Insider Secrets to Controlling Costs on the Design and Construction of Medical Office Buildings

Now more than ever, architects and builders are being asked to develop cost-effective medical office buildings (MOBs) without compromising durability, efficiency and quality. While there are countless solutions for saving time and money, the key to the most cost-effective MOB is an early team approach where the client, architect, builder and engineers work in concert to cost model alternative palettes of materials, processes and systems.

The earliest stages of planning and programming, often termed preconstruction, are the most critical for controlling costs as most issues are tackled before they become problems, or change orders. Working collaboratively from the start, smart architects and builders will put on their economist hats to scrutinize the cost-benefit relationships of materials, shell types, structural systems and more. More often than not, architects and builders with well-balanced portfolios of experience – office, industrial, retail, healthcare, municipal, high-rise, etc. – can deliver the greatest savings because they bring a larger arsenal of cost modeling secrets.

One such secret to saving time and money is with the creative use of precast concrete. Advancement in precast concrete casting methods over the last five to 10 years has made perhaps the biggest impact on cost-effective design and construction of MOBs. The building’s shell is where significant savings can be achieved, so using load-bearing precast concrete with brick veneer or brick form liner rather than full brick and block will reduce costs considerably while accomplishing an almost identical masonry look. The time saved by erecting a precast shell can also be substantial – as much as six weeks – which saves money.

In some cases, very specific thresholds exist for achieving the greatest precast economies. For instance, to achieve the biggest cost savings on a load-bearing precast concrete structure, the building must be two or three floors tall and cannot be less than 20,000-square-feet.

Like automobiles being designed around a unibody rather than a full-frame system, building structures and skins can be skillfully married to eliminate structural redundancies, reduce the steel frame and still maintain the structural integrity. When done right, the amount of steel needed on an MOB can be significantly reduced, realizing phenomenal savings.

Even more money can be saved by using precast concrete for floor structures as opposed to structural steel, bar joists and poured concrete. This then affords designers and builders more flexibility on selecting the foundation systems.

From an aesthetics point-of-view, precast concrete poses some limitations on architectural elements. To achieve the most cost-effective design, architects often need to live by three words – long, straight and flat. Aside from some aesthetic limitations, there are some minor engineering restrictions of precast concrete. For instance, the amount and type of punched window openings are limited. Too many windows or non-traditional openings may require additional steel structural support at a major expense. Also, if precast is used as the floor structure, it limits flexibility on coring through the floor slab for plumbing. Still, creative architects and builders can often achieve solutions to these limitations.

Beyond the structural and enclosure systems, early analysis of all systems can produce additional savings and/or more efficient scheduling. For instance, more economical roofing systems, such as a ballasted EPDM roof, can still come with a 25-year warranty. Even if the building is seeking LEED certification, cost-effective material alternatives exist that can significantly control costs and still achieve LEED benefits.

A costly pitfall worth avoiding is excess capacity or power of building systems. The most important thing to remember when building an MOB is that it isn’t a hospital. Many times, non-clinical MOBs don’t need a boiler and chiller system because a solid VAV system is more than effective for the space. Optimizing the building’s systems for the intended level of use can ultimately save $20 per square foot or more.

Site work can also add up quickly when the location isn’t utility-ready, retention ponds don’t already exist, or hilly land requires a lot of dirt hauling. If you’re not locked into a site already, finding a pad that is nearly done or has a common detention pond will save a lot of money.

Bottom line, collaborate with smart architects and builders as early as possible on your MOB project. Make sure the architect and builder provide counsel, ask tough questions, examine the cost-benefit relationships of every decision, and suggest alternative palettes of materials, processes and systems. In the end, you’ll receive the most cost-effective MOB that is extremely durable, efficient, attractive and of the highest quality.

Michael T. Leopardo is senior vice president of the specialized healthcare group at Leopardo Companies, Inc., the trusted builder for more than 35 hospitals. For more information, please visit or call 847-783-3000.

Charles E. Smith is president of Arete 3 Ltd., an architectural and planning firm with healthcare and medical experience. For more information, please visit or call 708-342-1250.

A version of this article also appeared in Chicago Hospital News (September 2009)