Design-Build Widens Window of Opportunity

Posted on August 31, 2011


With any leading medical technology, four constraints limit how successful the technology will be. The constraints are efficacy / applicability, target patient population, advancing technology, and cost of production.

For example, the constraints on a 128-slice CT scan would be:  its efficacy in its function toward its output, the patient population that can derive benefit from it, the next-big thing (maybe a 256-slice?) to replace it, and the cost of its production, and thus its economic relevance to hospitals who want one.

If you imagine, these four constraints each form one side of a rectangular window, which I define as the window of opportunity for this device. With each day, the window is slowly shrinking since technology is only getting older and one day closer to obsolescence. Yet if any of these four constraints is improved upon—such as science determines every American needs a 128-slice CT scan once a year for general fitness—that side of the window slides out and makes the window larger, therefore improving the window of opportunity.

For medical technologies that require physical infrastructure, design-build is the perfect project delivery method for improving the cost of production constraint.  This widens the window of opportunity.

Proton treatment is an excellent case study. Let’s take a look at the four constraints on proton treatment. First, its efficacy for cancer treatment and applicability is compelling enough that the number of treatment facilities is growing. Second, its target patient population is a fairly small segment of the cancer cases in the U.S. Third, there is likely another cancer treatment method under development now which will someday take proton’s place. Fourth, the cost of a center is quite expensive and it takes a long time to build. All of these factors limit the favorability of proton treatment for cancer.

Haskell is currently building its California Proton Treatment Center in San Diego. However, it is delivering the project design-build, which will save approximately a year off the typical timeline for this building type. Such speed puts the center in operation sooner, and completes the project with less cost than traditional project delivery. Thus, design-build widens the window of opportunity for facilities which choose to build in an integrated manner.

In this case, speed saves construction costs (general conditions, etc.), risk (bonds, weather), financing, and gets the building ready to accept patients sooner, which increases revenue. At the same time, it helps mitigate the constraint of advancing technology because it makes the proton treatment model applicable longer.

As an added benefit, a faster delivery method guarantees the facility will be the first to market in San Diego, which virtually locks out competition since these facilities are heavily dependent on geographic population centers for economic feasibility.

Design-build cannot do much to assist with the first three technological constraints—efficacy, patient population, advancing technology—but it can definitely help control the cost of implementation, which can mean the difference between doing something innovative, or waiting around while someone else takes the lead.