By Kyle Davis, Contributing Writer

Key Takeaways:

• Early involvement from facilities managers helps healthcare capital projects address operational constraints, utility risks and continuity-of-care needs before design decisions become costly to change.
• Facilities teams should influence equipment procurement and prefabrication decisions to ensure systems can be delivered, installed, accessed and maintained without unnecessary disruption to clinical operations.
• Strong commissioning and turnover plans, including maintenance access, documentation, controls integration and staff training, help facilities teams inherit systems that are reliable and maintainable for the long term.

Healthcare capital projects often are measured by visible milestones — groundbreaking, topping out, ribbon cutting. But for healthcare facilities managers, the most consequential decisions are frequently made long before any of those public-facing events. These decisions come when a project is just a set of assumptions about space, systems, equipment and schedule. 

That scenario is especially true for mechanical, electrical, and plumbing (MEP) infrastructure. The systems above ceilings, behind walls and beneath floors determine whether a clinical space can operate reliably, be maintained safely and adapt to future needs. When project planners bring in facilities teams only after making key decisions, they are left managing avoidable disruptions, difficult maintenance conditions and operational compromises that can last for decades. 

As healthcare organizations look ahead to 2027 capital programs, facilities managers should seek a seat at the table early, not simply to review drawings but to shape the decisions that affect operations and continuity of care from the onset. 

Engage before finalizing design 

The critical time to involve facilities managers in a construction project is during its definition and early design when the facility owner is establishing the clinical program, phasing strategy, budget and performance goals. By the time construction documents are complete, many high-impact MEP decisions already have become expensive to change. 

Facilities managers can begin their participation by asking several practical questions: 

• What operational constraints must the project team design around? 
• Which existing utilities serve critical patient care, diagnostic, pharmacy or life-safety functions? 
• How is the team going to navigate shutdowns, and what redundancy or temporary infrastructure will be required? 
• How will staff, patients, materials and emergency responders move through the area during construction? 
• Which systems are nearing end of life or have known capacity limitations that the project could address? 

These questions turn facilities input into design criteria rather than a late-stage checklist. They also help the broader project team recognize that an occupied healthcare environment is not a typical construction site. A short utility interruption, excessive noise or an overlooked access route can affect clinical operations well beyond the limits of the work area. 

Early involvement should include the people — maintenance supervisors, plant engineers, infection prevention staff, clinical representatives, security and environmental services — who understand the way a facility truly operates. Their perspectives can uncover conditions that are absent from drawings but critical to a workable plan. 

Testing, testing 

Equipment procurement often is treated as a schedule and budget exercise. It is both things, but it is also an operational decision. Facilities teams must help evaluate major equipment choices based on the way they will be received, installed, accessed, maintained and eventually replaced. 

Before finalizing a selection, managers should ask: Can the equipment physically reach the space without disrupting active departments? Is there adequate clearance for filters, valves, panels, coils and other routine service points? Will replacement require removing walls, shutting down adjacent areas or bringing equipment through patient corridors? Are the controls and monitoring interfaces compatible with the systems the facility team already uses? 

The goal of these questions is to ensure selected systems support the organization’s maintenance capabilities, staffing model and long-term reliability expectations. Planned well, these efforts become multi-year efficiency drivers. 

Facilities managers also should participate in procurement planning early enough to identify items with extended lead times and their downstream effects. A late piece of air-handling, electrical distribution or clinical-support equipment can force a project team into schedule compression, temporary workarounds or out-of-sequence installations. Those conditions increase risk in occupied facilities. A clear procurement plan should identify critical equipment, decision deadlines, storage needs, delivery routes and contingency options before the project enters its most disruptive phases. 

Prefabrication considerations 

In healthcare renovations and expansions, the duration of intrusive work can matter as much as the scope of work. Prefabrication can help reduce that duration by moving portions of MEP assembly into a controlled setting before they arrive onsite. 

Racks, corridor modules and other coordinated assemblies can allow installation work to happen faster and with fewer people working overhead in active or adjacent care areas. That can reduce congestion, noise, dust and the number of times crews must enter sensitive spaces. 

But prefabrication is not a shortcut to apply after construction begins. It depends on early coordination, accurate field verification and timely decisions. Facilities managers can add value by helping validate existing conditions, access restrictions and shutdown requirements before assemblies are produced. 

The key questions should be simple: What must remain operational while work occurs? Where can materials be staged without obstructing patient care? What ceiling access or above-ceiling conditions could complicate installation? How will the team verify that prefabricated components align with existing utilities in a building where field conditions may differ from drawings? 

By addressing those questions early, prefabrication can become a continuity-of-care strategy. 

Design intent and long-term performance 

A project is not complete when systems are energized. Facilities teams inherit the building performance, maintenance burden and troubleshooting challenges after construction crews leave. That situation makes the transition from design and construction to operations one of the most important parts of the project. 

Facilities managers should establish handoff expectations at the outset. Require a practical turnover plan that addresses commissioning, training, documentation, controls integration, spare parts, warranty responsibilities and post-occupancy support. Just as important, schedule training for the people who will operate and maintain the systems. 

During design review, focus on maintainability as deliberately as capacity and code compliance. Ask whether technicians can safely access valves, dampers, panels and equipment. Confirm that system labeling and documentation make sense to future technicians. Review sequences of operations with those who will respond when an alarm occurs at 2 a.m. 

If a facilities team cannot safely reach, understand and maintain a system under real operating conditions, the project is not fully operationally ready. 

Emphasizing early engagement 

Facilities managers should ask for defined participation in programming, design reviews, phasing workshops, equipment selections, mock-ups, commissioning and turnover planning. They also should document operational non-negotiables early and make them visible to every member of the project team. 

The earlier facilities expertise is integrated, the more likely a healthcare capital project is to protect daily operations while delivering durable value. Bringing facilities to the table at the start of planning is not an added layer of process. It is the way organizations avoid inheriting last-minute scheduling headaches, reactive fixes and systems that are difficult to live with from the day they open. 

For healthcare facilities managers, early engagement is the opportunity to move from reacting to project decisions to helping shape them. 

Kyle Davis is the division director of MEP services at Robins & Morton, a construction firm.