by Nicholas Fucci
Arguably one of the greatest healthcare renovation challenges circles around one key demand: that operations cannot shut down for a renovation to occur. Whether it’s a critical care space like an Emergency Department or a revenue-generating space within a Radiology Department, a vision of the final product might be clear, but how one gets there is often ambiguous and requires incredible team collaboration to bring that vision to fruition.
First, Do No Harm: The Architect’s Role in Infection Control
While execution matters, the burden of Infection Control is not, and should not be the contractor’s burden to bear. Every project should begin with an Infection Control Risk Assessment, which evaluates infection control for a specific renovation effort before the design work even begins. This assessment gives the architect an understanding of the potential failure points, and the ability to create a design and phasing plan that mitigates or greatly reduces infection risk.
Keeping the Exits Open: ILSM and Joint Commission
Joint Commission won’t give you pass just because you have an ongoing renovation. It’s critical to be prepared with interim life safety measures approved by local Authority-Having Jurisdictions before construction begins. At a minimum, these ILSMs require input from the facility management team, the clinical staff, the architect, and the contractor to ensure that renovation activities do not impact the level of care of ongoing operations. Often, this means providing additional construction phases which is critical for all parties to understand before beginning construction. Consider, for example, that access to egress and wayfinding for patients must be maintained.
Sequence Everything, Assume Nothing
Logistically, a contractor can’t price what isn’t defined, and a clinical team can’t mitigate operational hurdles without knowing them. A project’s Phasing Plan gives metrics to the intangible and allows a project team to adequately plan for interruptions to daily workflow. Facility staff need an understanding of how each phase of construction impacts operations, while a contractor needs an understanding of how accommodating operations could impact their budget and schedule. The two go hand-in-hand, and neglecting this coordination could spell disaster down the line.
What does this look like in practice? At QA+M Architecture, this typically means providing diagrammatic phasing plans for every phase of construction within the construction documents, with a clear understanding of where construction boundaries are and what utility tie-ins may require a shut-down. Once circulated and approved by the facility’s clinical staff, the contractor can use it as a starting point to layer on their constructability notes and help refine the phasing plan before they mobilize for construction.
A phasing strategy needs to be built into the design for any healthcare renovation project to succeed while maintaining facility operations. Many teams can design a space that looks nice and addresses a facility’s needs, but only the right team can make the construction possible.
Nicholas Fucci
Nicholas Fucci is healthcare project manager at QA+M Architecture.
