On any new construction or renovation project, there always seem to be a few consultants participating. One may ask why consultants are hired to do some projects that have the potential to be completed internally. The answer, with little surprise, often points to the bottom line. In many situations, consultants provide a greater knowledge base and offer more effective solutions at potentially significant savings. Compare it to cycling, in which a young cyclist may be able to ride 10 miles, but he or she may not accomplish this with great speed or incredible precision. Now consider a professional rider, capable of completing the 10 miles with precision, speed, and considerably less expenditure of effort. This is largely due to the focus and practice within a specific area.

In many regards, consultants are not that different. Due to their focus and familiarity with particular subjects, consultants can often create accurate, precise, and efficient designs, schematics, and lists in less time and with higher overall quality than internal staff.

No individual can cover every technology or discipline necessary in hospital construction, and consultants can fill gaps or perform more advanced or involved maneuvers with practiced expertise at times when it may not otherwise be available. In fact, most construction companies, architectural firms, and many other kinds of businesses have a lack of expertise in certain areas. The ability to call upon consultants allows for these gaps to be filled by experts within their respective fields in a timely manner, while not drawing vital resources away from the everyday projects performed within the organization. Lastly, they are able to do so outside the vacuum of the organization, often having a varied background or experience base around a focused project type.

The use of consulting groups in many aspects of health care is rapidly growing, especially in situations where internal staffing is already spread thin or lacks the expertise to be of significant support. Using a qualified and professional consultant or consulting organization can pay fiscal and operational dividends for years to come. But how do you determine with whom your organization should work? How do you compare consultants, when in some cases it may seem like comparing apples with mangoes? Here, we shall discuss the many aspects to consider, how to weigh them against one another, and ultimately, how to use these tools to select the right group for your organization.

Playing the Political Game

Sometimes the greatest advantage of using consultants is their ability to stay free—or work to stay free—of office politics. For instance, in some organizations the chief of a given department may carry with the title a significant amount of clout. This influence—in terms of capital considerations or construction projects—means his or her vote carries significant weight. When a consultant is used, much of this can be circumvented via the consultant’s unfamiliarity with or disregard for the political charge—allowing the consulting organization to focus solely on the best option for the client in light of its strategic goals. In short, a consultant will not have to deal with the political fallout that could occur internally by standing up to an organization’s political powerhouse.

In some organizations, the act of stepping up and challenging a boss not only can prove difficult, but can also have a significant and lasting operational impact. However, this can usually be avoided with a consultant, allowing the project to run smoothly, leaving an outside party to bear bad news and preserving internal working relationships.


Are You Unique?

What exactly distinguishes one organization from the next? There are a number of very basic characteristics that differentiate consulting organizations such as size, experience, geographic proximity, historic relationship, and fee structure or process. While these may seem relatively straightforward, they may in fact be convoluted, and your decision might as well be a shot in the dark if you choose to consider just one piece of this puzzle when making a decision.

For instance, 10 to 15 years ago, geographic proximity was perhaps one of the most important aspects of a consulting group’s allure. Today, the wireless world has made geography less of an issue. Since proximity still plays a role in determining the best fit, it should be weighed appropriately. Face-to-face meetings should still occur regularly, while much of the behind-the-scenes work can be accomplished from nearly any point on the globe. It is important to note that travel expenses in some cases are part of a consultant’s fee structure, but these are controllable expenditures, either containing a set cap, a set number of visits, or other limiting parameters.

Another aspect that comes under considerable scrutiny is experience. Experience is, by most accounts, a key ingredient in the successful provision of support from a consulting firm. Interestingly, many consulting firms presently pair senior or experienced consultants with their younger, less practiced counterparts to produce an unforeseen benefit: The vital experience of a seasoned professional can steer the ship clear of hazardous waters, while the fresh perspective and jump-right-in attitude often attributed to inexperience can bring new concepts and innovative solutions. Youthful vitality and a new perspective are helpful. The inherent abilities in these pairings go hand-in-hand with the next aspect to consider—organizational size.

The size of the consulting organization may be of little consequence in a highly defined, perhaps routine, consulting venture. However, in most one-of-a-kind ventures, the amount and breadth of knowledge within a consulting organization can be priceless. In fact, this extensive knowledge is often considered a driver toward hiring a consultant. Highly complex projects require internal time expenditure, which far outweighs the fees charged by an external consulting organization. Moreover, a consultant’s coworkers’ specialized abilities have the potential to provide huge added value. When a consultant can seek answers from colleagues in the same office, as opposed to chasing down information from a general contractor, supplier, or other consultant, it allows for deliverables to be provided in a more timely manner.

