Simulation of design changes impact in healthcare construction projects using system dynamics

Design changes (DC) contribute significantly to construction projects' delays and cost overruns. Many research efforts tackled DC management, yet with less efforts in healthcare construction (HC) projects which involve multiple stakeholders including medical users and require meeting engineering and medical specifications. Therefore, a new system dynamics (SD) model that simulates HC environment, considering engineering and medical factors that can potentially trigger DCs, was developed. It simulates, as well, DCs' ripple effect in inducing further DCs due to errors encountered while processing the DCs, and time extension that make the project vulnerable to DCs to catch up with the latest medical advancements. Using a real HC project, the proposed model is validated, and a sensitivity analysis has been conducted to identify the most sensitive factors to DCs. Thus, the new SD model is a useful tool to allow proactive DC management and sound decision-making to maintain the planned project performance.