U.S. Healthcare Needs a New Approach to Design and Construction

Today's high costs and other tough challenges call for a rethinking of the model for project delivery, advises healthcare architect Paul Sabal of HFA Architecture + Engineering

BENTONVILLE, Ark., Aug. 5, 2025 /PRNewswire/ -- The U.S. healthcare industry needs a more efficient approach to design and construction amid today's high costs and other serious challenges, advises Paul Sabal, the Healthcare Practice Leader at HFA Architecture + Engineering.

"Healthcare systems around the country continue to grapple with higher construction costs," writes HFA's Paul Sabal in the July/August issue of Medical Construction & Design (MCD).

In his column, "Rethinking Traditional Ways: De-risking healthcare construction through integrated approaches," Sabal—a 43-year industry veteran of healthcare design and construction—also points to challenges such as:

• the scarcity of skilled labor
• supply chain stresses
• new regulations
• expanding schedules, and
• the need to integrate more sophisticated technologies into new medical projects.

To de-risk the construction process, Sabal encourages the healthcare industry to shift from today's "design-intent" model to one based on fabrication.

"In the traditional model, architecture and engineering firms' drawings represent intentions rather than fully realized structures," Sabal writes. "A vertical line may indicate a wall, but its internal components remain undefined. Likewise, a line symbolizing a three-inch pipe omits critical details, such as flange valves and fittings, which are only added later by subcontractors during fabrication."

Therein lies the challenge. This lack of detail often translates into costly requests for information (RFIs) and change orders on healthcare projects.

By contrast, Sabal advocates an approach in which advanced coordination firms rely on design for manufacturing and assembly methodologies in collaboration with the design team to produce far more granular and accurate designs for accelerated work in place.

"Advanced coordination runs parallel with early design processes with continual review and cross check of the emerging work product," Sabal explains in the MCD piece. "With this focus on ferreting out costly RFIs, change orders and redundancies of effort, construction partners then take advantage of constructable information from the design team. Simply put, innovation driven by advanced coordination turns uncertainty into cost savings."

When contractors and subcontractors do enter the picture midstream, they can review the detailed documents that have been produced by the design and advanced coordination teams, sign off on them, and then hit the ground running with assembly and construction, using the models for highly precise work.

The advanced coordination team can also review contractor change orders, diagnose the cause of recurrent delays, and align with fabricators to serve as a valuable resource during assembly and construction.

"In our experience, the accelerated schedule, improved design and construction accuracy can reduce overall project costs by 5-10%," he says. 

He also highlights potential procurement savings through partnerships with global supply-chain companies specializing in construction materials and equipment.

"Supply chain partners collaborate with the design and advanced coordination teams to initiate procurement as early as possible, proactively locking in prices of long lead time items to reduce the risk of escalation," he explains. "These firms also can evaluate pieces of large equipment and store materials to make them readily available to contractors as needed. From boilers and chillers to Sheetrock, doors and frames, this streamlined process reduces delays and enhances overall project efficiency."

Finally, he recommends working with A+E firms that offer multidisciplinary in-house teams—including interior design, landscape architecture, MEP, structural, and fire-protection engineering—to further streamline workflows.

This multifaceted approach is about more than individual elements such as prefabrication, modular construction, or building information modeling. As Sabal sees it, the goal should be to bolster the efficiency of the entire project-delivery process, with its deeply interconnected components.

"By de-risking design and construction," he concludes, "the healthcare industry can enhance quality, shorten project schedules and, most importantly, save capital costs that can be redirected toward improving patient care and outcomes."

Read the full column here:
Rethinking Traditional Ways: De-risking healthcare construction through integrated approaches

Media Contacts:
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Elisa Krantz
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SOURCE HFA Architecture + Engineering