During the planning and construction of a new outpatient facility, unforeseen problems can slow the timeline, shatter the budget, cause aggravation and even threaten the entire project. To help you understand common pitfalls - and how to avoid them - Outpatient Surgery conducted a survey of readers who've been through projects of their own. Here's the best advice from our 33 responders.

Hire seasoned help
Without question, this is the most common tip we garnered from our readers. Both the architect and general contractor should have direct experience designing and building surgical facilities, they say, or you'll risk losing time, money and, possibly, the opportunity to optimize your facility. One reader who hired an architect with no ASC experience said this oversight cost him four months and $50,000 because he had to start fresh with a new architect. Song Park of St. Mary's Outpatient Surgery Center in Palisades Park, N.J., says the principals of this 7,000 square-foot, multispecialty ASC lost six months and $75,000 during the design process because the initial plan did not meet American Institute of Architects (Medicare) and state-licensure requirements.

One reader's new facility, now complete, has no reserve electrical capacity for future needs. "I had an engineer walk through the old hospital and count how many electrical outlets we had," says Fred Brownstein, RN, CNOR, the surgical services materials coordinator for Capital Regional Medical Center in Tallahassee, Fla. "But he didn't look at how many we needed, and how many outlet strips we were using ' I never expected less electrical capacity to be placed in a new, 21st-century hospital than we had in our old building."

Conversely, John Poisson, the chief operating officer of Physicians Endoscopy, says it took less than three months to build out the $2.1-million, 10,000 square-foot, six-OR, freestanding Michigan Endoscopy Center in Farmington Hills, Mich., precisely because he found firms that handled similar projects in the past and had solid relationships with the state health department. "Identifying and contracting with the right architect and general contractor are two of the more important steps in constructing an ASC," he advises. "Identify architectural firms well respected within the state DOH."

Keep everyone involved
Keeping every end-user - surgeons, administrators, nurses, techs and support staff - involved in each step is the only way to ensure a fully functional facility. What may seem negligible to even experienced architects and contractors can make a huge difference to staff. "Construction and blueprints are only the start," says Marlene Brunswick, RN, the director of nursing for Findlay Surgery Center in Findlay, Ohio. "Fine-tuning the location of small items like switches, alarm panels, towel dispensers, dishwashers and cabinets can make the final product much better."

Adds Mr. Brownstein: "We changed our architect's initial designs. We closed in two hallways to make two sterile cores for storage of supplies. We changed from single-wide doors to 'doors-and-a-half' with magnetic catches. We no longer have to fight doors to get beds into the OR."

Jennifer Misajet, RN, the director of surgical services for North Colorado Medical Center in Greeley, Colo., says end-user input helped her team ensure the OR suites could accommodate proper positioning of patients, staff and complex equipment. "Physician input also resulted in our adding a second nurses' station for patients ready for immediate discharge" to improve workflow, she reports.

Importantly, say our responders, group involvement keeps costs down. "Our frequent meetings and planning sessions with both the general contractor and subcontractors helped us see potential problems way ahead of time. This let us minimize change orders and stay on schedule," says Linda L. Burns, the administrator of the $1.8-million, multispecialty Doctors Same Day Surgery Center in Sarasota, Fla. Our responders agree team involvement prevents the possibility of blame games when the facility opens and translates into employee satisfaction. "The more people believed in this goal and the more input they had, the more they were willing to stand behind this project," notes Sheldon W. Hall, the OR nurse manager for Canton-Potsdam Hospital, Potsdam, N.Y., referring to his $10-million hospital outpatient facility that is still under construction.

Admittedly, scheduling regular meetings everyone can attend can be enormously frustrating. To help meet this significant challenge, Ms. Misajet made sure her architects were available for drop-in meetings between 6 a.m. and 6 p.m. on pre-arranged days. "These no-appointment-necessary meetings enabled physicians and staff to review plans and discuss the project as their schedules allowed," she says.

Consider an objective observer
Although it's imperative to get everyone involved, decisions become more difficult when there are many points of view to consider. This is why it may help to hire an unbiased observer, advises Cathy Miles, the director of surgical services for Marinette, Wis.-based Bay Area Medical Center.

"Many discussions in the planning phase were viewed from three different perspectives. Architects want visual appeal, clinical staff want operational efficiency and finance people want it done for the least amount of money possible," says Ms. Miles, who participated in the planning and construction of her $13-million hospital outpatient facility. "All these perspectives are vital to the success of the final building, but we sometimes needed that outside person, our facility planner, to look at the whole process and help us find the right answer."

Hold contractors, subcontractors and vendors accountable

If you don't stay on top of your contractors and vendors, you may be in for some costly mistakes and/or delays. The experience of Beverly Kirchner, the president of Genesee Associates, Inc., in Lewisville, Texas, is a case in point. Two years ago, her center had to fork out an unanticipated $20,000 to blast out and re-pour a foundation because the drain for the primary autoclave was malpositioned by just two inches. During this same project, the engineer installed plumbing for one piece of equipment at one end of the room yet installed electrical wiring for the same piece of equipment at the other end, and no one caught the error until it came time to install the equipment. To avoid such oversights, Ms. Kirchner recommends forcing equipment vendors as well as contractors into reviewing the architectural plan on site before concrete is poured and before wires and pipes are installed. "Keep the vendors and contractors talking and working together on the installed equipment like OR lights, autoclaves and sinks," she advises.

Ann Deters, president of the $2-million, multispecialty Physician Surgery Center in Rolla, Mo., says delays were her biggest problem. She lost one month, $20,000 and $100,000 in opportunity costs because subcontractors "overpromised and under-delivered" and wanted extensions on their deadlines. To avoid delays, appoint or hire a key project manager (who in some cases may be the experienced architect) to represent your interests through the project. "This person must be there on a regular basis to work through various construction, equipment-installation and state-regulatory issues, and to hold all parties accountable and on task," she says.

Keep good records
Once you get up and running, don't consider the project to be over, as ongoing maintenance and troubleshooting are likely to be the order of the day. Keep good records of materials and supplies and maintain your relationships with the project manager and subcontractors because you'll need them later. "If the paperwork, blueprints, warranty information, installers and manufacturers are on record, you can build a valuable reference for later," says Ms. Brunswick.

The great unknown
Throughout construction projects, the chance you'll encounter unavoidable problems always exists. Richard Mattison, MD, a plastic surgeon at Eye-On Excellence Plastic Surgery in Atlanta, Ga., lost four months and $20,000 because of a snail-paced local-inspection process. "We couldn't close the sheet rock until our electrical system was inspected. All of the contractors had to stop what they were doing, and we had to wait four days for the local inspectors to make their way out here," says Dr. Mattison. Nevertheless, if you take these five tips to heart, you'll save a lot of time, aggravation and money - all the while coming closer to the facility you always dreamed of.