It is no secret that healthcare construction is challenging; from understanding the complicated utilities involved to the numerous codes and regulations required, managing a healthcare design and construction project takes a lot of experience and patience. When that project involves construction in an occupied facility, the work goes from difficult to extremely challenging. Any time construction is happening around non-construction workers it is important to communicate expectations and be sensitive to existing conditions; however, when those non-construction workers are hospital patients and staff, the communications and planning become imperative to insure injuries and infections in patients do not occur. What the construction team deals with daily, for example sheetrock dust, dirt from excavations, and wet environments to name a few, could be deadly for patients with immunocompromised illnesses. For these reasons working in an occupied facility becomes a constant blend of investigating, planning, communicating, and executing the plan. Deviations from the plans agreed upon can result in dangerous conditions.
In the investigating stage, it is important to learn as much as possible about the existing utilities-where shut off valves are, what the electrical panels feed, what spaces are adjacent and above and below and their hours of operation. Knowing these items will aid in the construction plan and phases that are developed. The contractor should walk all of the spaces of the facility, even those not being renovated, with facility personnel to gain an understanding of the building. Although work may be limited to one particular suite the utilities could be tied elsewhere and could affect other spaces.
In the planning process, in both design and construction, it is important to know the extent of the work being done and what spaces the hospital is capable of relinquishing for construction. This will help determine how phasing is done and if swing space (existing unoccupied space that can be used to move people into) is available or if enabling work (temporary construction in either unoccupied spaces or shell spaces) needs to be planned. Also during the planning phase it is necessary to involve other hospital departments such as Environmental Services, Public Safety, Infection Control, and Information Technology, to review the work being done, any changes in hospital operations required (changes in traffic routes, cleaning techniques, closing of spaces). Managers also use ICRA (Infection Control Risk Assessment) and PCRA (Pre-Construction Risk Assessment) forms, typically developed by the hospital, to assess the work and requirements of construction. These are reviewed and signed off by the Infection Control and Safety Department and become part of the overall construction execution plan.
Communication during the construction of an existing facility is paramount to creating a successful project. All parties must clearly understand the work that will take place and the impacts to the space. This includes communication on infection control procedures with subcontractors and how to work within a facility, to communications with hospital staff and having them understand noise issues, what areas will be inaccessible, and impacts to patients, staff, and visitors. Communications must be on-going throughout the pre-construction and construction of the project.
Finally, the execution of the plans put in place must be completed as agreed upon by all parties. Any deviation from the plan can result in patient safety issues, delays in construction, and mistrust of the contractor. If there is a need to change a plan it is important to bring all parties together to discuss the reasons, the new plan, and get agreement by the hospital for the changes.
Although construction within an operating facility is tricky, it can be done with the right team and with a good understanding of the work needed, an understanding of the existing facility, and some patience in the planning process. A successful team will be skilled at the investigating, planning, communicating, and execution of a plan, as well as having the ability to change course at a moment’s notice.
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