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Avoiding change orders (and other renovation headaches).

Construction doesn't have to be that expensive

CHANGE ORDERS. Those budget-breaking words are nerve-racking for many healthcare facility administrators during renovations and expansions.

Change orders create headaches for every party involved in the construction process -- administrator, architect and contractor. Design or construction alterations will cost both the healthcare facility (which pays for additional materials and labor) and general contractor (who loses money on the administrative costs required for every change).

In addition, changes can cause the general contractor to lose momentum in the project and delay on-time delivery of the job.

For example, if the request for another window is made after drywalling has been completed, the entire scheduling of contractors goes awry. First, a carpenter must cut a hole into the drywall for the window. If conduit is in the way, an electrician must be called to move the conduit. The carpenter then reframes the window and a drywall contractor repatches and tapes the wall. This one window, in effect, becomes a separate, significant job within the job.

Scheduling each subcontractor also can become a logistics nightmare. If each sub's timetable permits, the change can be made in about two days. But if the carpenter or drywaller is booked for a few days, this one change may delay the project for a week or more until work can be assigned.

Avoiding Change Orders

How can change orders be avoided? Open communication among all people involved in the project is the key.

Prior to the initial meeting with the general contractor and architect, facility administrators should meet with their staffs to discuss office floorplans and layouts. Input by employees should be obtained during this preliminary stage.

Drawings can be posted on a bulletin board in the conference room. Staff should be encouraged to review the new layout and provide comments. The location of filing rooms, types of lighting and placement of doors are some of the issues that should be addressed and agreed upon by management and staff.

This first -- and crucial -- step should help eliminate a majority of the problems that occur during construction.

When the administrator has a consensus among all department heads, plans can be finalized with the architect and general contractor. All three parties can then carefully scrutinize and agree upon every aspect of the project together.

General Contractor's Responsibility

If healthcare facility managers follow these steps, they can just about eliminate the need for change orders. However, general contractors must also do their part.

When renovating existing office space, the architect and contractor should make a list of potential problem areas and anticipate changes or design flaws not noted on the blueprints that may disrupt work flow. Power sources should be verified and key mechanical areas -- such as HVAC ductwork and plumbing lines -- should be carefully examined to ensure exact location.

Before renovating existing space, for instance, the contractor should verify the power requirements and source. Can the electrical panel sufficiently supply power for the new space? If not, a breaker panel should be added before the project begins. If the need for additional power is determined while construction is under way, the project temporarily comes to a halt, change papers are filed for the panel to be added, and the job flow is interrupted.

Monetary compensation cannot replace the problems, disruptions and delays that can result from change orders. Therefore, it's in the best interest of both the healthcare facility and general contractor to reach a final consensus one very element of the project before the first stud is set.

For more guidelines for interior renovation, see "Renovation Tips," p. 12.


For Installation Planning

* Nursing homes should have separate, sterile treatment rooms. To help create a sterile environment, treatment rooms are pressurized. Large amounts of filtered air pumped into the room prevent outside air from entering the room when the door opens.

* Floor designs should be planned so every door can be seen from a nurses station without the use of mirrors or monitors. A central open nurses station surrounded by patient rooms is most effective.

* To prevent residents from falling, lighting should not cast any reflections. Indirect lighting generates the least amount of glare, but as the eyesight fails, often stronger light is required. Task lighting is most efficient for nurses stations.

* Every floor should include a ventilated storage closet to house emergency oxygen tanks.

* Walls should be equipped with corner guards and wall protectors to accommodate gurneys or wheelchairs.

* Facilities should be equipped with a separate medication room to lock up medication carts.

* Design plans must comply with ADA-approved handicapped requirements. For instance, doorways must have a minimum clear opening of 32" with the door open 90 degrees. All bathrooms must be handicapped-accessible. Elevators must be prevalent in facilities with more than one floor.

For Safety and Efficiency During Construction:

* Work must be planned in phases, and often completed during low activity times to minimize disruptions to patients and staff.

* Cleanliness and work area isolation are crucial. Temporary drywall partitions or Visqueen barriers are installed in work areas to keep people out, reduce dust and dirt, and reduce some noise.

For Holding Down Costs:

* Remodeling has a tendency to "grow." To stay within a budget, isolate the areas that need renovating and only do what you planned on doing.

* Allow alternates for specified equipment and materials. Rely more on performance specifications rather than brand names or companies.

* Don't use "pre-approved" mechanical and electrical subcontractors. Many times they are not the most cost-effective choice. Allow each bidding general contractor the freedom of getting the best price for you. Remember, the general contractor is responsible for performance.

* Be sure your interior designers specify readily available and standard type carpet and wall coverings. Custom selections can cost up to 50 percent more.

Mitch Tarzian is president of Tarcom Corporation, which provides general contracting, construction management and design/build services, with a specialty in interiors. The firm, based in Elk Grove Village, Illinois, has completed more than 50 renovation projects for hospitals and healthcare facilities.
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Copyright 1993, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:renovation of nursing homes
Author:Tarzian, Mitch
Publication:Nursing Homes
Date:Oct 1, 1993
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