporate oversight over facilities upgrades, renovation, and management – not unlike that which is exercised over company-wide compliance issues. “We ran the numbers and we have something like $16 billion worth of physical plant,” says Gormley, noting that HCA’s focus is on long-term ownership. “The key to maximizing performance and minimizing capital and operational expenditures is to hold each [facility] to a certain standard. That requires continuous measurement and continuous improvement – all of which can be supported through our core group.”
High Standards, From Planning Through Implementation
With HCA’s concern to provide the highest quality of patient care while keeping costs in line, the impact of facilities all begins before anything goes to the drawing board, so to speak. Projects – whether new or for existing upgrades – are developed in two stages: 1) planning and development prior to funding; and 2) execution of contract documents and construction after funding.
The development of projects prior to funding is headed up by HCA’s Planning department, which works closely with HCA Design and Construction. The Planning department gets involved at the inception of a project, which begins with a market strategy and a concept. Claudia Stengel, vice president of Planning, explains HCA’s design philosophy:
“Unlike some building types, the design of healthcare facilities must address different services and acuity levels at each location; a ‘one-size-fits-all’ model doesn’t work for HCA. By developing designs based on best demonstrated practices and knowledge gleaned from over 300 projects developed and funded since 1997, we’ve become less didactic about how we implement ideas, allowing for more innovation and variances in the development of designs with the objective of aligning our facility designs with HCA’s operations,” she says.
One “specialty area” – compliance with the Americans with Disabilities Act (ADA) – is a top initiative within HCA. Bringing a legal and construction management background to his role as HCA’s ADA director, Jon Faill examines construction drawings and documents on new projects and evaluates existing facilities for ADA-compliance issues. “Half of what I do is interpreting code and talking with experts to determine our options,” he says. “The other half is converting that legal mumbo-jumbo into something we can actually design and build.”
Another area – Equipment Planning – is a bit of a misnomer, says Assistant Vice President Robert Bird, who considers his group’s role one of equipment management. “The difference being [that] planners work with a client to find out what they want and help them coordinate the purchase. We, however, help the client (one of HCA’s hospitals) decide what they need as much as what they want,” he says. Using the independent group purchasing organization, Health Trust Purchasing Group (HPG), Equipment Planning leverages the power of quantity buying throughout the selection of furniture as well as bigger ticket items such as monitoring and X-ray equipment. Bird adds that his department’s responsibilities include not only the coordination and purchase of these systems, but also the development of space programs and schematic design to house the equipment.
Once a project is funded, Construction – led by Assistant Vice President Drew White (West/Outpatient Services regions) and Assistant Vice President Steve Brecker (East/International regions) – leads the design effort, with Stengel’s Planning group offering design feedback as needed. The 24/7 nature of healthcare, especially since the majority of HCA construction projects involve complicated systems, upgrades, or expansions to existing facilities, adds to the complexity of this task, explains White. “For example, an ICU portion has to be maintained in a pristine state throughout the course of a major demolition and construction project on the facility that houses it,” he says. “When we’re constructing these projects, building them is really secondary. Patient care is always first.”
Brecker concurs with this assessment, noting that he and White, while serving different geographical regions, present a unified front and big picture mentality: “[We] make good decisions up front, plan appropriately, don’t allow shoddy work, and pay a fair and honest price,” says Brecker. To maintain this cohesive partnership, White chairs all internal meetings with HCA construction managers, while Brecker chairs all external meetings with architects and contractors. “At the end of the day, the HCA philosophy prevails,” notes Brecker. “Think long term; remember that different markets require different subtleties; and respect quantity, quality, cost, and time. Most importantly, at the end of the day, we’re here for the health and safety of our patients. At HCA, we’re inspired to do the right thing.”
At times, doing the right thing requires taking a bold step toward the future. In this regard, HCA is presently hosting and managing an architectural competition for the “medical campus of the future,” says Stengel. “Although we’ve sought competitive responses to individual project programs and scope in the past, this is the first time we’ve created a formal forum for a comprehensive design concept and approach.” According to Stengel, nine firms have been asked to apply their best solutions to a list of criteria developed by HCA.
Operations and Management – for the Long Term
As a responsive long-term owner, HCA Design and Construction can never consider its work done; maintaining and operating best-in-class facilities at their peak is part of the group’s holistic approach. Engineering Director Mike McIlwain and his staff of building and environmental engineers, an energy manager, utility analyst, and coordinator make sure it’s done – and done well – by interacting closely with the hospitals’ DPOs. They oversee HCA’s capital corporate programs ($33 million in 2004, comprising chillers, roofs, façades, sprinklers, and more); HVAC commissioning; programs that encompass emergency support and compliance with requirements of the Joint Commission on Accredited Hospital Organizations (JCAHO); environmental due diligence and operation issues; national energy programs; and a pilot program called FAM (Facility Asset Management), which involves recommissioning/tune-ups and preventive maintenance on energy/engineered systems in 10 HCA facilities. According to McIlwain, “As a whole, the DPOs see this department as one that’s ready to help them; they see us as support, and we’re an advocate for them.”
