Performing Hospital Renovations with Surgical Precision

by Graham Cooper, Senior Project Manager,

ASHE Certified Healthcare Constructor

It’s no secret that hospital renovations can be fraught with complexities and hidden pitfalls, making collaboration among all stakeholders critical.

Front-line staff can provide insight into existing workflows while the Authority-Having-Jurisdiction can aid in assessing Interim Life Safety Measures and code deficiencies. Likewise, early contractor involvement can prove advantageous across multiple fronts.

From feasibility assessments and extensive cost control to detailed scheduling and well-coordinated logistics planning, collaboration at the schematic phase helps to ensure (1) schedule and budget expectations are met, (2) the hospital’s vision is achieved, and (3) patient and staff safety is maintained at all times.

Include All Stakeholders to Achieve Optimal COLLABORATION

...Never be afraid to ask, "Who are we missing?" to ensure the right team is involved.

Choate installed a 24-patient-room, temporary hospital unit in the parking lot of Navicent Health in Macon, GA to increase their facility capacity at the height of the COVID-19 outbreak. This is the second installation of “Liberty Boxes” made by BMarko Structures from shipping containers.

The process of assessing impacts begins with feasibility assessments and preconstruction reviews. Such reviews aid determining which mitigation measures are appropropriate and which inspection measures should be implemented during the construction process. Well-documented protocols must be established with clear lines of responsibility among team members. Understanding necessary mitigation measures is integral for determining cost, schedule, and phasing impacts.

Renovations within an occupied healthcare environment present vast safety challenges that other construction projects do not. Limiting construction risks requires a tailored, project-specific approach to safeguard the health of patients, staff, and guests.

Proper vetting of subcontractors is critical; all must understand and be willing to comply with a hospital’s rigorous standards. To aid in the vetting process, Choate, for instance, conducts comprehensive subcontractor pre-qualifications. Each firm’s financial strength, past performance, staffing, and safety record are closely assessed. Such assessments, however, are just the start.

The hospital will routinely maintain its own requirements for construction personnel. On-site workers must be willing to undergo specific hospital-required screenings and vaccinations and commit to full-time badging on site. In some cases, hospitals will also require workers to receive basic certifications administered by the American Hospital Association. Choate has the ability to train our partners to achieve across-the-board compliance.

Post-vetting, additional opportunities to reinforce protocols and expectations occur during the procurement phase and subcontract negotiations. For instance, the procurement phase provides an opportunity to ensure adequate cleaning and proper safety equipment are accounted for at each step. The subcontract will, likewise, detail and document all safety requirements to be followed.

Once the project is underway, expectations must be reinforced through comprehensive on-site training and monitoring for compliance. Choate’s safety management personnel and dedicated project superintendent, for instance, reinforce positive behavior while conveying zero-tolerance for non-compliance with required protocols.

Appropriate mitigation measures must be in place for separating construction activities from hospital operations, as required per the hospital’s ICRA and in collaboration with the project team. Temporary construction enclosures should be high-grade and installed with negative air containment systems monitored using manometers and air scrubbers as required. Such systems must be inspected regularly.

Ductwork must be sealed, and HVAC systems should be protected with filter fabric and MERV-rated filters. Likewise, a consistent process for worker entry and exit will aid in mitigating dispersion of contaminants into and around patient/staff areas (anterooms, specialized floor mats, floor sweeping compounds, etc.) and from clothing and equipment. Additional safety measures will likely be required per the hospital’s ICRA. Such measures should be discussed during the preconstruction assessment.

Proper logistics are critical to project success, and this success begins and ends with communication. By keeping the hospital’s team aware of the location of construction activities well in advance of actual execution (and at all other times), they are able to stay multiple steps ahead of the process and accommodate accordingly. This process includes detailing delivery and debris removal paths, as well coordinating, noting, and posting worker

Off-site production of pre-manufactured components (e.g., DIRTT wall systems, HVAC ductwork, headwall units, electrical components, etc.) offers multiple benefits over on-site construction. Moving work off-site, for instance, reduces the sheer number of on-site workers, thus decreasing competition for space and time among trades. Fewer workers on-site also mean less impacts to ongoing hospital operations, greater ability to physically distance, and reduced infection transmission potential among field teams.

Vehicle congestion around the site can also be reduced, a benefit welcomed by patients, staff, and visitors alike. Quality can also be easier to control in a factory environment, resulting in lower failure rates and greater standardization of components. Because off-site production can run parallel to construction, “speed to site” of components is also enhanced and greater certainty in scheduling can be achieved.

Make Logistics a Top Priority

entrance and exit points. Lean practices utilizing just-in-time (JIT) deliveries can prove advantageous, but strict lay-down areas must be coordinated in cases where JIT is not employed. Parking and spatial needs must also be well-communicated. Meanwhile, workers must be given explicit parking instructions to avoid additional traffic congestion or blockage of ambulance entry/exit points.

Collaborative preconstruction planning, weekly coordination meetings, and daily updates with the project team and hospital staff are critical for fleshing out potential impacts, planning innovative solutions, and sequencing actions accordingly. Proper communication also applies to subcontractors, as sometimes the most critical communication is training construction workers to adjust to changes in protocol.

Properly orchestrated and communicated construction activities eliminate impacts that would otherwise be felt across the spectrum (e.g., existing workflows, emergency access, visitor and staff parking, administration, entry, etc.). Thus, when phasing construction operations, communicating “who, what, where, when, and how” to team members and impacted staff is critical.

Micro-phasing plans also prove beneficial for minimizing and communicating impacts to public or occupied areas. Micro-phasing plans outline durations, worker access paths and protocols, and construction work hours, as well as all signage to be installed to notify impacted parties.

Construction affects everyone — administration, providers and staff, vendors, visitors, and most importantly, patients. Noise, vibrations, odors, deliveries, system shutdowns, and construction work hours can be disruptive factors in any occupied environment but are amplified in a hospital setting. Combined, these can significantly affect overall patient satisfaction levels and a hospital’s bottom line.

No matter the size or scope of a project…

...the single most important success factor is communication — upfront planning and collaboration with the project team to anticipate, assess, and mitigate facility impacts and constant communication with the hospital’s team to avoid unnecessary aggravation for patients and staff.

“With careful planning, Choate’s team and workers performed the scope while maintaining and monitoring all Infection Control Standards and without disruption to surgical scheduling or patient care. The project requirements were demanding, and the Choate team exceeded our expectations.”

Brian Evans, CHFM, Director of Facilities Management, Coastal Carolina Hospital // PROJECT CCH Decontamination Room Renovations