Building Activation: Four Tactics for Success

Activation is a sophisticated, high-stakes process. Ensuring on-time completion requires managing a detailed work plan.

By Douglas King, Contributing Writer


Healthcare construction projects — whether it is building a new facility from the ground up or renovating an existing property — are notoriously complicated. And construction is only the first step. Once the project has reached the point of substantial completion, it is time to start planning for building activation. 

Activation sounds like a simple process to prepare the completed facility to open for business. In healthcare, building activation is a sophisticated, complex process that demands experienced, highly trained practitioners. It is also a high-stakes endeavor. The cost of operating a healthcare facility is steep, and a hospital or other healthcare facility must be fully operational and compliant before it can open its doors to patients and generate revenue. Ensuring on-time completion requires creating and managing a detailed work plan and coordinating a long list of disparate teams and tasks. 

From installing medical equipment to managing regulatory requirements and thoroughly cleaning every square inch of the facility, building activation work plans can have hundreds of entries with thousands of moving parts. Healthcare facilities managers working with an experienced partner can ensure healthcare systems avoid delays, stay within budget and ensure a smooth activation process. 

Delivery and installation 

In a hospital with hundreds or even thousands of rooms, making sure each one is properly appointed and fully functional on opening day is no small task. Almost every room in a healthcare facility is outfitted with specialized equipment. During building activation, that equipment needs to be installed, calibrated, tested and commissioned for use by doctors, nurses and other healthcare professionals. These staff members also need to be trained to use new equipment properly. 

Activation workplans need to include detailed schedules for these activities that take multiple variables into consideration. For example, large pieces of equipment including MRI and PET scanners might require special floor support due to their size and weight. Also, some equipment purchases might be delayed until the team determines the kind of technology the design will support. 

Activation workplans also need to include specifics on furniture delivery, storage and placement, as well stocking thousands of necessary supplies, including cotton swabs, surgical gloves, pharmaceutical products and cleaning supplies. Each category might need to be counted, stored and secured differently, depending on the way the products will be used — a process that further complicates activation. 

Spotlight on cleaning 

Infection prevention and overall cleanliness are critical priorities in a healthcare facility, and construction inevitably kicks up a great deal of dust. Environmental services workers need to perform different levels of cleaning at various points during activation. This phase includes post-construction cleaning followed by a more thorough cleaning before installing equipment. 

Environments with especially stringent infection prevention protocols, such as operating rooms, also require a terminal cleaning at this stage, after which everyone who enters the space must wear a clean suit. Throughout the rest of the activation process, the facility should be cleaned periodically to remove dust and other build-up, followed by a final, detailed terminal cleaning just before the facility opens. 

Regulatory considerations 

Managing regulatory requirements is another critical component of the activation process. Failing an inspection can delay opening or reopening after construction, which creates a litany of problems for a healthcare facility, including a potential negative impact on its bottom line. 

The facility must comply with complex layers of local, state and federal regulations, the latter of which are tied directly to reimbursement from government-sponsored healthcare programs including Medicare and Medicaid. These regulations are significantly more extensive than the building codes governing other kinds of commercial buildings. 

For example, hospitals that include on-site pharmacies must comply with a specific, separate set of codes that govern the operation of pharmacies. An experienced partner who knows how to navigate these layers of regulatory requirements can help ensure that facilities pass various inspections and open on schedule. 

A smooth handoff 

The final stages of activation, during which the construction team transitions the new or renovated facility to the facilities team and day-to-day operations staff, often require close cooperation between groups that do not normally work together at all. The closeout process includes testing and commissioning building systems, which involves verifying that the building’s mechanical, electric, plumbing and HVAC systems are working properly. 

This phase is especially important in hospitals, where air flow is an important component of infection control. Systems testing and commissioning take place at the end of construction and again within the same year to ensure systems are still functioning as intended. 

During the closeout period, the construction and facilities teams also must produce critical documentation, including manuals, drawings and certifications, that articulate details related to the ownership, insurance, operation and maintenance of the facility’s equipment. This point in the process also is the time to establish a command center and the operational key performance indicators the facilities team will use to measure building performance. 

When it comes to healthcare construction, taking a project from completed building to fully activated, operational facility is a complicated process. Due to the high stakes, it is not an opportune time to experiment with a do-it-yourself approach. Enlisting the support of a partner with a track record of managing successful building activations can be the difference between welcoming patients to the new facility on schedule and incurring costly setbacks and delays. 

Douglas King is vice president and national healthcare sector leader with Project Management Advisors Inc., a national real estate consulting firm providing services as the owner’s representative. He has more than 40 years of international experience in complex, large-scale healthcare projects as a designer, educator and researcher. 



June 14, 2023


Topic Area: Maintenance and Operations


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