Understanding a consulting organization’s standards of practice, core values, and ultimate goals as an organization represents a very important aspect of determining if it is the right fit. While in many instances the goal of the organization is fiscal success, its core values and standards of practice give insight into its leadership and direction. Generally, an organization seeks out and employs individuals who exemplify its core values and adhere to its standards of practice. This is really no different from the values and goals within one’s clinical/biomedical engineering department. The core values of a consulting firm can be considered the fingerprint of the organization, representing its character and priorities. While by no means a definite identifier, the values of an organization may indicate how it works through a project toward a specified end result. For instance, an innovative organization—though aware of current common practices—may take a project in a direction not previously envisioned, providing a service in a more prolific, efficient, or cost-effective manner than previously thought possible.

Background Checks

In most, if not all, proposals provided to organizations, a consultant or consulting group will provide a list of professional references. Checking these references carefully is perhaps the easiest and fastest way to get a solid feel for the quality of the consultant, its deliverables, and its ability to meet deadlines. By most accounts, health care is a very large but very tightly knit community. It is common for any one of the 6,000 hospital CEOs around the country to pick up the phone and request information from a peer. And, with the exception of direct competitors, this practice can—and should—be employed by clinical/biomedical engineering directors and managers. Scheduling a quick 15- or 30-minute meeting with the references of a consulting organization can save considerable money and prevent headaches down the road. It is important for the medical technology professional to keep in mind that he or she will ultimately need to deal with the outcomes once the project is complete—be it maintenance dreams or nightmares.

Strengthening the Team

Ultimately, the right consultant is a healthy blend of each of the characteristics discussed. Evaluating these features will be a process for the team charged with selecting the consultant. This brings up the final and a key aspect of choosing the right consultant—teamwork. Typically, a single individual should not choose the consultant for an organization. There may be situations and projects in which one person chooses, but in general, it is important to use a team evaluation approach, just as in consulting itself. With clinical technologies having an impact on most new construction and renovation projects, clinical engineers and biomedical technicians are given an avenue to supply essential insight. The ability to understand the technical terminology and the opinions of a given consulting firm prove invaluable during the team evaluation process. Furthermore, considering or using a consulting firm does not diminish in any way the worth of the internal knowledge base. Rather, the consultants should become, when possible, extensions of the internal knowledge base, providing new perspectives with additional insights, background, and experiences.

In turn, some level of self-evaluation will prove beneficial in the final stages of consultant evaluation. Determining one’s organizational core values and recognizing how they align with the respective consulting group’s is always a helpful step. Not unlike those used during capital budgeting processes, creating a scoring matrix—often overseen by the clinical/biomedical engineering department—can increase objectivity and progression during the evaluation and selection process. In the end, keeping each of these aspects in mind, and discussing how the organization feels, will determine which consulting group wins the race.

Barrett Franklin, MS, is a clinical engineer with KJWW Engineering Consultants, Naperville, Ill.

Common Types of Consulting Firms

Understanding the focus and breadth of knowledge of consulting firms and who hires them provides a picture of how and why consultants can benefit a health care facility. The list below represents some of the main areas consultants cover.

  • Accreditation—Typically hired by the client to come in and do mock surveys—such as for a Joint Commission inspection—these consulting groups help guide an organization toward accreditation preparedness.
  • Construction Administration—Construction administration is unique in that this is not typically a separate consulting group, but rather one service of a larger firm functioning as an ombudsman for the client. They work to advocate both internally and externally in support of the field activities associated with the construction, installation, and final punch list acceptance.
  • Electrical—Typical tasks performed by electrical consultants include designing the building’s lighting systems and power. This consultant works with the building owner to design an appropriate and fiscally acceptable system.
  • Fire Protection—FPE consultants focus on the design of a building’s wet pipe sprinkler system and standpipe system—aspects of the fire alarm system. If necessary, they may also focus on peripheral plumbing such as dry pipe, pre-action, and deluge piping.
  • Furniture/Design—These consultants work with the client to develop and provide the client’s preferred environment for different areas within a facility.
  • Information Technology—IT consultants can cross many modalities within a health care institution. They often work to support all areas of computing, or computer-related tasks.
  • Mechanical—Generally, mechanical consultants focus on the HVAC system, although they may also support additional design services such as medical gases and master planning. The mechanical consultant works with the building owner to design the system that fits both the set budget and need.
  • Medical Equipment—These planners support the processes involved in renovation and new construction. Medical planners typically have a breadth of knowledge crossing many modalities and provide both clinical and technical insight in support of the design, acquisition, and installation process for new and relocated medical equipment.
  • Plumbing—Plumbing consultants’ primary focus is on the domestic water system, including sanitary and vent piping. They may also be involved in the design of a storm water system, as warranted by the environment.
  • Structural—Structural consultants work closely with the architect and owner to design economical and safe supporting structures for floors, walls, columns, and foundations to shore up the building. Typical tasks include design to resist normal forces associated with vertical floor loading combined with wind and/or earthquake forces as well as heavy equipment.
  • Technology—As clients’ needs vary, technology consultants support a wide array of technologies such as security, audio/video, cabling, etc, which are converging on the Internet Protocol platform. They work to bridge the gap between the various groups supporting each facet.