Sunil Shah spent 40 years at Kaiser Permanente, watching the same conversations repeat themselves over and over. "Why does it cost so much? Why does it take so long?" As VP of Facilities Planning and Design, overseeing a $30 billion capital portfolio, he got tired of the questions. More importantly, he got tired of not having better answers.
Shah went to his regional president with a pitch: invest in what I think we need to do, and I'll deliver a 20% reduction in cost and time. Ten years later, that promise is becoming reality.
At HealthSpaces, Shah walked us through Kaiser's transformation to a digital platform, cutting design time from 18 months to three months—and delivering their first project with a 24% time reduction and 20% cost savings.
Kaiser operates one of the largest healthcare construction programs in the country, with 4,000 active projects worth $15-18 billion at any given time. With 800 medical office buildings and 40 hospitals in its portfolio, Shah gets asked about costs and timelines "almost every hour."
The scale made inefficiencies painful. Unlike health systems that build one hospital at a time, Kaiser needed a repeatable approach that could work across its massive portfolio.
Shah's transformation required nine sequential steps with "no shortcuts." "You can do parts of things, but you will never get to the actual reduction in time and money if you don't try to do these nine steps," he told the HealthSpaces audience.
Most health systems want to skip straight to prefab. Shah knew that was a dead end. He started with something exponentially harder: getting 2,500 clinicians to agree on a single way to work.
The first four steps took years. But they made everything else possible.
Kaiser focused on medical office buildings for strategic reasons. California's OSHPD "governs that space with an iron fist" for hospitals, as Shah put it. Plus, they'd just completed a massive seismic replacement program.
"We had a lot of medical office buildings to catch up on."
They also broke shell and core into 15 standardized components with fabrication-level drawings. These components can assemble into different building configurations while maintaining pricing certainty.
Shah's breakthrough started with cardboard. His team built three full-scale prototypes and gave 200 tours to 2,500 clinicians. They ran ethnographies and ideation sessions to understand how care actually happens. The result: 34% more patient throughput from the same square footage. "That never shows up in any financial calculations," Shah noted, "but it reduced our capital plan because we didn't need to build as many medical office buildings."
"If you can't get your clinical colleagues to agree on one way to operate, it's very difficult to build buildings with lots of variations and reduce cost," Shah explained.
That clinical agreement became the non-negotiable blueprint for everything that followed: standardized rooms, departments, and eventually, entire buildings. In fact, Kaiser found that 90% of their medical office buildings built over the last 25 years could fit into just three or four standard designs.
Kaiser converted space programming from spreadsheets scattered across drives to a SharePoint database. What used to take 12-18 months now happens "within hours."
They created 220 room templates—not design intent sketches, but construction-ready components with furniture, casework, medical equipment, and building systems fully specified.
These rooms combine into departments. Departments combine into clinic modules. Modules combine into buildings.
"We wanted a manufacturing platform," Shah emphasized. "Revit is not one of them."
Their platform lets planners drag and drop components to create floor plans. Once locked, all associated data—IT requirements, medical equipment, MEP systems—automatically ports in.
Kaiser didn't just standardize designs—they built strategic partnerships, securing pricing agreements for 70% of their typical building. The result: 75% of their buildings are now prefabricated. Steel erection for a 100,000-square-foot building takes 10 days, with full dry-in within two months.
Kaiser created two positions that didn't exist before:
Digital Archivist: Captures every field change in real-time and updates the digital library. "It's not in some architectural as-built that nobody gets easy access to," Shah explained. "Our standard details get updated, put into the library, go into our next project."
Integration Manager: A reimagined general contractor role. They coordinate Kaiser's supply chain partners through pre-construction and construction while Kaiser retains project risk.
This shift reflects a fundamental change: Kaiser acts more like a manufacturer with a supply chain than a developer hiring contractors.
Their first fully implemented project using this model is under construction in Lakewood, Colorado, set to open in early 2026—the one that will achieve the 20% cost and time reductions Shah promised a decade ago.
After 40 years at Kaiser and 10 years building this platform, Shah finally has different answers when people ask why construction costs so much and takes so long. The answer isn't shorter. But it works.
Watch his full talk below...