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6 Essential Tips for Healthcare Owners During Construction: Insights from Architects & Engineers

By Megan Yoder, RA, EDAC

September 12, 2023
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When healthcare projects are passed from designers over to the General Contractor for the start of construction, the transition should be seamless for all parties at the table, including the owner. However, as many healthcare facility managers know all too well, this becomes a new fast-paced chapter, sometimes filled with “growing pains” for their maintenance team, vendors, and staff. As an advocate for the owner, architects and engineers at Design Collaborative have plenty of experience with this shift of focus.  Once the groundbreaking is complete and shovels start flying, there are a few key items to launch the first discussions in the jobsite trailer on day one.

 

 

The Kickoff

It may seem like a simple tip, but the General Contractor should be encouraged to schedule a construction kick-off meeting, with a robust agenda. It’s beneficial to invite as many attendees to the table as they are available, including any end user groups impacted by the immediate start of construction.

Additional Tips:

  • Keep Imaging department managers in mind who may need to schedule patients’ visits around construction movement/vibrations around their specific rooms.
  • Healthcare facility projects can take numerous months, if not years. Whether it’s a small clinic, or a complete OR department renovation, establishing a clear and determined “go-live” date will keep all parties accountable for not only progression of work, but also to track down critical answers during construction.
Indiana Michigan Power Center - Corporate Headquarters collaboration area
Indiana Michigan Power Center - Corporate Headquarters collaboration area
Van Wert Hospital Clear Signage

Not Just a Phase

If an overall phasing plan has been created by the General Contractor, we advise it to be discussed early and at the top of the kick-off meeting agenda.

Hospitals and outpatient facilities have numerous parallel flows of traffic, including patients, staff, and support vendors entering and exiting throughout the day. Ideally, the Contractor comes with a phasing diagram draft to discuss with the owner’s leadership team. It’s critical to flag any non-negotiable shutdowns or any intolerable overlap prior to construction because this will affect sequencing of construction, schedule, and perhaps cost.

Additional Tips:

      • If a serving kitchen is to be taken offline, has the owner made temporary provisions? If a waiting room is going to be disturbed, has the GC helped the owner identify an alternative path and waiting space for patients? Our design team will initiate these conversations during the design phase, but it’s good to revisit, prior to construction with the General Contractor.
Van Wert Hospital Clear Signage

ICRA walls

Construction managers are ultimately responsible for the purchasing/installation of ICRA (Infection Control Risk Assessment) walls and other ICRA components¹. Installing these temporary walls takes careful coordination between the GC and the owner, in order not to obstruct general staff corridor traffic or reduce emergency paths.

Additional Tips:

  • There’s a common yet complex ICRA component that can be underestimated: the General Contractor will need to monitor and maintain a specific air flow and pressure in the contained space through the entirety of construction. These required levels may need to be phased into the larger HVAC design, especially if replacing any air handler units is part of the scope of work. Having a contractor on-board that is ASHE certified also helps with ICRA items.
Unfinished Wall
Unfinished Wall
St. Rita's Medical Center Cath Lab

Sensitive Equipment in-use

Due to the sensitivity of patient diagnostic equipment, imaging projects come with their own precise levels of coordination. Prior to any construction kick-off meeting, temporary imaging mobile units should be discussed between the designer and owner.

Prior to any site mobilization, if it has been flagged by the designer or owner, the Contractor should come to a pre-construction meeting with a subcontractor specialized in active construction site surveying techniques that can monitor vibrations in an existing building. MRI rooms are usually located on an exterior wall, so if there is a construction path or underground work being done adjacent, the Contractor should work with the imaging department for a plan to minimize disturbance.
St. Rita's Medical Center Cath Lab

Rooftop Rumble

While there is never a good time for a hospital roof system to leak, the worst time is during construction, when there are other factors in flux affecting the interior condition. The contractor should be extremely aware of any potential vibrations caused by their construction process that may dislodge fireproofing material from the underside of decks or beams, compromising the fire protection and handing an inspector an item to flag.

Our design team takes great care to never position possible leak sources – roof drains & RTU equipment – above critical health services (ICU’s, surgical suites, patient rooms, MRI suites, Cath labs, radiology suites, pharmacies, etc.) Attention should be paid not only in design, but also during construction above these areas: vibrations that create noise to staff in these areas are intolerable and should be avoided, or flagged during phasing.
Roof with Mechanical Equipment
Roof with Mechanical Equipment
Steel Wall Framing

Hold the Drywall

We have found it incredibly valuable to host what’s called “rough-in walkthrough’s” with the owners, the GC, and the electrical subcontractor, prior to drywall being installed. This method is valuable in any space type, including patient overnight room, ICU’s, Operating Rooms, Lab Draws, any staff conference rooms with a large amount of AV, nurse stations, and any other general locations with casework.

We encourage the Contractor to schedule the walkthrough prior to drywall being installed and when all final power, data, and med gases are located on the walls in the room. The end users are invited to walk around the spaces and visualize the flow of the room during their daily routines. Even months after the design process is complete, we find that when surgeons, techs, physicians, and other staff are able to physically walk through their soon-to-be space, they can best tangibly visualize where they might need an additional power outlet, or other tweaks to lighting controls, etc.

Additional Tip:

      • To help the nurses, physicians, techs, IT member, and other end users visualize the space, contractors can use painters’ tape or cardboard to show the location and number of power and data outlets on each wall.
Steel Wall Framing

The shift from design to construction, especially on a healthcare project, can have many moving parts. These are just a few things that we as designers encourage healthcare owners to talk with Construction Managers about to help make the process as smooth as possible. Working together, we can all create a successful and efficient project all the way from design, through construction, and to the finished space!

[footnotes]

  1. ICRA assemblies are used to contain construction dust/debris from escaping a jobsite and permeating into the clean, healthy patient environment. They also might need to function as a temporary fire barrier between occupied areas and non-sprinklered construction zones.
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