By Ron Leger, Contributing Writer

Key Takeaways: 

• Healthcare facilities are different from many other building types because opening the doors is only part of the objective. 
• Healthcare organizations depend on a host of technologies that support patient care and daily operations. 
• The projects that seem to have the fewest surprises near occupancy are usually the ones where the construction team asked these questions early. 

Most healthcare construction projects are built around major milestones. Design completion. Groundbreaking. Topping out. Substantial completion. Inspections. Certificate of occupancy. Furniture installation. Patient first day. 

Those milestones are important because they help measure progress and determine whether a project is moving toward opening day. But one milestone often receives far less attention than it deserves: operational readiness. 

Understanding operational readiness 

In many projects, everything appears ready from the outside. The building was substantially complete, inspections were passed, furniture was installed, and occupancy planning was underway. The problem too often is that the facility was not truly ready to operate. Technology was part of the issue, but it was not the only issue. 

One such project involved a security operations center that was physically complete, but the access control database had not been fully programmed and validated. The card readers worked. The software was installed. The security staff had moved into the space. Yet the system was not fully prepared to support day-to-day operations. 

On another project, the nurse call system had been installed and tested, but portions of the clinical staff had not yet received training. The technology worked, but the people responsible for using it every day were still learning the system only weeks before occupancy. 

On other projects where network infrastructure was operational, application cutovers, device deployments and workflow testing had not been completed. The technology was available, but the operational processes that depended on it still were not ready. 

None of these situations were construction failures. In fact, most occurred on well-managed projects with experienced teams. The challenge was that everyone was focused on construction completion while operational readiness was assumed to happen naturally as the project approached occupancy. 

Healthcare facilities are different from many other building types because opening the doors is only part of the objective. The real goal is supporting patient care, and that requirement demands much more than completed construction activities. It requires trained staff, established workflows, functioning technology, operational procedures, maintenance processes and coordination across multiple departments. A building can be complete and still not be operationally ready. 

Spotlight on technology 

One of the most common areas where this shows up is technology. Healthcare organizations depend on communications systems, wireless networks, security systems, nurse call platforms, real-time location services, audiovisual systems and many other technologies that support patient care and daily operations. 

Technology itself is rarely the problem. More often, the challenge is everything around it. Staff training might not be complete. Operational procedures still might be under development. System ownership might not be clearly defined. Testing might have been performed, but the people responsible for supporting the system after occupancy might not have fully accepted it yet. 

That is where readiness gaps tend to appear. This is why I believe healthcare organizations need to start talking about operational readiness earlier in the project instead of waiting until occupancy is around the corner. One question I often ask project teams is simple: If the facility opened tomorrow, what would need to be ready for staff to safely care for patients? 

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The answer usually goes far beyond construction. Staff need to be trained, technology systems need to be deployed and tested, and workflows need to be validated. Facilities personnel need to understand the way systems will be operated and maintained, emergency procedures need to be in place, and the teams responsible for supporting those systems need to be ready as well. 

By looking at readiness this way, it becomes clear that it is not something that happens during the last few weeks before occupancy. It needs attention throughout the project. Design, construction, commissioning, activation — they all play a role. 

Laying the groundwork 

The projects that seem to have the fewest surprises near occupancy are usually the ones where the construction team asked these questions early. They know who owns what, they establish milestones, and they get the right people talking long before move-in planning begins. 

Nobody intentionally ignores operational readiness. Most teams are focused on delivering a successful project. The challenge is that readiness activities are spread across so many different groups that it is easy to assume someone else is tracking them. That is usually when things start slipping through the cracks. 

Many of the issues discovered shortly before occupancy did not actually start shortly before occupancy. Most usually can be traced back to assumptions that were made months earlier about responsibilities, training, testing, operational acceptance or simply who was supposed to be tracking readiness. 

Construction completion is an important milestone, but from an owner's perspective, it is not the finish line. The project reaches the finish line when the building is ready, the staff is ready, the processes are ready, and patients can walk through the doors with confidence that everything behind the scenes is ready too. That is operational readiness. Projects that focus on it early tend to have far fewer surprises when opening day finally arrives. 

Ron Leger, RCDD, RTPM, OSP, ESS, is an associate director with MGAC Technology Solutions, where he serves as a technology owner's representative supporting large healthcare capital projects. With more than 30 years of experience in telecommunications, technology systems and project delivery, Leger works with owners, designers, contractors and technology teams to help align planning, construction and operational readiness activities.