“We have to manage everything down to the last detail”

How technology makes healthcare construction builder Peter Mulcahey better equipped to deal with the extraordinary quality requirements in his field.

Part 2: Construction technology and the current and future state of healthcare construction.

"Builders who Care" is a series of interviews with construction leaders driving innovation in their field. These builders are committed to their craft and to positively impacting the communities they serve. From implementing sustainable building practices to deploying cutting-edge technology, these individuals are leading the charge in creating a brighter future for the construction industry.

This is the second and last part of our Builders Who Care interview with Peter Mulcahey. Part 1.


Disperse: In the last part we talked about what it takes to be a good healthcare builder. In this part, we want to focus more on the industry. What are some of the main challenges you see in healthcare construction today?

Peter: One of the challenges I deal with on a daily basis is that there is far more demand for great healthcare builders than the market is currently able to provide.

A lot of construction projects did not proceed since hospitals were already strained because of the challenges Covid presented. All that pent-up work still needs to be done. Hospitals don't do building projects because they want to but because they need to. To be able to provide the best care to their patients, but also to stay competitive.

So there is great demand from their side. At the same time, building is costly. Over the last two years, construction costs have increased over 20%. Yet the budgets hospitals have to execute their capital programs have not been able to increase to keep up with inflation.

What happens is that construction companies with limited healthcare construction experience come into the space. But they underbid, because they don't have a thorough understanding of what it takes to execute on time and budget without compromising patient safety.

For hospitals, the relatively low price seems attractive. And they might be tempted to go with such a builder, unaware of the risk and the problems they will face down the line.

For us, currently, there is far more demand than any one builder can handle. So it's essential to be aware of our capacity and not take on more projects than we can execute flawlessly.

We always want to execute flawlessly. And it takes time and effort to get the right teams together. The challenge is knowing which jobs to take and which not to take. And to make sure we have the project teams ready to deliver.  

Disperse: What does a typical day look like for a healthcare builder like yourself?

Peter: (Laughs) There is nothing typical about any day at work! Usually, construction is defined as the time between mobilizing on-site and the moment you are done with your punch list. Whereas in healthcare construction, sometimes planning a job takes longer than the job itself.

Having said that, nothing about my schedule is predictable, and I love that. The sheer number of things I get to do in a day keeps me from ever becoming bored or complacent.

Reducing costs with technology

A big challenge, though, is that there are only so many hours in a day. There are so many things to do on an average day that our staff must prioritize and only work on the most impactful activities. But in healthcare construction, you want to manage everything down to the very last detail. So that becomes a huge challenge.

Imagine you need to do ten things in a day to handle things properly, but you only have time to do seven of them effectively. That's us. So we are constantly feeling torn. And in my view, that's where technology can come in and take a bigger and bigger role in everything we do.

Reducing the schedule with technology

We can save so much time when we use technology to take care of all of those parts of our jobs that are repetitive and menial.

It costs a lot of money to build. And with the current inflation on top of the general escalation of prices, it is becoming obscenely expensive. Meanwhile, there is surging demand from the healthcare side. It strains hospital finances because they operate on very narrow margins.

In that situation, if I go to a client and tell them that I need to bring on three more staff members to ensure that I touch every single activity on the project, they will ask me how much it will cost. And then they are going to tell me they can't afford it.

So we just need to keep getting more and more efficient with fewer and fewer resources. We try to get the cost down so we can do more with less.

For me, that drives the desire to increase performance and accuracy. And also why we should try to decrease the schedule overall. Because the schedule tends to have the biggest cost impact. The longer a project goes, the more money it takes.

BIM and off-site fabrication

Disperse: Given that healthcare construction is a meticulously planned affair, do you use BIM often? And what about other construction technologies?

Peter: Yes, a lot of what we do is modeled in BIM first. And especially building in New York that's helpful because everything needs to go into very tight spaces.

Ideally, a hospital floor is 16 to 18 feet high to fit everything under the ceiling. But in New York, because of the nature and the age of the buildings, we might have 12 to 14 feet to go with. And that's in a good scenario; often we'll have less. We have needed to fit operating rooms in under 10 feet.

