SSM Health Care of Wisconsin: Rick Stoughton, Director of Project Management

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Managing the construction of healthcare facilities is a balancing act of budget and flexibility, according to Rick Stoughton, Director of Project Management for SSM Health Care of Wisconsin. “If you design too much flexibility into a space you will be way over budget, so you’ve got to pick and choose the areas where you want to be flexible. We’ve got to be good stewards of our resources and keep healthcare costs down,” he says.

SSM Health Care owns and operates 2 hospitals and is affiliated with 5 hospitals in Wisconsin which gives Stoughton plenty of opportunity to practice his balancing act. His top projects for the moment include a new $150 million free-standing hospital and clinic in Janesville, a critical access replacement hospital in Edgerton, and numerous remodel projects in Madison and Baraboo. The greater organization of SSM also has acute care hospitals in Illinois, Missouri, and Oklahoma.

Project Highlights

The biggest project on Stoughton’s agenda right now is a 158,000 square foot freestanding hospital and 160,000 square foot clinic in Janesville, Wisconsin. The total cost of the two buildings is roughly $150 million.

“It’s a high tech facility, with state of the art features,” says Stoughton. “It’s pretty much a steel composite structure with brick, glass and stone on the exterior and has a very warm feel thanks to the many features such as wood, fountains, and stone detailing on the interior.”

SSM likes to incorporate as many sustainable elements into the construction and design as possible, but they don’t strive for LEED certification. “As an organization, we feel that putting the dollars toward the energy efficient items versus the paperwork and the plaque on the wall is more beneficial,” Stoughton says.

“We’re doing a number of energy efficient design features such as heat recovery wheels and chillers, along with some other fairly substantial energy items,” he says. “We look at ways to save energy and recycle materials. That’s the biggest trend I see in hospitals today and I’m all for it. We’re putting things in that make sense, like a bus route to the front door. It doesn’t cost as much, and it makes sense to promote alternate modes of transportation. If it’s under a five-year payback, we’re definitely putting it into the project.”

SSM chooses their efficiencies focus on a case-by-case basis. For each building or remodeling situation, they do a thorough cost study and analysis and see how much energy they are going to save.

A small 18-bed hospital in Edgerton, for instance, is going to be geo-thermal. That’s not typically an option, but in this case they have determined that it makes sense fiscally as well as environmentally.

Building for Best Practice

“Everybody’s got buzz words for doing similar type research – evidence based or whatever you want to call it. We look at a lot of things in our system. We do a lot of research when we first design a hospital such as going to other facilities and looking at best practices. A lot of that is evidence based. We take a number of tours to settle on the design and layout that best fits our needs based on similar facilities designed by our architects and or done at other organizations. We prefer to take the best of the best,” says Stoughton.

SSM Health Care of Wisconsin has fully integrated medical health records and all the latest digital imaging. They believe in building the proper backbone for superior data and telephone connections. “It’s all internet based,” says Stoughton. “Everything is pretty much cutting edge when it comes to the electronic stuff.”

Building in a Buyers Market

“Each project has a little bit of uniqueness that determines how I want to contract for it,” says Stoughton. “This market is a buyers market. I am, as the hospital’s agent, the buyer. The longer you can keep it on the street and get the design fully baked, so to speak, the better off you are when it comes to change orders and cost over-runs and ultimately, the better off you are when it comes to managing the overall budget and cost containment for the project.”

Stoughton doesn’t go for design assist or partnering at this point with the way the market is. “Architects and builders and bigger contractors are promoting partnering because they make their highest profits and best margins on those types of projects,” he says. “When everybody is on a controlled budget with a guaranteed maximum price, the end result always tends to bump up against that maximum price. There’s no substantial savings.”

Stoughton prefers to work with a stable of two to four general contractors whom he knows does superior work. “We don’t exclusively use one general contractor, but we have our preferred list and a lot of the time the same guys are winning the work. As a system we are required to bid all major projects it out each and every time, and the contractors understand that they’ve got to sharpen their pencils, each and every time.”

A good contractor, in Stoughton’s book, is also very safety conscious. “When you are in the medical industry, patient safety comes first, and some of that goes all the way back to how you design and build the space,” he says.

The Evolution of Hospital Construction

“Hospital projects today are very complicated because of the technology and the sophisticated equipment that goes in them,” says Stoughton. “We’ve constantly got to keep thinking of the new technologies that are around the corner and not box ourselves in. The technology of tomorrow will be a lot different for specialty rooms like operating rooms and MRI’s. We’ll look at what the technology is evolving to and a lot of times we’ll size and setup the room for future technology. We’ll sometimes put in the back boxes for those technologies of tomorrow that aren’t quite here, or those technologies we just can’t afford yet, but we know we want to install in the near future. We’re constantly looking at the potential future upgrades and  designing in flexibilities as we’re planning, designing and building the projects.”

-by T.M. Simmons

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