Renovation Versus New Construction: Key Factors to Consider

January 1, 2008
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Reviewing current considerations involved in the age-old decision

Deciding whether to renovate an existing facility or build a new facility from the ground up is not for the faint of heart. Fortunately, there are a few key elements in the process that can assist you in clarifying the key decision points. Typically, these come up as the organization creates a master plan or conducts a feasibility study. The first step in considering either renovation or new construction is to gather assumptions. Starting here rather than a “goal-setting” meeting helps reveal the real goals of the stakeholders and allows assumptions to be tested. In the end, challenging assumptions allows for more creative problem solving and solutions to emerge as you weigh the options to renovate or build new.

The next step is to define goals with clarity of purpose. Project goals are not clichés, but rather have specific desired outcomes—a difference shown in the table. Clearly defining goals helps to tie the project to the operational pathway. It is also important to prioritize goals and to specifically answer the question, “Our definition of success will be fill in the blank.”

Clichés versus Definable Project Goals


Definable goals

We want to make the patient care space warm and inviting.

Patient satisfaction with the environment of care will increase 3 to 5 points.

New space to increase volume/admissions.

Increase exam/treatment rooms by 25% to reduce time to appointment delay to two weeks for routine visit.

More support space for parents.

Add 10 parent rooms, doubling existing rooms.

Decision: Renovate

Over the last four years, Massachusetts General Hospital (MGH) has completed more than $30 million in renovation projects involving several buildings on its main hospital campus and adjacent leased spaces located on a tight urban site in Boston. The master planning process started in 1998 and generated a series of major projects, resulting in the opening of the new Yawkey Ambulatory Care Center building in October 2004. This new construction, however, provided the opportunity for MGH to reorganize across a range of programs, from inpatient beds to primary care. Ambulatory practices moved out of the core into the new building, to neighboring leased space, and to new satellite locations miles away. Prior reorganizations had already moved nondirect clinical services—such as billing, public affairs, and IT—off campus.

Existing conditions posed multiple problems during planning and design, including minimal or no swing space available for temporary relocations; the need to maintain daily delivery of care; low to zero tolerance for any projects that might limit capacity even temporarily; and infrastructure obstacles such as small structural bays, low floor-to-floor height, and stressed ceiling plenums. Advance planning for phased implementation of the design had to be orchestrated with daily clinical and facility operations during construction. Multiple shutdowns of engineering systems had to be coordinated not only within the project boundaries, but also with adjoining departments.

The team that managed these multiple “backfill” renovation projects planned more than 300,000 building gross square feet. This core team developed options for the space assignments and renovation scenarios. These were presented to MGH leadership, who in turn assessed the needed capital planning direction in line with their strategic planning. Subsequent development by the core team and assessment by MGH leadership converged on the final plan. This was an iterative process, but once the decisions were made, the projects moved forward with what some might describe as a relentless pace.

The backfill renovation project strategy was to triage the projects into categories by building or subspecialty, such as intensive care units, and have the best experts paired as teams to address their areas of specialty. Allowing each team to identify its own challenges, from the physical space to the budget constraints and the personalities involved, helped maintain as transparent a process as possible.

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