We use BIM to fit everything in a virtual world before we execute. And the other part about BIM that's been helpful is that it's enabled us to do more off-site fabrication. We try to model and understand the space to the nth degree. Then we plan everything out and prefabricate ceilings, pipes, duct sections and even walls that have all the power requirements built in.  

Off-site fabrication also tends to produce better results because workers can focus more on what they are making rather than negotiating the healthcare environment with all its attendant challenges. We can minimize the noise and dust and just need to take care of transportation and installation of the prefabricated component.

Another advantage of a model is that it's easier to communicate with the hospital staff, for whom reading construction drawings is like a foreign language. They more readily understand what things will be like if we show them a virtual model.

Nobody wants to be the person in the room saying: "I don't know what I am looking at here." And when you just have the drawings, everybody tends just to nod along. But in reality, people end up saying: wait, this isn't what I expected. So BIM is a tremendous help in communicating construction plans to non-construction folks.

Using Disperse for alignment

Disperse: How does Disperse's technology fit into the picture?

Peter: I have used Disperse on the last fifteen projects I've worked on. It facilitates communication with people who aren't present, such as clinicians who can't afford to step away or architects, engineers and owners who couldn't go on-site during COVID. Disperse enables us to involve them remotely.

It's an incredibly powerful tool for the time of the industry we are in right now. Normally getting to the job site, walking the site, then staring at a minor problem and getting it resolved while involving multiple stakeholders is exceptionally time-consuming. With Disperse, we can just set up a remote meeting, pull up the model and get everyone informed and aligned almost instantaneously.

That's the simple way that Disperse supports project communication. And it's crucial because keeping people up to date with the job progress excites them and keeps them committed to the outcome.

Using Disperse for validation

But in addition to that, it's a compelling way to validate what we have been doing. And since building for healthcare is so precise, we have to check everything.

You can have the best BIM planning for the job, but if my duct crew goes out and starts installing pipes in the wrong location, it will have a ripple effect. The problem will continue to compound. And by the time we find out, it will take time to undo the initial installation and everything built on top of it.

Then it takes time and cost to find out the root problem and return to the normal sequence.

Having a tool that's constantly checking to ensure that things are being done in the field as planned, enables us to execute without needing to undo and redo things from time to time.

Using Disperse for lessons learned

Disperse is also helping us learn faster because we can sit down with the model after building and peel back the construction process through time. It enables us to figure out: how can we improve our process? Do we have a problem and where is that problem? Where did we go wrong, and how do we design a process so it does not happen next time?

Disperse supports us with planning and communication, but also with lessons learned and making sure the next project is better than the last.

Disperse: What about execution?

Peter: Without Disperse, my staff would probably need to be double the size. You see, checking the job needs to happen constantly and is highly repetitive in nature. With Disperse, I have a tool that frees up all the time spent on that.

It lets my people focus on valuable things like getting the construction done, rather than checking whether it's been done incorrectly. So it creates a shift from a reactive to a more proactive mentality.

Willing to work in alignment with the vision

One of the reasons I partnered with Disperse over other options was your willingness to follow our vision. To find out where the need is. And to develop your product along those lines.

I am excited to see where we can go next. How tools like BIM, laser scanning and Disperse can all merge and help us build even better.

Demanding a shift to improve healthcare

Disperse: Thanks so much. To round out this interview, do you have any personal observations you'd like to share about how to improve things in healthcare?

Peter: At a high level, treatment of illnesses comes at a very high cost, and the further disease progresses, the higher the cost. I am excited about what we can do to help people live better, healthier lives, about taking care of the wellness of people so they won't need hospitals that often.

We have a few new clients focused on the early detection of illness. It's incredible what they can do with full body analysis and preventing diseases in new and unique ways.

I will stay apolitical on this, but our government and insurance companies must focus on putting money toward wellness. There needs to be a concerted effort to prevent illness first, rather than just focusing on managing illness as we do now. I think this will fix our health system.

But it will require everybody to demand it before things shift.

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