Healthcare infrastructure projects are among the most technically demanding forms of construction. Hospitals require strict compliance with structural, medical, architectural, and safety standards while meeting ambitious government delivery schedules. To accelerate project implementation, many public facilities in Indonesia now use the Design and Build contract model, which integrates design and construction into a single contract. Although this approach shortens procurement time, it also increases the importance of producing accurate engineering designs from the beginning of the project.
The study focuses on the construction of the West Muna Regional General Hospital (RSUD) in Southeast Sulawesi, one of the projects included in the Ministry of Health's PHTC Batch 3 Program. During implementation, project stakeholders encountered repeated design revisions because several aspects of the initial planning documents did not fully match actual field conditions or updated technical standards. Those revisions affected engineering decisions, approval processes, and ultimately the overall construction schedule.
To investigate the causes of these delays, the researchers conducted a quantitative case study involving 31 respondents directly engaged in the project. Participants included the Project Owner's Representative (PPK), the Ministry of Health technical team, construction management consultants, design consultants, and Design and Build contractors. Data were collected through structured questionnaires developed from Focus Group Discussions (FGDs) and measured using a five-point Likert scale. The researchers analyzed the responses using Partial Least Squares Structural Equation Modeling (PLS-SEM) to identify the most influential factors affecting DED development performance. They then applied the Critical Path Method (CPM) to determine how those dominant factors influenced the project's completion time.
The analysis revealed that conformity with actual field conditions was the strongest determinant of successful DED development. When the design failed to reflect the physical characteristics of the construction site, project teams were required to revise engineering documents repeatedly. These revisions delayed design approval, postponed contractor mobilization, and slowed subsequent construction activities. According to the researchers, accurate site investigations should therefore become a priority before and during the design development stage to minimize costly redesigns.
The project's scheduling analysis produced equally important findings. Based on the Critical Path Method, the remaining contractual duration was 295 calendar days, while the projected completion time under actual conditions reached 343 calendar days. Without schedule acceleration or resource optimization, the project faced a potential 48-day delay beyond the contractual target.
The study also identified the project's critical activities—tasks that cannot be delayed without affecting the overall completion date. These include:
- Planning and permitting
- Foundation construction
- Earthworks
- Structural work for Floors 1, 2, and 3
- Third-floor architectural work
- Third-floor interior installation
- Third-floor furniture installation
- Testing and commissioning
- Project handover
Because each of these activities has zero Total Float, even a one-day delay in any of them directly extends the project's completion by one day.
Among these activities, the third-floor architectural work emerged as one of the most time-consuming phases. The floor accommodates operating theatres equipped with highly specialized components, including sterile partitions, hermetic doors, modular ceilings, conductive flooring, HVAC integration, medical gas systems, and surgical equipment. The complexity of these installations means that delays at this stage inevitably postpone interior work, equipment installation, testing, and commissioning.
The findings have broad implications for infrastructure planning in Indonesia. Public agencies, engineering consultants, and contractors can reduce project delays by strengthening preliminary site investigations and improving the quality of Basic Design documents before construction begins. Better coordination among stakeholders during the design stage could also reduce repetitive approvals and engineering revisions, leading to more efficient project delivery and lower implementation costs.
For policymakers, the study provides evidence that investment in thorough pre-construction planning may deliver greater value than relying solely on construction-phase acceleration. For engineering firms, the research highlights the importance of integrating field verification into every stage of Detailed Engineering Design development. These lessons are particularly relevant as Indonesia continues expanding hospitals and other essential public facilities.
As Abdul Khohar and his colleagues from Universitas 17 Agustus 1945 Surabaya emphasize through their findings, successful Design and Build projects depend on more than contractual efficiency. High-quality engineering decisions begin with accurate field data, and the closer engineering designs reflect real site conditions, the greater the likelihood that projects will be completed on time and within planned resources.
Beyond its practical recommendations, the research also demonstrates the value of combining PLS-SEM and the Critical Path Method to evaluate construction performance. The integrated analytical approach enables project managers to identify both the root causes of design inefficiencies and their measurable impact on project schedules, offering a comprehensive framework for future infrastructure management.
Author Profile
Abdul Khohar is a Civil Engineering researcher from the Master's Program in Civil Engineering, Faculty of Engineering, Universitas 17 Agustus 1945 Surabaya, specializing in construction management, Design and Build implementation, and project scheduling.
Budi Witjaksana is a senior academic at the Master's Program in Civil Engineering, Faculty of Engineering, Universitas 17 Agustus 1945 Surabaya, with expertise in construction management, project evaluation, and infrastructure performance.
Andi Patriadi is a researcher and academic at the Master's Program in Civil Engineering, Faculty of Engineering, Universitas 17 Agustus 1945 Surabaya, whose research focuses on engineering design, construction management, and infrastructure development.
Source
Article Title: Analysis of Project Time Implementation on Dominant Variables Influencing DED Development Performance Using the CPM (Critical Path Method) Method in the Design and Build Contract in the Ministry of Health's Batch 3 PHTC Program (Case Study: Construction of the West Muna District Hospital)
Journal: Formosa Journal of Science and Technology (FJST)
Publication Year: 2026
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