Explaining Blox

Blox CEO Chris Giattina was asked to speak to a group of healthcare, real estate and facilities managers about how Blox is leveraging their design manufacture construct process to dramatically reduce time to market, cost of construction, and total cost of operation for healthcare facilities.


In 2000, Honda Motor Company came and said, "Chris, we would like for you to lead the design and construction of a really big project in Alabama. It was important for our state." They said the first phase of the project was a training facility, and it needed to be open one year before the big factory was open. We had our first meeting, a kickoff meeting, with no official program, no equipment list, and really not much more than the Japanese leadership saying, "We want a world-class facility to train 4,000 workers in 200-person shifts, and we want it nine months from yesterday." Of course, being the type of people we are, we said, "Yeah, that sounds like a great amount of fun. We will take that on." And we did.

Fast forward to our second meeting, and we learned three things about the Japanese and their leadership style. First, they offered all of Honda's resources to help us help them be successful. This was crucial, and I don't think we would have gotten there without that notion. Second, it became clear this was not the first time they had asked their trade partners to solve a really hard problem. Third, and most importantly, there was no chance in the world they weren't going to open this thing nine months from last week.

Fast forward six weeks, and we've broken ground. Imagine that—six weeks later, we have broken ground on a thousand-acre site, moving dirt and getting ready for foundations. By this point, it was abundantly clear that unlike the Japanese automotive industry, the American design and construction world had failed to invest in the research and development necessary to deliver a high-quality space in compressed schedules. So, a group of architects, builders, and engineers got together, and we began thinking about a framework that would allow us to fix that. We came up with a goal—it was our man on the moon notion, and it was two by two by two. We wanted to create a framework that would yield twice the quality of traditional construction, measured by objective benchmarks like energy efficiency, lifecycle cost, and patient experience.

The second part was that we wanted to deliver these things at twice the speed of traditional delivery, measured objectively from permit to certificate of occupancy. Finally, we wanted to do this in such a way that we delivered to the owner twice the value or half the cost. If we could do this, we felt like we would be relevant in a world of clutter.

An example of how you get there is interesting. If it were two times two times two and equaled eight, and it was an 8% change, then there are many ways to get there with value engineering—maybe change the specifications, maybe competitively bid it. But if you realize that that's an eightfold increase, an 800% delta, then you're not going to get there by thinking conventionally. So, we have to think about it differently. We said, what if we go from model to fabrication, eliminating intermediate steps? This approach isn't about simplifying but eradicating unnecessary steps.

We take that approach to hundreds of things that we work on. We want to go from a thoughtful building information model to fabrication G-code, which allows us to work in a fundamentally different way. That requires technology at a level that didn't exist in our industry. This graph shows a cloud-based platform, akin to an ERP, that takes raw materials, organizes them with manufacturing constraints, regulatory constraints, and best-in-class manufacturers to make standard products. These products are then distributed through a secure web portal, demonstrating the basic use of technology to change the paradigm.

All of this needs a framework, and the framework is Design Manufacture Construct (DMC). DMC is ridiculously simple. We're from Alabama, and it says we will teach a legion of designers to leverage manufacturing productivity to simplify construction. This will make a difference.

We focus on three things: creating systems instead of brute force to make repeatable processes, achieving quality in a dwindling skilled labor market, and doing this with the speed to market that allows us to invest in tooling and R&D. This is a typical North American job site, with inefficiencies inherent to any job site. Imagine this construction fence around every project as a black box—this is your hospital, and these are the men and women, methods, and materials needed to build it.

With DMC, we lasso a critical mass and pluck it out. Something magical happens in both places: over here, we take 800 parts and organize them into a lean facility. This lean facility takes 13 integrated trades, creating many parts daily, hundreds weekly, and thousands yearly. Over here, the general contractor now has an opportunity they didn't have before: 25% fewer people, less complexity, less material, less regulatory burden. This leverage changes the gravitational orbits of all subtrades, creating a leveraging effect. This is low, but the 25% removed becomes 40%.

This is DMC version one, and HCA is our wonderful case study. This has been a five-year program, working in 20 states on hundreds of projects. It looks like this: HCA has dozens of building types, greenfield projects, vertical expansions, outpatient clinics, etc. Despite robust design standards, there's an explosion of variety at the granular level. We proposed standardizing finite sets of parts, from 400 rooms to nine standard parts. This reduction in variation woke up the department, enabling meaningful standardization.

This led to interchangeable parts, enabling programmatic decisions instead of project-level decisions. These parts are installed from Miami to Las Vegas, with cost benchmarks showing initial premiums that reduce significantly at scale. By pushing through initial costs, we see potential gains, moving more from the black to the red.

Our next step is the freestanding emergency department, small but complex, using an approach akin to Boeing's chunking method. This involves creating large, complex modules that assemble like Boeing's aircraft. Our Uber modules, 15 feet wide, 15 feet tall, and 60 feet long, are the largest DOT allows. They contain various facilities, from central energy plants to patient rooms. This method radically changes the construction site, enabling faster, more efficient assembly.

This freestanding ED, with its modules and exterior cladding, is dried in and conditioned within six weeks. We continue to refine this process, reducing design time and manufacturing duration significantly. Construction improvements are ongoing, with lessons learned from each project. This journey aims to achieve higher quality, faster rates, and lower costs.

Our next goal is DMC version three, focusing on acute care at a significant level. This involves universal patient rooms with best-in-class materials, creating an iPhone-like experience in healthcare. These Uber modules can stack 30 stories high, expanding our capabilities in healthcare construction. The goal remains: twice the quality, twice the speed, at half the cost. Thank you for your time.