1. 38 Medical Construction & Design • July/August 2007 www.mcdmag.com
By Gregory S. Knoop, AIA, LEED-AP
Oudens+Knoop
Value Engineering in Healthcare
dous amounts of energy to operate
every year. Healthcare services
are an enormous human industry
measured in cost of delivery and
rate of success in saving lives and
curing ills. Small percentages in
improvements resulting in lower
construction costs, lower operational
and maintenance costs, and higher
efficiencies and rates of success in
care should be an attractive pros-
pect for anyone in the business.
I have been fortunate to par-
ticipate in many effective VE stud-
ies for large federal projects. I also
have suffered through afterthought
VE projects that brought less than
satisfying results. I will combine my
experiences with a vision of ap-
plication in the design and con-
struction of healthcare facilities.
The basic goal of VE is to get
better value for a project by decreas-
ing costs, increasing profitability,
improving quality, saving time, and
using resources more effectively. For
architects and owners who assumed
that VE automatically cheapened
the project, these goals should
be a great relief. If you are being
sold cheapening as a VE process,
you’ve been mislead. Value engi-
neering is the search for quality.
Timing is everything. Being forced
into VE after project bids come in
high to cut costs usually is a non-
value-oriented exercise. I would
advocate starting much earlier in
the process with a third-party peer
review team composed of architects,
engineers, healthcare programming
experts, equipment experts (where
applicable), a healthcare profes-
sional (doctor or experienced nurse)
and a cost consultant. The best
time to start VE is during the early
design phases, and, when needed,
a follow-up study in the midpoint
of construction document phase.
A VE team often is not just
evaluating the work of a designer,
but also the priorities of the owner,
the trends of the industry, and the
behavioral patterns of the build-
Let’s value
engineer the
project…”
When most design professionals
hear these words their hearts sink.
When hospital administrators hear
these words, they imagine they
are in a losing boxing match and
are up against the ropes. When
builders hear these words, their
hearts beat with excitement.
There is no reason that we all
can’t get excited about the true
values of value engineering. The
key is timeliness and attitude.
What are the common threads?
Quality, care, cost and timeliness…
Healthcare projects comprise bil-
lions of dollars in construction every
year. It is typical to have projects of
$10 million, $20 million and more.
Healthcare buildings use tremen-
of Care
The Value

2. www.mcdmag.com July/August 2007 • Medical Construction & Design 39
ing occupants. Another reason for
third-party teams and a sequestered
process is to free the VE team of
biases by the owners, designers and
the history of the project to date.
Value In, Value Out
What are the goals of these studies?
Here is a brief summary of the goals
espoused by SAVE International (an
organization that seeks to promote
the use of the value methodology),
along with specific commentary
for healthcare construction.
• Decreasing costs: This usually is
the No. 1 goal. The healthcare
industry cares a great deal about
decreasing costs, and so do the
patients. The team needs to look at
both first-time costs and life-cycle
costs. A quality improvement in
process discovered by the VE team
also can involve risk management
savings due to improvements in the
success rate of care.
• Increasing profits: This is a
favorite goal for business clients. If
we invest in a building, we want to
profit from it. We want our workers to
be efficient, perform faster, make
fewer mistakes and improve our
bottom line. We want buildings that
create an environment to facilitate
these goals. An intelligent VE
process can reach deep into the
common quality goals and calls for a
diverse team of experts to make
effective studies for these complex
projects.
• Improving quality: Improving
quality is the core mission. A value
engineer should take a page from the
Hippocratic oath and do no harm.
• Saving time: Time is money,
especially in construction. But time
burns away energy and resources.
Timeliness and timelessness can be
the true test for the quality of a
building and its design. Longevity
can be a valuable commodity.
• Using resources more effec-
tively: Buildings are big material and
energy consumers. Smart ideas can
lead to responsible and responsive
design and construction.
• Solving problems: This is the
goal of the VE process.
The VE Process
The process commonly used for VE
has many variations and can range
in magnitude and scope, but usually
involves the following processes:
• Introductions and presentation:
The owner and design team present
the project to the VE team, and all
parties meet to ensure that there is a
Quality, value,
serviceability and
functionality are
mandated in every
project for Sibley
Memorial Hospital
to facilitate quality
healthcare services
to patients.
Sibley Memorial
Hospital projects
exhibit quality
materials and
construction at
economical costs.

3. 40 Medical Construction & Design • July/August 2007 www.mcdmag.com
responsibilities to the institution.
With interest in evidence-based
design, the VE peer review process
can help to audit and validate find-
ings. Inversely, evidence-based de-
sign studies can contribute resources
to VE groups. On grander scales, a
multi-hospital provider or a national
HMO may want to test the economies
of solutions that may arise in a mul-
titude of locations. The VE process
can help get the answers. Value
engineering can help advocate qual-
ity in the outcome of these healthcare
facilities, which can only contribute
to the quality of care that is provided.
Healthcare buildings are not
simple boxes filled with doctors,
nurses and patients. The hospital
has been an evolving building—
especially in the past century. The
buildings are part of a process. They
truly are enormous machines.
The undertaking of funding,
designing, constructing, commis-
sioning and licensing large health-
care building projects is a complex
process involving many people
and often spanning many years.
For such enterprises, VE can be an
important peer review process that
could lend invaluable assistance
to the project and the process.
A quality study should be intro-
duced at the right time in a project;
it must be teamed with experts
who have a mandate for quality.
So next time you hear some-
body say “Let’s value engineer
the project,” you might just think
it sounds like a great idea. n
• Evaluation: Evaluation involves
studying and validating the ideas.
• Recommendation: This step
involves the selection of those ideas
that will benefit the owner and
improve the project’s value.
• VE presentation: The VE team
presents the information and
provides a document recording all
the recommendations.
• Implementation: The owner and
original design team take the VE team
recommendations and prioritize them
for incorporation into the design.
Imagine that an expert group can
find ways to improve or test different
solutions on your surgical suite, your
emergency department, or your labor
and delivery department. Perhaps the
solutions are about materials speci-
fied. Perhaps the team was able to
study the program to reduce recovery
bays, or point out ways to increase
output with your design through
analysis of the shift cycles or longer
operation hours. Perhaps the VE
study advocates planning alternatives
that the original team was discour-
aged from implementing. Perhaps the
hospital board wants third-party veri-
fication that it is getting the best qual-
ity project with a reasonable budget
as a method of exercising its fiduciary
common goal for the project to
succeed. The VE team is not a
replacement design team; they are
there to help the design team execute
its project successfully.
• Information gathering: This pro-
cess involves researching drawings,
specifications, estimates, reports,
the Joint Commission recommenda-
tions, Certificate of Need, and other
programming information.
• Analysis: This facilitates under-
standing of the design intent and
critical goals, including functional
analysis.
• Creative brainstorming: This is
the process for generating ideas from
all the expert perspectives.
Gregory S. Knoop,
AIA, LEED-AP, is a
principal at Oudens
Knoop, Knoop +
Sachs Architects
in Chevy Chase,
Md. He is a Bach-
elor of Architecture
graduate of Carnegie
Mellon University and a registered archi-
tect. Knoop has participated in multiple
value engineering studies for federal
government agencies. He also has worked
on dozens of healthcare projects.
Lobby for Renais-
sance Skilled Care
Building at Sibley
Memorial Hospital.
Healthcare
buildings
are not
simple boxes
filled with doctors, nurses and
patients. The hospital has been
an evolving building—especial-
ly in the past century. The build-
ings are part of a process. They
truly are enormous machines.