In my hometown of Orlando, medical construction is booming like never before. Both of the region’s major hospital systems are undergoing massive expansion, and the newly created Medical City in nearby Lake Nona – which features a world-class VA Medical Center, the Sanford Burnham Prebys Medical Discovery Institute, Nemours Children’s Hospital and two academic research centers – is changing Central Florida’s healthcare landscape in dramatic fashion.
But that’s just part of the story. Across America, more healthcare systems are building satellite campuses and small- to mid-sized offices that extend their reach deeper into surrounding communities. According to Colliers International, 62 percent of medical office space under construction in the U.S. as of March 2015 was located off-campus, and overall tenant demand for healthcare real estate continues to increase.
Further, the report found that “many medical systems and third-party developers (are) opting for ground-up construction, concentrating development near dominant hospitals and health systems and targeted population groups.”
As a general contractor, I regularly field questions from potential clients in the market for building or renovating a medical facility – everything from doctor’s offices to the skilled nursing components of a senior care community. Understandably, the topic isn’t second nature to most healthcare professionals, so they’re looking for a wide range of information that will make the process as seamless as possible.
My advice boils down to two things: Find the best general contractor for the job, and understand what to expect throughout the process. Let’s explore both areas.
What to look for in a general contractor
The best combine large-firm capabilities with a small-firm, customer-centric approach. They want your business – today and tomorrow – and they do that by building strong relationships based on trust, integrity and consistent performance rather than just bottom-line objectives.
When choosing a general contractor to build a medical facility, here are six factors to consider:
- Expertise: What is the firm’s experience with related projects? How knowledgeable are they when it comes to your specific medical needs and industry regulations? A good general contractor should be able to provide expert advice when it comes to choosing and installing the right kind of flooring, lead-line drywall, mechanical, electrical, plumbing, lighting, specialty furniture, fixtures, and other technology.
- Referrals: What percentage of the firm’s business comes from repeat customers? (The higher the better.) Ask for recommendations from local industry professionals, subcontractors and trusted professionals. Visit projects the general contractor has built, and ask for a list of client referrals. Consult with the Better Business Bureau, and look to industry organizations that have membership lists, such as the Associated Builders and Contractors or the Association of General Contractors.
- Willingness to negotiate: Sophisticated clients negotiate contracts with general contractors rather than sacrificing quality and service by simply “bidding out” their jobs to the lowest-cost provider. Most owners have a preliminary idea of the cost per square foot. During the bidding process, ask for a complete cost breakdown proposal that spells out the conditions and project scope. The general contractor can also obtain multiple bids from subcontractors to ensure competitive pricing.
- Attention to detail: Make sure the firm provides a detailed schedule and that it is followed. Schedule changes are sometimes uncontrollable and inevitable, so when expected delays arise, the general contractor should provide a written explanation and revised completion date.
- On-site quality: Professionalism, organization and control are highly important, especially when coworkers or colleagues visit the job site. The best firms employ superintendents who make sure their area is clean and safe – and that the crew is doing its job appropriately.
- Red flags: Be wary of general contractors who have reputations as “low-cost” providers. Low bidding often creates an adversarial relationship between the owner and architect. A firm that recklessly cuts corners to keep costs down ultimately compromises the overall project quality, schedule and budget.
- Communication skills: General contractors must balance the demands of owners, architects and subcontractors, so it’s important to find someone who can communicate effectively with all parties and maintain a good working relationship. Communication is the key to staying on time and within budget.
What to expect during the build
While the approach will vary from firm to firm, here’s a basic outline of how experienced general contractors will guide clients through the build process:
- Initial client meeting and early collaboration can involve everything from clients articulating their vision to (in some cases) presenting preliminary concepts and space plans or full construction documents. From there, clients usually choose from a design/assist procurement strategy, a design/build project delivery system (to minimize owner risk and create a one-stop shop and single-source responsibility) or a traditional bid/build process (where the client contracts with the design team and contractor separately).
- Preliminary budget pricing provides early insight into what it will cost without spending money for a full set of design documents. Once the owner is comfortable with the budget, the architect is given approval to proceed with a set of design documents to secure building permits.
- Final proposal preparation and sub-bidding take place after the design team finalizes the “permit-ready” construction plans; meanwhile, the permitting agency reviews the documents for compliance. Even more accurate pricing can be obtained during this phase. After contracts are signed, most general contractors will provide a written bar chart schedule and commit to a finish date.
- An on-site manager/superintendent is assigned to ensure compliance with the schedule and job specifications. A project manager will report to the client to make sure performance is on budget, ahead of schedule and being done in a quality fashion. If changes or logistical problems arise during the project phase, your general contractor should be able to facilitate solutions quickly and effectively.
- In the closeout phase, general contractors perform a number of important activities, including final cleanup, inspections and internal punch list prior to the final walkthrough. The goal is to instill clients with a sense of satisfaction and closure so they can move forward with other important business matters – like keeping patients’ health top of mind!
Todd Andrew is president and owner of Andrew General Contractors, a full-service Orlando-based firm he started in 1996 after nine years of management and operational experience in the construction industry. Andrew GC has built and renovated dozens of medical facilities and labs for clients in the fields of dentistry, diagnostics, derma-pathology, OB/GYN, ophthalmology, skilled nursing and general wellness. To learn more, email tandrew@andrewgc.com.