When people talk about the challenges involved in opening a new healthcare building project, different considerations may come to mind depending on which stakeholder you talk to. Is it the grand opening events with all of the pomp and circumstance? Is it the never ending list of punch-list items and overlooked details? Is it obtaining the necessary regulatory approvals to operate the new facility? Is it communicating the changes to staff? The community? Anyone who has been through the process knows it is a carefully orchestrated dance of all of these and more.

Opened in July 2009, the new 259,000-square-foot Pavilion at Paoli Hospital in Paoli, Pennsylvania, included a replacement ED, ORs, Surgery Department, and ICU/PCU. It also provided new private med-surg rooms. The addition, a $145 million project, nearly doubled the size of the existing hospital's square footage. The dollars were funded out of operations and the hospital's largest capital campaign ever-a three-year philanthropy endeavor that paid for more than 10% of real project costs.

Like many healthcare systems, Paoli had to consider the impact of moving fully functioning departments into a new wing, while seamlessly maintaining the organization's level of service in all of the existing areas. To keep things running smoothly, the Operations Steering Committee covered everything from life safety inspections to approval of purchase orders at biweekly meetings.

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An extensive marketing and public relations campaign that included the mediums of print, TV, Internet, and radio, conveyed to both internal and external audiences a consistent message about the new facility, the evidence-based design features that had been used, and how they could improve patient care.

The team developed a “Diary of an Opening” to focus on the increasing level of activity required in the four months preceding the July opening.

Lessons learned:

• Preparation, preparation, preparation! Each purchase order required nine signatures to ensure compliance with approved budgets and scopes. Despite considerable fluctuations in the cost of materials over the course of the project, Paoli still opened the facility on time and on budget.

• The team involved many people in its process for operational planning and education. Operationally, it was important to have key stakeholders attend all meetings to provide consistency and keep the teams on the path to the same goal.

• Having each department produce a two-minute video was a wonderful way to engage everyone in the education process. People really enjoyed seeing this when complete and it fostered great morale amidst all the changes.

• Have a Move Plan and then have a Plan B. The phasing of opening our new Emergency Department before the new inpatient units resulted in throughput issues. We had to quickly adjust the opening of one of the units to accommodate the increased patient flow. Having the flexibility to adapt to unforeseen conditions was critical.

• Following the opening, one primary lesson learned has been patience. Verbal accolades follow easily, but seeing quantifiable results takes time. Re-education is also necessary. Prior to the opening, it is easy to overload staff with too much to remember. Once working in the new building with reduced anxiety, going back to re-educate is beneficial for all.

• For public relations and advertising, it is important to identify the appropriate messaging early, identifying a single source for statistics, and being aggressive within legal limits. Not only should the messages differentiate you, but the events themselves. While everyone enjoys the grand opening, our street teams stood out because they were interactive and not something people were used to seeing. Targeted events for specific audiences were also effective, especially in the context of multiple receptions within a short timeframe, providing economies of scale for tables and decorations.

Now that the addition has opened, the team has disbanded, but there are still follow-up items. For example, the infrastructure required for cell phone use is undersized. With more communication systems using this technology, it is an immediate need. We used multiple technologies for door openers (card swipe, keypad code, and automatic push-button doors). In hindsight, this should have been simplified to one system for improved ease of use by staff. The requests for modifications and additional equipment continue to be submitted and evaluated.

Finally, there are still all of the projects and decisions that were delayed or moved down the priority list that needs to be addressed. An opening never ends on opening day. HD