As regional engineers, Byron Hall, Tony Black, Randall McFarland, and Tom Cassidy are on the front lines with the DPOs, addressing day-to-day concerns with their technical expertise while helping hospital personnel implement appropriate on-site energy- and code-/compliance-related programs. Direct energy procurement, utility rate negotiations, and the associated regulatory intervention come under the oversight of Energy Engineer Jon Ervin and Analyst Christine Harding. About 80 percent of HCA’s gas ($40 million) and 15 percent of its electricity ($25 million) are purchased annually through direct energy procurement. HCA’s capital corporate programs, under the oversight of Capital Programs Engineer Jack Stelle, with assistance from Coordinator Terri Bromley, are driven by compliance or return on investment, says Stelle, adding, “We typically handle about 150 new projects every year.” This group also handles environmental due diligence on divestitures and purchases and addresses operational issues like IAQ, mold, ongoing site work, and more.
Day-to-day operations for HCA’s Corporate Campus and Shared Services, comprising 3 million square feet of space and more than 2,700 employees, is the responsibility of Corporate Facility Management Assistant Vice President Brian Weldy and his staff of 12 engineering, systems, maintenance, and support professionals. “Adds/moves/changes, maintenance/repair operations, utilities, a main data center – we deal with all of those from an operations perspective, as well as maintenance,” says Weldy. The group also oversees HCA Shared Services, a $100-million strategic roll-up of back office administrative functions – accounts receivable, supply chain operations-purchasing, warehousing, and distribution. “During the last 3 years, Corporate Facility Management assisted in real estate evaluation, design standards, project management, and go-live turnover in this area,” notes Weldy.
While maximizing operational efficiency through a life-cycle approach to maintenance and operations throughout the Corporate and Shared Services areas – underscoring the importance of reliability, safety, occupant comfort, and system efficiency – Weldy has applied those initiatives to his most recent undertaking: team leader of the HCA Design, Construction, and Facilities Website. Weldy explains that the website content features design standards, facility information, and project data, adding, “The key to a good building design and operation begins with clarity of objectives. Our website is an information content portal that helps everyone here – DPOs, HCA staff, and design and construction partners – pull together the information that pertains to each facility.”
Business as Usual?
Gormley is never one to rest on the accomplishments of HCA’s Design and Construction group; rather, he points to the continuous improvements that have been successfully applied to each HCA facility and his team’s integrated approach to problem-solving and future-proofing the HCA portfolio as yet “another step in the process. I believe in the incremental approach,” he says.
Bottom line, however, is that making a difference – in any endeavor – requires the talent and diligence of a team and the clear-sighted commitment of their leader. Fortunately, at HCA Design and Construction, doing the right thing is about having the right people.Linda K. Monroe (firstname.lastname@example.org) is editorial director at Buildings magazine.
Diversity Partnerships are Also the Right Thing
Although committed to a culture of diversity for many years, HCA’s Design and Construction group recently established a formalized Diversity Business Inclusion (DBI) Program, which enhances the participation of minority, women, and diversity business enterprise firms in the contracting and purchasing process. According to HCA Design and Construction’s Director of Financial & Administrative Services Juliann Cataldi, the goal of the group’s DBI Program is “to foster an environment that enables all members of a business community an opportunity to participate in HCA’s development program.”
Rob Horton (pictured), the group’s diversity director, brings a strong background and understanding to the program. “Building hospitals is a very specialized procurement,” he says. “While there are formalized diversity programs based on federal, state, and city requirements for contracting goods and services, HCA, as a private-sector owner, implemented its Diversity Business Inclusion Program as a catalyst for supporting community-based businesses.”
It is the objective of HCA Design and Construction to ensure that minority, women, and diversity business enterprise firms have an equal opportunity to receive and participate on HCA Management Services LP contracts. “Not only that,” adds Horton, “we are also asking our partnering vendors to mirror our department’s DBI program as a model for their own program. In the first eight to nine months, we are seeing positive diversity results from our partnering firms who have embraced our program.
“More importantly, HCA is committed to providing high-quality, cost-effective healthcare to the communities we serve. Towards that purpose, HCA’s Design and Construction department has established a Diversity Business Inclusion Program to increase the participation of minority and women business enterprise firms within the design and construction of our hospitals.”