How To Avoid Day-Two Challenges in Construction Projects

Ensuring the involvement of professionals who will work in the space is critical to project success.

By Jerry Maffia and Douglas King, Contributing Writers


The completion and successful handover of a healthcare project requires meticulous planning, seamless collaboration and effective communication among a range of stakeholders. The pressure on healthcare facilities owners and managers to deliver projects on time and within budget is ever-present. But this drive for efficiency can overshadow a crucial consideration of healthcare construction: Does the space work from the end user's perspective? 

It can be difficult for end users to truly understand the way a space will function or malfunction until they start operations, and this often results in costly post-occupancy modifications. For project teams, being aware of potential so-called day two challenges ahead of time is essential to avoiding future cost and scheduling issues. For this reason, it is imperative to continue the active involvement of end users and operations teams beyond the planning stage throughout the design and construction process. 

Educating end users 

While collaboration between construction professionals and end users is critical, it is important to acknowledge that end users likely do not have a deep understanding of construction processes. To foster a productive partnership and minimize misunderstandings, design and construction teams should conduct page turns with end users that cover timelines, processes and potential disruptions. This process can provide the knowledge to ask relevant questions and effectively contribute to decision making. 

Because there might be a perception of ego with the end user and the design and construction team, the engagement process must be approached with empathy and understanding from all involved. It is imperative for project managers to remember that while end users might excel in their chosen healthcare professions, they are not trained in design or construction and might have trouble understanding the layout of a drawing without deeper explanation. 

Also, they often are not used to saying, “I don’t understand” in a professional context and might not volunteer their questions for fear of seeming uninformed. When in doubt, project managers should err on the side of overexplaining to ensure end users fully comprehend the information being presented. 

To minimize late or post-occupancy changes, regular communication with end users is essential to keep them informed about project progress, milestones and potential impacts on their operations. They also should be invited to attend project meetings and site walk-throughs at strategic points in the design and construction process to enable them to envision the finished space, ask questions and make requests before it is too late. 

Before it is too late 

Project teams should include a "pencils down" milestone in the schedule to mark when changes can no longer be accepted without impacting the cost and timing of the project. Engaging those who will use the space daily helps create a sense of ownership, fosters cooperation throughout the project, mitigates late changes and provides the end user with a view of the process and the cost of building the facility. 

For example, consider the design and layout of operating or procedure rooms. A surgeon’s perspective and insight are invaluable in ensuring the space fits their specific needs. 

Consulting during the design phase with surgeons who will perform specialized procedures in the space enables the creation of more functional and efficient operating rooms by strategically placing equipment and instruments based on procedural workflow. Tailoring the final space to a medical professional’s requirements gives project teams the ability to help healthcare professionals deliver the best possible care to patients. 

Engaging facilities operations 

The involvement of end users must extend beyond operating rooms to encompass patient rooms, nurse stations, laboratories and administrative areas. Input from doctors, nurses, technicians and other healthcare professionals is invaluable because their firsthand experience and knowledge will shed light on processes, equipment needs and patient requirements that design and construction professionals otherwise might not have insight into. 

When it comes to healthcare facilities, it is not just the medical staff who need to be involved in planning discussions. Environmental services, maintenance and operations professionals play a vital role in healthcare spaces due to their expertise in maintaining cleanliness, hygiene and infection control. 

For example, cleaning products and air filtration are crucial to maintaining hygiene and indoor air quality in medical and laboratory environments. Choosing the right kind of flooring and surface materials is crucial because the chemicals needed to clean certain materials can have negative effects on the medical staff and patients or compromise the air quality in labs, which can impact the outcome of tests or experiments. Including members of the facilities operations groups in the design and building process can help mitigate unforeseen issues once the facility is in use. 

Technology considerations 

Rapidly evolving technology can pose challenges when planning spaces for future occupants. This challenge was exemplified in a recent project we worked on involving the installation of an MRI machine. The decision about which MRI to purchase was delayed until the last possible moment as the users awaited the most advanced machine. But the delay in selecting equipment put other aspects of the project on hold, ultimately prolonging the project's duration. 

While every client wants the final space equipped with the best available technology upon opening, it is essential to find a balance between anticipating technological advancements and making informed decisions within the project timeline. 

Establishing and maintaining the involvement of the people who will work in the space is critical not only to the success of a project but to the long-term success of the institution. While this process can get complex, it is well worth it because the end user is best equipped to make suggestions that ultimately contribute to the facility’s bottom line. One way or another, they will have to pay to make these critical changes, and sooner is almost always better and less costly than later. 

Jerry Maffia is a project director at Project Management Advisors Inc. Douglas King is the firm’s vice president of healthcare. 



October 30, 2023


Topic Area: Construction


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