William A. DaigneauOperations & Facilities ManagementVice President, Chief Facilities Officer

CMAA Owner’s Forum

May 3, 2010

“Here We Grow Again!”Managing Growth at M. D. Anderson Cancer

Center

Title

Here We Grow Again ●CMAA Owners Forum●May 3, 20102

Growth Over 10 Years FY 1999 – 2009

FY ‘09Increase‘99 - ‘09

Total Patients Served (approx.) 96,500 1.9x

New Patients (approx.) 33,200 1.8xPatients on Therapeutic Clinical Trials (approx.) 11,179 2.0x

Research Expenditures1 $510.3M 3.3x

Trainees 6,358 2.9x

Faculty and Staff (FTEs) 17,451 2.0x

Facilities (GSF approx.) 11,610,000 2.5x

Here We Grow Again ●CMAA Owners Forum●May 3, 20103

TitleNorth Campus

Mid-Campus

South Campus

East Campus

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M. D. Anderson Cancer CenterNorth Campus

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What We’ve Built2 Hospitals (including surgery, GMP facilities)

4 Outpatient Clinics6 BioMedical Research (up to BSL-3, GLP’s)

3 Vivaria4 Office Buildings2 Hotels3 Data Centers2 Warehouse4 Parking Garages3 Imaging (Cyclotrons, PET, MR, etc.)

3 Treatment Centers (Proton/Linear Accelerators)

4 Conference Centers w/ TeleMedicine2 Freezer Farms1 Blood BankPlus roads, central plants, parks, underground utilities (sewer, water, fiber, retention)

Equal to adding a 600k GSF building every year for 15 straight years, totaling $4 billion

Here We Grow Again ●CMAA Owners Forum●May 3, 20106

How We Built It• Hard Bid Lump Sum

• CSP

• CM at Risk

• Design-Build

• Job Order Contract

• Multiple Contracts

• Third Party, w/ and w/o Equity Involvement

• Greenfield

• Constrained Site

• High and Low Rise

• Steel and Concrete

• New Construction and Renovation

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How We Managed It

• 125 person in-house PDC management group

• Agile processes Mall developers Toyota Lean Standard modules/kit of parts

• Project organization/decision-making

• Trust but verify - documentation

• Building relationships - fairness

• Advance planning

Here We Grow Again ●CMAA Owners Forum●May 3, 20108

What We Learned

• Project and situation - determine best delivery method

• Contracts - read only when disputes arise

• Contract terms – have multiple interpretations

• Project success - directly related to team member quality, commitment

• Project schedules - run by hope and prayer

• Teamwork - direct function of who’s making, losing money

Here We Grow Again ●CMAA Owners Forum●May 3, 20109

Issues in the Industry

• Construction quality - too much rework

• Subcontractor management expertise

• Adoption of Lean concepts

• Educating Owners (www.coaa.org)

• Greater standardization & transparency

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Questions?

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