Recorded live on the expo floor at Advancing Prefab 2026 in Dallas, this conversation with Robert Crotty, VP of Design & Construction at HCA Healthcare, is a masterclass in what it actually takes to run prefab as a program, not a project. Robert was hired by HCA a decade ago to advance offsite construction, and the timing of this recording, at an event literally named Advancing Prefab, wasn't lost on either of us. We cover how a major health system tests, refines, and scales prefab components across hundreds of in-flight projects, why healthcare is the right proving ground for innovations that will eventually reach housing, and what manufacturers and trade contractors should be thinking about during slow periods. Key topics below! 🌲 Upcoming Events: Advancing Construction Leadership (APRIL 28-29, 2026 IN DALLAS TX) US employers reported 1.3 million workplace injuries IN 2024, and construction still sees some of the highest rates of serious harm. Leading firms recognize that safety is a catalyst for innovation, project quality, and profitability. The question remains: How do we bridge the gap between the boardroom and the boots on the ground? Use code BUILDPERSPECTIVES10 to save 10% off at registration. Register at: https://advancing-construction-safety-leadership.com/ International Mass Timber Conference (IMTC) March 30 – April 1, 2026 | Portland, OR The premier gathering for the mass timber and tall wood building industry. Build Perspectives listeners get an exclusive discount! Use code IMTC26_SEIMS10 to save 10% off at registration. Register at: masstimberconference.com Key Topics Covered in This Pod: How HCA manages hundreds of concurrent projects — from lobby refurbs to new hospital builds — using an incremental construction model that mirrors community demand curves and reduces the risk of large-scale prefab commitments gone wrong. Why moving work off-site typically delivers a 2x productivity improvement, and how that math becomes a survival strategy when 400,000 skilled tradespeople are leaving the industry with no pipeline of replacements. The case for making prefab decisions early in design — not late — and how HCA's partner program cross-trains GC teams by sending them to watch live installs before they're responsible for one. Why healthcare construction (often $1,000+/SF) is the innovation proving ground that makes prefab better and cheaper for housing and hospitality over time — and Robert's advice for factory operators on using off-peak demand to train workforce rather than curtail operations. How smaller health systems, trade contractors, and manufacturers can think programmatically about prefab without HCA's volume — through GPOs, collaborative buying, and latching onto GCs already building their own offsite capacity. The Toyota Production System truth that construction keeps learning the hard way: you can tour every factory you want, but without the culture, none of it sticks. Connect with Robert Crotty on LinkedIn: https://www.linkedin.com/in/robertcrotty/ This episode was recorded live at Advancing Prefabrication 2026 in Dallas and made possible by the support of Project Fluent and the Advancing Construction event series. Learn more at www.advancing-prefabrication.com. Build Perspectives is hosted by Tim Seims and Carolina Baffigo. If this conversation resonated, please subscribe, leave a rating, and share with someone in your network who needs to hear it.
