The project manager should establish processes for communication that keep team members informed and in control of information.

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Whether one is new to the health care project management field, a veteran taking on a new role or a professional looking for a different perspective, there are common tools and best practices that can help project managers avoid problems, manage change, improve communications and deliver successful projects of any size, from equipment replacements to greenfield hospitals.

This article discusses some best practices to make sure that projects are successful. For an in-depth look, project managers should check out the American Society for Health Care Engineering’s The Facilities Manager’s Handbook for Health Care Project Management.

Aligning expectations

The project manager will often come to the table somewhere in the middle or end of the project development stage. Long before they arrive, strategy departments, organizational leadership and other stakeholders have been thinking, planning and budgeting. Because of this, it is important to spend time at the project kickoff stage and throughout the project timeline learning from each other and aligning expectations.

Project managers should take time with other stakeholders to review the approved budget, scope and schedule. It is common in the design and construction process that something has changed from when a project is conceived to when the design and construction teams come to the table. If a long amount of time has passed since conceptual planning or leadership approval, additional review is essential.

Every person at the table will have their own ideas and definitions of success. A great exercise at the kickoff of a project is to document each stakeholder’s definition of success and goals for the project and collectively create team project goals and critical success factors. The goals may then be referenced through each phase, from conceptual planning through construction and occupancy. Everyone involved in the project delivery will be aligned and working toward the same outcomes.

Managers should define who the authorities having jurisdiction (AHJs) are and what is required by them. AHJ requirements and timelines can have impacts on scope, budget and schedule. Requirements can also change from one project to the next. Professionals should meet with AHJs early in the design process, if possible, to get feedback on the project and avoid surprises late in the game. Considerations include:

Budget. It is critical to understand the marketplace as compared to approved project budgets. Professionals should pay particular attention to the dates on project “opinions of probable cost” and approved budgets. Escalation and market changes may require an adjustment to the project budget, or the scope may need to shrink to align with the budget. Even a few months can make a difference. If project managers are involved in the development of the project budget, they should include time to get input from design and construction professionals who have the pulse on where costs are trending. Including an appropriate cost contingency is required. Right-sizing the budget upfront can prevent future challenges and disappointment if otherwise avoidable cuts have to be made.

Scope. Successful project managers have a good understanding of what is and isn’t included in the scope of a project before they begin. It is important that they review the scope in detail with all project stakeholders and team members and compare it to the approved budget. Professionals should pay close attention to scopes that are often owner-provided, such as information technology and furniture, fixtures and equipment. These can inadvertently be overlooked or underbudgeted in the planning process. Professionals should involve consultants and facilities staff early to do field work and confirm the available capacity and age of building systems when working on an existing building.

Schedule. The schedule of design and construction is highly dependent on the architect and their consultants as well as the general contractor. A best-case scenario is that design and construction professionals are involved during the planning phase in creating the approved design and construction schedules, based on their experience. In all cases, it is important to discuss the leadership-approved schedule early in the project kickoff process to manage expectations and adjust as needed. The project may be one that impacts or is impacted by other projects, so it is important to communicate schedule changes broadly. Professionals should work with the consultants and contractors early in the design process to identify equipment or materials that may have long lead times or supply chain challenges. These items should be ordered early to avoid schedule delays during construction or occupancy.

Stakeholder engagement. It is critical to engage all stakeholder groups that will be responsible for managing and operating the completed facility. Clinical staff must be included, too. New staff members who come into the organization or stakeholder group during the process may have their own ideas about how a space should function and may want to make changes to the design, so it is important to continuously engage staff and stakeholders throughout the process. The project may be too far along for redesign, so realigning expectations of new stakeholders is critical to carrying the design forward. Engagement is especially important with organizational or departmental leadership.

Managing change

Every project is going to experience changes throughout its duration, but successful project managers are equipped to deal with it. Common instigators of project changes are related to staffing needs, equipment, materials, programs and regulatory agencies. Considerations include: 

Staff. It is common these days that key stakeholders in a project change from start to completion. New leadership in a department or organization can be disruptive and challenging for the entire project team. With new leaders come new ideas for workflow and productivity, and often requested changes to design and equipment needs. When change requests happen later in a project, the cost of change increases. Staffing needs or full-time equivalent (FTE) employees may change, along with procedures and protocols. It will be valuable for the project manager and their consultants to discuss FTEs and general policies and procedures as part of the early design process and walk through existing areas of operation.

