Several doctors might visit a patient in the same hospital, and if they recommend different medications without consulting each other, they might waste the patient's time and money and, worse yet, jeopardize his or her health.

A healthcare facility under construction can suffer in much the same way if a lead decision maker—someone who will take in all the stakeholders' input and have the final say—is not chosen from the hospital's administrative staff to oversee the project. Although obtaining input from a variety of staff members is essential to the project's success, one person—a final decision maker—needs to be in charge to keep the construction process well organized.

Hearing From Staff

In a perfect world, layout challenges would be smoothed out during the design phase of a construction project. However, although designers can rely on their expertise and the historical data available to them to accomplish this, they also must recognize that each facility operates differently, which requires that they work in collaboration with the hospital staff and the construction manager if they are going to produce a properly functioning facility.

Suggestions should be gathered during the design phase from various people from the building's facilities group, nursing staff, and environmental services and security departments. Once construction begins, it's too late—and too expensive—to debate or rethink the design.

“If the owner wants to meet with the end users to review the design of the final product, it's important to get that input at the shop-drawing stage. This should occur before walls and no later,” says Brad Fierst, CG Schmidt project manager at Waukesha Memorial Hospital in Waukesha, Wisconsin. “That's when we start making casework and cabinets. It's the owner's last chance to tweak design details before costly rework would be required.”

The end users have a great deal of valuable information to offer at the design stage. A nurse who knows about a new addition being planned at her hospital is probably excited about the technology that will be available, the look of the addition, and how it will improve patient care. However, she also should be thinking about what she likes—and dislikes—about the existing facility and be ready to relay that information to the hospital's final decision maker. Such forethought and coordination from staff can actually speed up the construction process, thus reducing costs.

Mike Olin, CG Schmidt's assistant project manager at St. Joseph's Hospital in West Bend, Wisconsin, worked on mock-ups for this state-of-the-art, patient-safe hospital. To enhance safety, all of the hospital's patient rooms were laid out identically. This uniformity not only helps to reduce treatment errors once the rooms are in use, but it also simplifies the gathering of feedback from staff after walk-throughs of the mock-ups


“During staff walk-throughs, we're counting on staff to know what they will need in terms of locations for monitors, sharps disposal containers, or chart holders,” Olin says. The locations of such accessories can either significantly enhance the functionality of an area or detract from it, causing potential health hazards. For example, placing a nurse-call pull cord slightly out of reach obviously would be detrimental. Unfortunately, most design drawings don't contain this much dimensional detail.

Noting even the smallest of details will help facilitate the final touches of the construction process, speeding up construction and creating a more customized facility. Therefore, one of the best things hospital staff members can do in preparing for new construction is make notes about “little things” they've observed—specifics such as when they have to reach too far to grab something, when a machine is too far from an outlet, if the refrigerator needs to be closer, or whether a countertop is too low.

This end-user input is crucial to foreseeing how each area of the hospital will function. After all, the latest, most expensive equipment is useless if no one can access it when it's needed. Staff input can be taken too far, however, and too many voices can complicate the construction process and cause confusion. This is where the final decision maker comes in.

Appointing a Leader

When a healthcare facility is finished, there will not be multiple locations for storage racks, holding trays, and disposal containers to satisfy the wishes of every staff member who has offered an opinion on where these things should be placed. Therefore, one staff person needs to have the authority to consider all the staff input and then make final decisions.

Having a final decision maker onboard will enhance the success of the construction project and its timely, cost-efficient completion. It also gives the staff and construction team a single point of contact. This person should be an authoritative administrative staff member who has great communication and documentation skills. He or she also should have a good relationship with staff and a willingness to learn about the construction process.

Ask and It Shall Be Given

A construction manager is responsible to make sure the final decision maker knows exactly what he or she is buying and how much it costs. Fierst says that for construction managers to accomplish this, they need to step out of their normal thinking process and use layman's terms to explain construction processes to those staff members serving as final decision makers on their projects. He says it's all too common for decision makers to sign off on a drawing without knowing how the finished product will look, function, and feel.

Fierst also encourages the hospital's decision maker to ask the construction manager detailed questions before signing off on an order. For example, the decision maker should urge the construction manager to physically show how deep a counter will be, where a pencil drawer will go, or how much cabinet space will be available.

When the hospital's final decision maker signs off on orders for vendors and product samples without adequate communication, money and time can be wasted. There is also the risk that the project space won't properly accommodate the owner's/staff's needs.

At Elmbrook Memorial Hospital in Brookfield, Wisconsin, good communication between the final decision maker, the hospital staff, and the construction manager helped to improve the efficiency of the construction process. For example, they were able to make adjustments soon after their stroll through a mock-up birthing room revealed what could have been an inefficient, or even dangerous, placement of an equipment supply cart. The initial room design had the cart positioned across the room from where it should have been. During the walk-through, however, the head nurse of the department pointed out the necessity of placing the cart near the birthing area. To accommodate this, carpenters built custom casework to create a perfect fit for the cart without having to disturb the medical gas outlets.

To summarize, a construction manager's attentiveness to much-needed input from hospital staff and the staff's involvement in planning for a construction project are both essential to reaching everyone's shared goal of completing the best project—on time and within budget. This is best accomplished when the owner appoints a final decision maker to oversee the project—one who is open to suggestions from fellow staff members and who can synthesize their ideas into a workable plan that the construction manager, architect, and engineer can transform into reality. HD