By Christopher Toussaint and Kevin Pellegatto, Contributing Writers

Key Takeaways:

• Plan healthcare renovations around ongoing patient care, using temporary access, infrastructure and carefully sequenced phases to keep critical services operating.
• Treat every construction decision — including shutdowns, noise, vibration, dust and site logistics — as a potential factor in patient safety and the hospital’s ability to deliver care.
• Build strong communication with clinical teams, facilities staff and community stakeholders, while making infection prevention and adaptability central to the construction plan.

Modernizing an active hospital or other healthcare facility starts with a fundamental reality: Construction must adapt to patient care, not the other way around. The question is not simply how to construct what is shown in the plans. It is how to deliver that work while patients continue receiving care and physicians, nurses and staff continue providing it — sometimes on the other side of a wall, below a floor or in the spaces surrounding the project. 

That reality is evident in the work across Yale New Haven Health’s New Haven campuses, where our teams are managing very different projects that share a common challenge: modernizing critical healthcare environments while the facilities continue to operate. 

At the York Street campus, the work involves major infrastructure improvements in one of Connecticut’s most complex healthcare facilities. The improvements include critical electrical upgrades and construction of two new penthouses on the 12th and 13th stories, with the neonatal intensive care unit directly below and an active LifeStar helipad nearby. 

At the St. Raphael campus, the work includes a nearly four-year, $120 million renovation of emergency department and heart and vascular spaces. The work is being delivered through approximately 10 microphases, with completed portions including a new emergency department entrance and waiting area, relocated CT and radiology functions, and five heart and vascular labs. 

Together, these projects offer complementary perspectives on healthcare construction. One focuses heavily on the infrastructure that allows a hospital to function, and the other reaches directly into the spaces through which care is delivered. 

Planning several moves ahead 

Hospital renovation can feel like a game of chess. Designers and contractors rarely get to make the move they ultimately want to make first. Instead, teams must create temporary conditions, relocate functions and complete enabling work before construction can advance. 

For example, rebuilding the emergency department entrance at St. Raphael required maintaining ambulance access throughout construction. A lane closure on a congested urban street required establishing temporary circulation and constructing a temporary ambulance canopy before the permanent drop-off could be completed. 

The same principle applies to clinical spaces. Turning over five heart and vascular labs required careful sequencing because taking procedure spaces offline affects services beyond the immediate construction area. In an operating hospital, one construction activity can create a chain of operational consequences. 

For facilities teams and builders, the construction schedule has to begin with an understanding of the way the hospital operates and not simply the way the building goes together. 

Treating precision as a patient-care issue 

That operational understanding becomes even more important when construction involves the infrastructure that allows the hospital to function. 

At York Street, major electrical upgrades touch the backbone of an operating facility. Work must be planned around existing systems and active clinical operations, with shutdowns and changeovers carefully sequenced so new infrastructure can come online while hospital functions continue. The physical constraints add another layer: Equipment and systems have to be moved through and installed within an existing hospital rather than on an open construction site. 

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The additions on the 12th and 13th floors illustrate the same principle in a different way. Construction is taking place directly above an active NICU and adjacent to the LifeStar helipad. When helicopters were inbound, rooftop materials and debris had to be cleared because of the hazards created by rotor wash, requiring the construction team to respond to the needs of emergency operations around it. 

At St. Raphael, maintaining approximately 50 emergency department beds while construction proceeds presents another version of that challenge. The goal is not merely to deliver the new space or infrastructure. It is to understand the potential effect of every construction decision on the hospital’s ability to provide care. 

Communication as part of the construction plan 

Some of the most important tools for an active healthcare project are not physical ones. 

Before implementing the temporary emergency department entrance at St. Raphael, the project team needed to understand the workflow of emergency department staff and gain their buy-in. Coordination then expanded to hospital facilities personnel, city traffic officials, the mayor’s office and neighborhood alders. 

That communication cannot end when the construction plan is approved. 

Our teams establish direct relationships with hospital department leaders and provide cell phone numbers so staff can immediately reach us if noise, vibration or another construction activity affects their environments. The objective is for the construction team to become part of the hospital team rather than an outside contractor working around it. 

For healthcare facilities managers, establishing these communication channels before problems occur can be as important as establishing the physical logistics of the project. 

Putting patients at the center 

Healthcare construction also brings responsibilities that might be less pronounced in other building types. Infection prevention, dust and airborne-particle control, noise, vibration and access take on greater significance when vulnerable patients might be just feet away from active construction. Team members working in these environments receive healthcare-specific infection-prevention training to prepare them for those conditions. 

But patient-first construction is broader than any individual protocol. It is a way of approaching decisions. The most successful healthcare projects align the construction strategy with clinical operations from the beginning. Phasing, temporary infrastructure, logistics, shutdown planning, communication and infection prevention all serve the same objective: protecting the continuity of patient care while healthcare professionals continue doing their jobs and facilities evolve around them. 

For builders, achieving that goal requires technical expertise and precision. It also requires listening, adaptability and an appreciation for what is happening beyond the construction zone. Iin an active hospital, the work is never simply about the building. It is about building around care. 

Kevin Pellegatto is a senior project manager with Gilbane Building Co. with 15 years of construction industry experience. He leads the phased renovation of the Yale New Haven Health Saint Raphael Campus emergency department and heart and vascular center, a complex project transforming critical patient-care spaces while the hospital remains fully operational. 

Christopher Toussaint is a senior project manager with the firm and specializes in healthcare infrastructure and highly technical occupied renovations. He manages the Yale New Haven Health emergency power upgrades project at the York Street Campus, where major electrical and building systems improvements are being implemented within a 24/7 hospital environment.