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Navigating the Complexities of Healthcare Renovation Projects: Phasing, Safety, and Patient Care

By Craig Scully PE, LEED AP

March 29, 2024

Healthcare renovation projects are among the trickiest to coordinate because in many cases, the services provided need to be able to remain relatively uninterrupted while the construction is being done.

The first essential step is asking the right questions to determine what exactly has to be done, how much time crews have to complete the work, and whether the work can be done while the facility is operational.
Van Wert Health Surgery and Inpatient Construction
Van Wert Health Surgery and Inpatient Construction

Our role as architects and engineers is to understand the needs of everyone involved.

It helps to have some construction knowledge as we create the timeline for work, so that we’re able to estimate how long a certain project will take and anticipate what contractors and subcontractors are going to need. We can then relay that to the client and hopefully come up with a plan that will make everyone happy. Communication is key in that regard. Occasionally, it even requires a bit of negotiation. We might have a contractor who says, “I can get that done in a day,” and we have to tell them, “Well, we need it to be done in four hours. How can we make that happen?” Or we have to go to a client who insists that they can only afford a few hours of downtime, but we can say, “That’s just not realistic, so how can we work together to find a better solution?” If they tell us there’s no room for any downtime, how can we be creative and say, “Can we have a one-hour window each day? Can we work evenings and weekends so there’s minimal disruption?”

It might make sense from an efficiency standpoint to completely shut down for a short period of time so work can be done.

The automotive industry does this. They’ll do a two-week shutdown where they retool the assembly lines and that’s when they’ll also take care of updating mechanical, electrical, and plumbing systems. It might mean contractors are working 24/7, but by doing that, they can be 100% operational once that’s done, rather than trying to work at 50% for an extended amount of time. That’s sometimes impossible when it comes to healthcare, but it’s a question we need to ask and an option we may want to consider.
Design Collaborative Team at Work. Design Collaborative Services - Architecture, Engineering, Interior Design
Design Collaborative Team at Work. Design Collaborative Services - Architecture, Engineering, Interior Design
Mercy Hospital Physical Therapy Rehabilitation Room

Another thing to consider – that’s exclusive to the work we do in the healthcare industry – is that at the end of the day, they have a patient that we’re trying to maintain safe environment for.

We have to keep that in mind and think, “How do we continue to do the work without putting them in harm’s way?” There have been situations where we have to just say to the client, “Look, from an efficiency standpoint and a safety standpoint, it really does make more sense to just shut things down.”

Sometimes it may make more sense to build a completely new facility rather than try to renovate an existing one. For example, we were working with an old hospital that had three operating rooms and we were going to renovate two of them. It would have required them to completely close those two ORs for a window of time, and they determined that just wasn’t feasible, so we ended up not moving forward with that project. Fast forward ten years, at the end of the day it just made more sense cost-wise, time-wise, disruption-wise to actually build a new hospital.
Mercy Hospital Physical Therapy Rehabilitation Room

I did a phasing project for an 18-story building that was going to be completely occupied.

We ended up doing three floors at a time while keeping the other floors up and running. That project took five years because they had to complete three floors, then take a break between the phases to move people, then start construction again. It can definitely be done, but it might take a bit longer.
Van Wert Health Building Frame Construction
Van Wert Health Building Frame Construction

There are so many things we have to address when doing healthcare phasing projects, and there isn’t usually one simple solution that works in every situation. That’s why it’s crucial to have a team of people who fully understand the intricacies of getting the work done, who can adapt to the needs of both the client and the contractor, and who will keep patient safety at the forefront.

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