Hospital Construction Phasing Techniques to Mitigate Strategic, Operational, and Physical Impacts
December 12, 2014 | Minta Ferguson
Hospitals have a tremendous opportunity to save time and money by addressing the phasing of capital improvement projects early. Here, we discuss phasing techniques to activate as soon as the Master Facility Planning (MFP) stage to maximize capital and reduce the potential for schedule delays and undesirable operational ramifications.
A thorough phasing strategy defines an approach to the anticipated impacts of interrupted services in the following areas:
- Strategically in terms of revenue and patient volume
- Operationally relative to inconveniences in patient care
- Physically, by minimizing disruption, accidents, and safety/infection risk to patient populations
Phasing Information to Assist the CFO
In the MFP stage, CFOs need to understand the ongoing financial ramifications of proposed projects. This enables them to balance capital needs with revenue generation and to coordinate the commencement and completion of projects with available funds, debt capacity, and financial forecasts of future years.
A Phasing Allocation Dashboard can illustrate the project schedule with cost allocation by phase and summarize all costs by quarter. One can visualize the impact of different phase start dates and inflation rates on the total cost, as well as cost by quarter or fiscal year.
This tools help clients make decisions that save money: the shorter the construction duration and the fewer the phases, the lower the project cost.
Phasing Information to Assist the COO / CNO
Many COO /CNO leaders use construction phasing schedules to analyze the impacts of interrupted services and applicable market metrics such as the threat of outmigration. Their input helps balance the timing of potential capacity limitations with business growth needs and expected increasing or decreasing volumes. The timing of phases may be driven by a high season (e.g. flu in the ED) or a low season, where more capacity may aid in accelerating a phase.
Ideally when renovating, the number of treatment locations is sufficient for current volumes; the best case is that the first phase of construction adds treatment locations. Alternatively, “open chairs” (spaces that serves as a temporary location for a critical function while the replacement is under construction) are made available. Or, perhaps newly added space will remain operational once the new department is up and running. By making these types of decisions in the Facility Master Plan phase, hospitals can minimize a negative impact to profitability by eliminating or minimizing costly temporary departmental relocation. In contrast, if timing takes precedence, entire departments can relocate temporarily to reduce downtime and meet critical deadlines.
Each of these scenarios may affect patient flow and/or staff work processes. Leaders of the department must plan develop an operational plan for each phase. How will patients enter the department? Where will providers see different types of patients once inside? How will staff work together to care for patients? How will construction affect patient volume, and what temporary configuration can accommodate an unanticipated increase in volume comfortably?
Computer simulation modeling offers a way to test and predict the outcome of each potential scenario during the schematic design phase, so that the design team can develop an appropriate construction phasing response, managers can provide adequate staffing coverage, and leadership and caregiver teams are aware of how the department will perform under potentially adverse conditions.
Phasing Information to Assist the Director of Facilities
Many Directors of Facilities prefer to evaluate projects based on total project cost, while separating construction costs from soft costs to identify budget line items for equipment, furnishings, and so forth.
Even prior to the design of the project, a dashboard tool can help estimate individual budget line items by phase. While cost-estimating exercises using industry standard unit costs are commonplace, Directors of Facilities find additional value in understanding line item costs by phase.
Also, in the Schematic phase, creative construction phasing plans can help Directors of Facilities minimize disruption, accidents, and risk to patients.
The careful delineation of phases can mitigate the impact of dust producing activities, access to chases/ceilings, utility work, and wall reconfiguration. Limiting the number of phases to what is critically necessary can potentially reduce accidents by moving staff, equipment, and furniture only once. Likewise, utilizing swing space is one way to limit the number of phases with the benefits of reduced cost and more efficient moves.
In traditional design-bid-build construction delivery, the Schematic phase offers a perfect opportunity for early inclusion of the contractor and key trades as decisions during these discussions can impact the long-term plan. In delivery models such as IPD and Design Build, contractor involvement from project inception results in enhanced interdisciplinary coordination, informed decision-making earlier in the process, faster evaluation of collateral impacts or make-ready moves, and more accurate and detailed estimating.
The sooner hospitals initiate phasing planning, the better. This exercise establishes expectations early so that stakeholders can understand, plan for, and agree to unavoidable impacts or inconveniences that ultimately affect the quality of patient care.
Minta Ferguson works with project stakeholders to define the program, scope, and size of facility and master planning projects. Through rigorous due diligence, an in-depth understanding of how users interact in an existing space, and visionary ideas for ways they could operate better in the future, the resulting space plans she develops are highly informed.
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