Building Rapport: How Relationships and Integrated Teams Drive Project Success
Hospital projects are complicated in the best of times, and many of our clients are currently facing the dilemma of adding new space in the face of lower revenues and an uncertain future. Recent challenges have spurred project management innovations including the adoption of virtual big rooms and virtual platforms for tracking construction progress. But a critical—and often overlooked—aspect of project management is the importance of strong relationships and truly integrated teams. By investing in key relationships and broader, deeper collaboration, teams can better navigate complexity and innovate better, faster delivery methods.
A version of this article was originally published by Project Management Institute. It was written by John Flanagan.
Hospital projects are complicated in the best of times—but throw a pandemic into the mix and the design and construction of healthcare projects becomes even more complex. Many of our healthcare clients face this dilemma currently, especially those trying to add new space in the face of lower revenues and an uncertain future.
But there is a silver lining. Recent challenges have spurred project management innovations including the adoption of virtual big rooms and virtual platforms for tracking construction progress. A critical—and often overlooked—aspect of recent project management trends is the importance of strong relationships and truly integrated teams. By investing in key relationships and broader, deeper collaboration, teams can better navigate complexity and innovate better, faster delivery methods. To put it more succinctly—people build relationships, and relationships build buildings.
Our recent work with NYC Health + Hospitals/Coney Island, soon to be renamed NYC Health + Hospitals/South Brooklyn Health and its Ruth Bader Ginsburg Hospital, illustrates the importance of this principle. During work on the project—a 315,000 sf inpatient hospital and campus renovation opening this year—the pandemic hit, upending some of the project’s assumptions, including surge capacity needs. The subsequent design changes alone—which required a range of modifications that enable the hospital to dramatically scale up care—could have caused major delays. But the project team was able to deliver the project on schedule, working primarily virtually, by building a strong foundation for integrated delivery. More specifically, there were three key project management strategies the team developed that enabled this efficiency and flexibility— build integrated teams, form strategic relationships, and engage early with key authorities.
Build Integrated Teams
The scale and impact of the pandemic compelled hospitals around the world to reconsider their capacity needs. After the pandemic hit, the client wanted to dramatically increase its surge capacity by enabling all single occupancy patient rooms to surge to double occupancy, a change which would typically have required months of additional work and had major cost implications. Instead, the project team demonstrated that 60% of this capacity increase would meet surge needs and could be done without increasing the schedule at all. This process depended heavily on having a truly integrated design, medical planning and construction team that addressed issues together simultaneously rather than coordinating independent work.
Normally, the design team would generate plans and give them to the construction manager to coordinate with their trade contracts, but in this case, the design team, contractor and relevant trades worked together to run through scenarios in a live digital model of the building. This enabled the team to analyze the schedule implications of various design changes on work already coordinated and determine the best approaches for increasing surge capacity.
Many of the time saving strategies adopted—such as minimizing the number of trade contractors involved for electronics and headwalls or locating dialysis boxes where they could be installed more easily with existing trade contractors—required the detailed on-the-spot expertise that’s only possible through an integrated approach between all parties, from the designer to general contractor to trade contractors. This integrated approach also enabled the team to analyze and develop design solutions to accommodate evolving technologies and physician needs over the multi-year lifespan of the project more flexibly.
Form Strategic Relationships
The project encompassed a complex array of organizations on the client side—the hospital administration, NYC Health + Hospitals; the end user, Coney Island Hospital; and the managing agency responsible for delivering the project, NYC Economic Development Corporation. It was also funded by FEMA as a key part of NYC’s resiliency strategy after Hurricane Sandy. Each of these entities were heavily invested in the project’s success but also had their own unique priorities and needed to be able to communicate effectively with one another and the project team. This could have entailed significant coordination work, which was further complicated by the realities of social distancing.
Rather than trying to align every layer of this diverse group of stakeholders, the team strategically focused its energies on building strong relationships with key decision-makers at each organizational level—mirroring the client’s organizational structure on the project team side. These decision-makers, in turn, were able to build trust in and become champions for the process within their own organizations. These relationships also enabled the team to make decisions more efficiently, as working relationships and trust developed.
Engage Early with Key Authorities
Approvals can be a time-consuming aspect of project delivery, as they introduce new decision-makers late in the process who are unfamiliar with the project. Since a basic premise of integrated project delivery is that early engagement can be critical to better outcomes, the team forged relationships with key authorities early in the process to streamline processes and approvals.
Typically, approvals are done at the end of construction and can be disruptive to the project schedule if deficient conditions are identified. Instead, the team opted to bring on the Department of Health as an unofficial team member as soon as the building began to be enclosed. This allowed the department to familiarize themselves with the building and its critical components in advance. This potentially shaved weeks off the final site inspection timeline as the department was already well-versed on the building by the time the final walkthroughs were done.
The complexity of hospital design and construction underscores the importance of strong relationships and broader integration, starting with the nucleus of the project team and reaching out to encompass trade contractors, building authorities and other key parties. As the healthcare landscape shifts, recent project management innovations will continue to evolve, driving more efficient project delivery and consequently better projects. But the fundamental principles of effective project management—including the importance of relationships and close collaboration—will remain the same.