There are hundreds of buildings constructed every year that require mechanical, electrical, plumbing, and technology systems (MEPT). These buildings are designed by architects, the MEPT systems are designed by engineers, and both are built by an assortment of construction trades, inspected by code officials and accreditation agencies, and typically require individuals with various levels of knowledge to maintain and operate them.

Depending on the philosophy of the healthcare organization, and the senior leaders’ trust in the maintenance team, the facility managers may or may not be involved in the overall design, build, and commissioning processes of the new or renovated building. In many cases, organizations depend on the architect and engineer to design what they feel is needed and fits within budget. This is a mistake. And here’s why.

No building is ever built to perfection, and they’re never totally maintenance free, even when building information modeling (BIM) is used to address conflicts in system design/installation prior to work beginning. Problems creep in. Oftentimes, incomplete drawings or specs go out for bid, especially on fast-track projects. As requests for information (RFIs) or construction bulletins (CBs) occur on a project and the end result is a change to a drawing, a process, or to a particular budget (construction, equipment, furniture, etc.), are all team members included/copied on the change? Is the owner made aware of everyone who must respond to the RFI or CB, and whether or not there will be an additional charge for assisting with the response? If not, this means that every RFI or CB could involve an additional, unexpected cost increase to the total project budget.

For those who must maintain the finished product, it’s guaranteed that they will not be 100 percent satisfied with what was designed, specified, and built. The MEPT design team, the various tradespeople, and assorted consultants very seldom have anyone working on their teams who’s ever had direct responsibility for the day-to-day operations of a physical building.

If you were to put an architect, an engineer, a construction manager, a representative from each trade, a facility manager, and a maintenance mechanic on a project at the same time, the facility manager and mechanic would in most cases find more design problems during construction than would any of the others. Architecture and design professors, and technical instructors seldom spent time in class talking about daily maintenance, staff competency, development of preventive maintenance programs, accreditation agency standards, living with a poorly designed project, or basic capital planning. They don’t bring in guests who can describe what it’s like to have to live with a poorly designed and engineered building.

As the general workforce continues to age, there are more 20 and 30 year olds working as building tradespeople or design professionals. Ever watched a young tradesperson install a valve 12 feet up from the floor above a drop ceiling in a hard-to-see location? Ever heard this same tradesperson stop and ask the foreman: “Hey, boss, are the maintenance guys going to get to that valve without tearing the ceiling out, let alone find the valve to begin with?” Probably not. BIM does a good job of spotting horizontal conflicts, but it won’t catch the hard-to-reach and hard-to-see items like you do when you look straight up—this is why you take video or photos during a project, before the ceilings go in.

How about the tradesperson who’s installing a piece of equipment where it was designed to go, realizes there will be no way to maintain it properly later, but installs it anyway because that’s where the plan says it should go? Are designers looking for these types of issues when making field inspections? Are external design and building teams revisiting projects 12 months after occupancy to check up on staff (including maintenance staff) satisfaction?

Before a new-build or renovation project starts, the maintenance team should be given an opportunity to meet the chosen design team, or maybe even be included in the interview process. With the team chosen, the facility team should be allowed to meet with the architect, engineer, builder, controls team, and the commissioning team. During these meetings, the maintenance team can describe the design elements that cause problems, the design elements that work best in their environment, and any existing operational components the design team should be aware of prior to starting the job.

Examples of design elements that work well:

  • Placing shut-off valves just above the ceiling and within easy reach
  • Leaving sufficient space around equipment for easy service access
  • Avoiding placing major shut-off valves above ceilings in rooms when there are major shut-off valves above corridor ceilings (and thus will be easier to access)
  • Using a building automation system that allows the staff to access all levels of it
  • Keeping exterior elements as maintenance-free as possible
  • Avoiding putting cable trays directly under piping systems, or valves right over them, that can’t be reached
  • Locating cooling units in data rooms or cooling units right over the server racks.

Examples of design elements that don’t work well:

  • Designing an external finish with multiple caulk joints
  • Specifying materials that are so specialized that minimum orders and additional setup charges are required when reorders become necessary in the future
  • Placing fire system piping and valves in janitor closets.

Remember that the facility and maintenance teams are just as important as the owner and clinical staff to keeping a healthcare facility running well. Architects, designers, and engineers should keep these tips in mindant ashen you follow up on a project later, always ask what went well, what needs improvement, and then keep those responses in mind when designing your next facility.


Robert Harris is director of facility services and construction for Sauk Prairie Memorial Hospital in Prairie du Sac, Wis., and currently serves as the owner’s representative on a $68 million replacement hospital project. He can be reached at