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Keeping Construction Under Control
How to manage your place while you expand its space.
John Reinke
Publish Date: October 10, 2007   |  Tags:   Facility Construction and Design

A floor plan literally changes around you during a renovation or expansion project, you'll need to call on many skills to keep pre-op, OR, PACU and other areas up and running. As a surgical services project manager supervising my fourth construction at as many facilities (a three-OR hospital adding three new ORs and remodeling three existing rooms), I've jotted down some keys to navigating a construction project as painlessly as possible.

The importance of an intermediary
If you have the foresight to hire an architect and general contractor who specialize in healthcare projects to undertake your expansion - and I strongly recommend this - you'll have a solid assurance that they'll be more familiar with clean construction, infection control measures and other specialized preparations and logistics required to let their crew work around your facility's surgery schedule and required restrictions.

But you can't depend on them to know exactly what your staff needs during construction nor once the construction is completed. Administrators and architects may plan a project and general- and sub-contractors put the pieces together, but your surgeons and staff have to operate within the resulting product, regardless of whether the changes prove to be efficiently done.

That's why it's critically important to hire a specialist in this type of construction - or to assign a willing and knowledgeable member of your staff - to serve as a surgical services project coordinator and to include them in the expansion process as early as possible in the planning stages.

The role of the surgical services project coordinator is that of an intermediary between the people who'll be conducting surgical activity during construction, the people running the facility and the people building the new space. Ideally, the coordinator would have a say in all aspects of the expansion, including the review of plans, daily decision-making, troubleshooting during construction and equipment planning and procurement.

A coordinator's qualifications
The coordinator should understand the workflow to and from the ORs and central sterile, because your architects and contractors won't intuitively know who needs to get where, when and how. This clinical understanding must be coupled with a basic knowledge of the mechanics of construction. The coordinator has to be able to read blueprints and to speak the contractors' language in order to see the whole picture, anticipate issues and communicate concerns.

Assign this person exclusively to the job of surgical project coordinator, if possible. During previous employments, I'd served double duty as director of surgical services and project coordinator, but overseeing surgical construction and managing the ORs' day-to-day operations are both full-time jobs. The project coordinator needs to be available to make critical decisions on an as-needed basis, at any given instant, and he can't be tending to a surgeon's requests in the OR while a construction crew waits outside for him to take a look at something.

Design-Build Lets You Phase In Construction

We kept our surgery center operational during a major expansion of our 64-bed hospital's attached ASC by using a construction method known as design-build. This simply means that a single contractor handled both the engineering and building of the project. Construction crews didn't need to get engineers to approve a design change if an unforeseen setback occurred; the same company handled the entire operation and could sign off on modifications more quickly. Here's the design-build plan that we used for our surgery center expansion: two new ORs, a larger PACU, more pre- and post-op beds, a state-of-the-art decontamination and sterile processing area and larger spaces for the support staff.

Construction Phase 1S

  • Relocate existing PACU into existing OR shell
  • Storage in north rooms to relocate to undetermined location

Estimated start: December
Estimated duration: 7 months

Construction Phase 2S

  • Temporary PACU room in operation

Estimated start: January
Estimated duration: 9 months

Construction Phase 3S

  • Temporary PACU room in operation
  • Core reopened with the following additions: pre-op and storage alcoves

Estimated start: January
Estimated duration: 9 months

Completed Department

  • Surgery center renovation complete
  • Relocate PACU room to new location; convert OR shell to equipment storage
  • Close existing ORs in hospital for cardiopulmonary renovation

- Rose McCullough, RN, MSN

Ms. McCullough ("[email protected]")) is associate administrator for patient care and CNO at Angleton Danbury Medical Center in Angleton, Texas.

Clinical input
In any expansion project, you're looking for as little downtime as possible and looking to keep your physicians happy. That's why it's a good idea to gather early input from the clinical staff who'll actually be working around the construction.

A clinical review during the planning stages can help to identify potential friction points that may occur during the building process as well as larger issues that are likely to create pitfalls in the finished structure: an HVAC vent that may present an infection control hazard or a wall that will cut into workflow efficiency. While it may seem like an additional obstacle during pre-construction planning, correcting problems early in the process, with a pencil eraser, is much more convenient - and less expensive - than correcting them after the bricks and mortar are in place.

The review shouldn't stop once the blueprints become actions. If you don't delegate the supervision of the expansion to a surgical services project coordinator, you may want a walk-around manager to conduct on-site observations during construction, recording concerns and possible corrections to a Dictaphone or notepad. This will help reduce the incidence of overlooked or unaddressed issues that were forgotten in the stream of other daily priorities.

Communication is key
In any surgical expansion project, you can expect that you and your staff will run into conflicts that need solving on a more-or-less daily basis. The primary tool for resolving, and perhaps forestalling, these conflicts is communication, open and often.

Meet with both management and the staff doing hands-on patient care on a regular basis and, through word-of-mouth and written communication, let them know what they can expect in the coming days or weeks that will affect their work environments.

Describe the changes - and inconveniences - they can expect to encounter and let them know what aspects you'll be able to steer. You'd be surprised how many blow-ups you can avoid by telling everyone in advance, "I can control some problems that occur if we look at solutions together and you need to let me know what I can do to help you." It goes without saying, of course, that you'll have to respond fairly quickly when they do let you know about their concerns.

Communicate through several channels: staff meetings, bulletin board postings, even a scheduling board dedicated to project timing and activity news. Most importantly, keep your staff informed and give them the maximum warning possible before any upcoming changes occur. An OR that will be closed for a weekend, an equipment room that must be emptied or the construction of a temporary wall will require announcing and posting with time for all shifts to get the news.

The doctors of drywall
It's possible that the biggest communication challenge you'll face is ironing out fixes with the construction crew while the project's in full swing. Simply put, you'll need a Nextel-type instant communication device and diplomacy, along with phone numbers for the contractors in charge on site.

Construction in close proximity to surgery presents several major concerns, chief among them dust, noise, vibration and storage. You can control all three factors on an as-needed basis. Barriers can be constructed against dust, and contractors specializing in healthcare work will know how to do this.

Combating vibration and noise, however, requires advance preparation. You'll have to discuss the issue with the contractor in charge early on and set down a solid rule with him that if certain equipment or work is going to create excessive noise and vibrations, you'll want to know ahead of time to inform staff and possibly create alternate plans. Further, if your surgeons have scheduled sensitive procedures such as neurosurgery, cardiovascular or orthopedic surgery, in which patient safety may be compromised by noise or vibration, you'll want the contractor to understand that your phone call to them will stop those factors in a hurry, for the length of the procedure.

You'll want to assume from the start that any available storage space you have during construction will not be sufficient for your facility's needs and that other arrangements will have to be made. It might become necessary to install temporary storage trailers on site or to rent off-site warehouse storage space. Keep in mind that if you found your facility's storage space inadequate before construction began, more will not magically appear once the project kicks off.

No shortcuts to success
There is nothing worse than leaving an expansion project up to the CEO, the architect and the general contractor alone and hoping it'll soon be over. A knowledgeable clinical manager who takes an interest and has a voice in the project can help to lead his or her staff through the radical changes that follow and to make the resulting renovations more efficient. There are no shortcuts to that kind of success, but you can still detour the worst mistakes with the help of a qualified project coordinator.