How HCA Scaled Modular Construction Across $5B in Projects

When Rob Crotty joined HCA Healthcare 10 years ago, he had a mandate to "improve by 10%." Nobody defined what that meant. Coming from manufacturing, Crotty decided it meant 10% faster, cheaper, and better quality—all at once.

At HealthSpaces, Crotty shared HCA's decade-long evolution from costly modular pilots to systematic success across their $5 billion annual construction program, managing 400 active projects, with most being expansions and renovations of existing facilities.

The $1.5 Million Lesson

HCA's challenge was immediately complex: unlike new construction, most of their work involves existing footprints. "When you start talking about modular and prefab, you gotta deal with an existing footprint," Crotty explained. "That adds a wrinkle when you want to standardize."

Early modular experiments proved to be expensive lessons. They tested a "kit of parts" approach on freestanding emergency departments, purchasing $1.5 million worth of prefab content for projects that typically cost $5 million.

The result? Projects cost $6.5 million.

"Nobody changed how they did their pre-construction work because they didn't know what this thing was," Crotty explained. "Mechanical costs stayed exactly the same—$110 before and after—even though we provided 20% of the content."

The prefab wasn't the problem. The workflow was.

From Failure to Program

In 2018, HCA killed its freestanding emergency room program. The traditional stick-built approach took 8.5 months, while their modular approach took 7 months but carried a 15% cost premium. The math didn't work.

Today: stick build takes 11 months, modular takes 7.5 months. That five-month revenue acceleration more than compensates for any premium.

What changed? HCA stopped debating individual projects and built a program with four systematic levels:

• Custom components (underground electrical)
• Project-adapted standards (exterior walls)
• Configured standards (modular ceilings that install in one day vs. weeks)
• Pure standards (head walls by equipment type)

"Once you move to program management, your costs continue to go down," Crotty said. "You're even with stick build or better."

The Safety Case Nobody Debates

Falls from roofs, ladders, and scaffolding are the top three causes of construction deaths. Prefabricated exterior walls minimize the need for workers on scaffolding.

"I can't imagine why we'd want people up on scaffolding trying to hand-build a wall," Crotty said. "This is the only prefab we do that no one debated the benefits."

What Actually Works

After 10 years of testing, HCA's real results:

• Schedule acceleration: Consistently achieved with “prefab intense” projects
• Cost savings without accelerated revenue: 5-7% (not the 30% vendors promise)
• Labor efficiency: 30-40% reduction on prefab elements
• Safety: Cleaner job sites, fewer workers at height

The key insight: Coordinate modular design during the initial phase, not after. "If you wait till construction documents to say 'let's do prefab,' you won't do as much, and it'll cost more."

The New Reality

HCA now tells architects upfront which prefab elements they'll use, allowing designs to accommodate modular from the start. They've moved from asking "should we use modular?" to "which modular elements fit this project?"

The lesson: expect the learning curve to be initially expensive, but systematic deployment delivers real value across large portfolios.

After 10 years of trial and error, Crotty has a clear message: modular works, but only if you're willing to change how you work.

Watch his full talk below...