Among the worst sounds a construction manager can hear is that deep breath, followed by a whistle, that emerges after clients see the bids that come in. If clients aren’t prepared for this, the construction manager has not done his most important job: eliminating surprises. The most critical time to prepare a client for what the costs will be is well before the plans are drawn and out on the street, and the most rudimentary objective of a construction manager is to make sure clients fully understand what they are buying. Taking the time to discuss the details with the architect and the client is job number one.

Most healthcare providers throughout the industry are not averse to spending money (and thank heaven for that!). In today’s marketplace, healthcare providers realize that they must accommodate change in order to be competitive. If they were com-pletely averse to spending money, they would not be speaking to designers and builders. What they are averse to is spending money in the wrong place, at the wrong time, for things they don’t need, or in greater quantities than necessary.

What good construction managers learned a long time ago is that a facility can be built and in operation for some time before an administrator or facility manager truly understands what he or she purchased. Inevitably, this leads to surprise and disappointment. I remember a client who walked through his facility six months after it had opened and noticed that a pane of glass was missing in one of the interior windows. “What happened there?” he asked. I was relieved to know that it had been damaged by accident only a month earlier by one of the hospital staff during setup for a meeting, and not by our tradespeople on the job. When he asked when it would be fixed, I had to inform him that it would take five months because the glass would have to be ordered from overseas. He was shocked, surprised, and disappointed that we had exposed him to such costs. In short, we had failed.

How can a construction manager do better? There are three significant steps toward improving one’s record of avoiding nasty surprises: (1) gain the consensus of the entire design team each step of the way before giving a cost estimate to the client, (2) plan an adequate amount of time for this process, and (3) stay in touch with the decision making between major budget updates.

The entire design team must agree on the thousands of assumptions built into an estimate before taking the numbers to a client. Imagine if the opposite were to occur. Let’s say a builder is handed a set of schematic plans to produce an estimate. There is little or no interaction during the compilation of the budget, and the team heads into a meeting with the client to tell him about the costs for his project. Will this be a big deal? Probably. Let’s examine exterior glazing as an example of why.

The builder might assume that a less expensive curtain-wall system or even “storefront” (an even less expensive system) would be selected instead of a high-end curtain wall for the exterior of a significant face of the building, without having consulted with the designer about this. During the next budget-update meeting, several results can occur, none of them pleasant. For example, the builder may appear to be “cutting corners,” or the architects, when they indicate their preference for the more expensive material, may appear “extravagant.” The client may feel forced to compromise. At the very least, the project team will not appear to be a team at all, which will certainly cause the client to question his or her choice of professionals to work with. These are good reasons to confer with and gain consensus from the entire design team, including the builder, before meeting with the client.

Another mistake is not taking enough time to compile and explain the costs. Obviously, building consensus between the construction manager and the designers will take more time than simply throwing a number out in front of the project team unannounced. The consensus process will require more time, as will allowing some adjustment in the numbers after the architect and the owner review them. It’s true that many clients don’t understand this process and may get impatient waiting for the results, but explaining the long-term benefits of the process and indicating the level of input they will have usually helps anxious clients get through this.

The final and fatal step toward unpleasantly surprising the client usually results from the construction manager’s growing out of touch with the trend or flow of design decisions between major design milestones. Thousands of decisions are made between the concept estimates and the completion of schematic design, and even more occur during design development. Many of the best builders ask that they stay involved in the design discussions throughout, not so much to “control” the design as to stay in touch with the decisions and their cost impact. Up-to-the-minute tracking of changes will keep the client informed of the implications of their decisions, help the designers know whether they are meeting the client’s expectations on more than just cost, and make the next budget more accurate.

Eliminating surprises completely may be impossible in this industry-there are just too many details. Planning the budgeting process with the consensus of the entire team, however, comes closest to a surefire way to make the process smooth and consistent. Chances are, it will lead to the sweetest sound a construction manager can hear during a budget update or on bid day: a yawn, followed by a quiet smile of contentment. HD

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Healthcare Design 2003 May;3(2):10-11