Strong currents are exerting a force on the future of healthcare capital construction; they are impacting every discipline from planners to architects, engineers, finance groups, and owners. These currents constitute a sea change that affects every phase of a capital project, from initial master planning and approval to the postoccupancy evaluation. These tidal forces are affecting projects no matter where they are in their life cycle and they include new economic realities, uncertainty about healthcare reform, corporate awareness of green building and sustainability, innovative financing, new delivery models, and even the way architects produce drawings. Any one of these realities would present a challenge, but with the convergence of so many profound changes, the industry has been stretched and shaken to its core. Metrics and benchmarking are among the tools healthcare leaders are developing to help manage costs and risks, and to chart a course through these uncertain and challenging times.Healthcare costs have soared, putting healthcare reform high on the national agenda. Part of these cost increases are attributable to escalating construction costs and the increased volume of healthcare projects that started in 2003 and were a dominant force until 2008, when the economy went from full speed ahead to a full stop overnight. Problems with the money supply have interrupted many privately funded projects. In an attempt to control cost and risk, owners have expanded their stable of delivery options to include costplus, shared-risk, and incentive programs; integrated project delivery; design build; and lean construction. There is an emerging consensus that reducing a company's carbon footprint and building in a sustainable manner are corporate responsibilities. Alternative financing and tax credits are being used to lock in escalating energy costs. Architects are transitioning from twodimensional computer-aided design and drafting to three-dimensional modeling or building information models, which demand new skills and a new partnership with contractors. These major shifts at the core of the industry are occurring just as the Baby Boomers are beginning to retire. With the Boomers' departure, years of accumulated knowledge and expertise will be lost. Any of these changes alone represents a major shift in practice, but all of these changes together have created immense risks and opportunities that will require constant re-evaluation, personal change, a new level of cooperation, and hard work to meet the healthcare needs of the future. …
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