Causes and effects of rework on the delivery of healthcare facilities in California

This research focuses on identifying the causes of rework within a design and permitting process of healthcare facilities in California. Causes of rework were identified and categorized. Three computer simulations were created to illustrate the effect of rework on system performance. One explores the throttles affecting a production process. The other two illustrate the effect of rework on two organizational case studies.;Research extending a taxonomy describes causes of rework in the process. I obtained data from industry workshops to determine the current state process for the healthcare construction industry. I used a multi-tier categorization framework to classify the causes of rework. This laid the foundation for further exploration through computer simulation.;The first case study, workflow of a mechanical contractor, illustrated the complexity involved in the process from their point of view. I used computer simulation to reveal the pressures on the construction process due to incomplete drawings and changes to them. I determined that implementing a delayed management strategy is one way to reduce negative rework.;Understanding demand and capacity using simulation models provides intuition on the elements affecting workflow variation in a production process. I identified three throttles that control production throughput: (1) inflow of projects, (2) resource capacity, and (3) likelihood of rework. Simulations highlight the tradeoffs management can make between the latter two.;The second case study, effect of alternative review on workflow, describes both the current and future state process of a plan review agency. I obtained data from them and constructed a model to simulate their workflow. Simulations showed that an alternative review process can improve system performance. This research showed that negative rework can be detrimental to system performance. To improve performance we must break free from traditional project roles, where information is isolated and protected, and move to an environment where we understand the workflow of others and of all combined. The occurrence of negative rework can be reduced by engaging more stakeholders, earlier in design, fostering an integrated and collaborative environment.