Operational costs of construction projects are often not factored into either a hospital operating budget or the construction budget. Many hospitals fail to project the costs and potential revenue loss of operating dual departments, or operating a department at less than full capacity during renovation. When these costs are realized, they become budget-busters, often impacting the construction budget late in the project, or being a drain on the overall operating budget. It's important to encourage owners to identify all the budget pitfalls they might experience during a construction project.

A good practice is to begin with the end in mind. Once the design and construction teams have been selected, the initial budget discussions should identify operational cost impacts, which include not only utilities, but additional staffing for messengers and patient transport around construction sites, additional wayfinding, service recovery costs for noise or other complaints received, and additional security details. Early identification of these issues mitigates these cost "surprises."

One of the many objectives of a good preconstruction effort is to identify these potential budget impacts and develop a plan to address them. Depending on the hospital's Accounting Department policies, some facilities may want to capitalize on these costs while others may want to treat them as operating expenses. Be sure to include your finance department contacts in these discussions. Have you seen other ways to help owners reconcile and unify the operating and construction budget?