Equipment. It is possible that equipment specified early in the design process may not be available or may have changed during procurement. Considerations include power or data requirements, size of equipment from one model to the next, changing clinical needs or technology becoming outdated. Good communication with procurement teams on lead times and arrival times of equipment is important to manage the schedule, storage and installation duration of equipment.

Materials. One of the most frustrating changes is when materials are discontinued or modified over the life of the building. Examples include new flooring installed next to existing flooring when the color or pattern has changed slightly, or flooring that is discontinued and cannot be matched, often incurring additional costs to replace a larger amount of product. Design teams must research existing product availability early in the process. Additionally, they should avoid design elements that are too trendy and may not be in stock long term. When possible, facilities may also keep adequate extra materials, or “attic stock,” on-site.

Programs. There may be significant reasons for a program revision during a project. Consider the impact that the popularity of electric vehicles has on the project demands for electric vehicle charging stations. Similarly disruptive program changes occurred for projects in the design phase during the COVID-19 pandemic as hospitals scrambled to adapt. Additionally, recent decarbonization efforts will continue to disrupt long-term strategic planning efforts and projects that are underway. Project managers should keep project budget and schedule in mind as program changes develop.

Regulatory agencies. Regulatory agencies, such as the Centers for Medicare & Medicaid Services, can require project teams to redesign aspects of projects due to regulatory changes. State health departments may have similar impacts with changes in adopted codes or processes. Changes to U.S. Pharmacopeia drug compounding regulations resulted in changes to most inpatient hospital and other compounding pharmacies, including those under design or construction. 

City planners, reviewers or inspectors can request design changes during plan review periods or during construction. Certain code changes that happen during a project can become effective immediately. Project managers should keep project contingencies available to allow teams to comply with these late changes.

Clinical impacts

Communicating and keeping clinical staff and leadership informed is a key role of project managers. It is important to try to identify impacts early and minimize the impacts and their duration to reduce revenue losses. Project managers should be sure to communicate often on when vacating areas is required and when new spaces will become available for operation. Considerations include:

Phasing work. In fully functioning health care facilities, project work is often phased to keep departments operating. Phasing of work will impact project schedules and increase costs, impacting the budget. The benefits of maximizing operations and revenues may take precedence over budget increases. It requires daily communication with the general contractor, clinical staff and facilities teams.

Shutdowns. Scheduled shutdowns of building systems are often required during construction. An approval process by stakeholders and leadership is likely already in place to ensure that patient care is not impacted. Project managers should educate the general contractor to submit any shutdown request or patient care disruption in a well-planned and scheduled manner to give everyone adequate time to review and respond to the request. They should work with facilities leadership and the contractors to prevent shutdowns from occurring during the busiest times of day for patient care.

Other considerations

In addition to these best practices, project managers should consider other factors that can greatly impact planning, design and construction success. They include:

Team dynamics. The project manager, stakeholders, consultants and contractors are best modeled as a team. Roles and responsibilities should be defined early on. “In addition to the scope, schedule and budget, some of the most important items to identify in writing upfront are how decisions will be made and who decision-makers will be,” says Joshua Mulhall, manager of planning, design and construction for national real estate services at CommonSpirit Health in Phoenix. “Identify how conflicts will be resolved or escalated if necessary. The project manager must foster an environment of open communication which endeavors to respect the talents and expertise that exist among team members. Seek to build mutual trust. An effective and efficient project team dynamic will allow for a profitable experience among project consultants.”

Communication. Project managers should establish processes for communication that keep team members informed and in control of information. Ideally, consultants and the general contractor should not communicate directly with clinical staff or other stakeholders. All communication should come through the project manager. Project managers should figure out what works for the team to be efficient. They should identify problems as soon as they arise and work to find solutions. Additionally, they should keep stakeholders informed and establish regular communication with clinical staff.

Set for success

Taking time to get organized and aligning expectations at the start of projects will save time, effort and stress during design, construction and occupancy and set the project team up for success.

Managing project scope creep

Scope creep is the gradual growth or expansion of a project program during design and construction. It should be expected that projects will change throughout the design and construction process due to new innovations or technologies, ideas, regulations or unforeseen conditions. It is important to remain mindful of changes and their impacts on budget, scope and schedule to avoid cost surprises during bidding and costly redesign.

Project managers should be sure that the approved project program is documented in writing and share it with the consultants and stakeholders. They should revisit this document throughout the project and especially at the end of project milestones.

Stakeholder signoff of the design is important to ensure that everyone agrees on the scope and design prior to construction. This offers a layer of accountability for all parties to be active participants in the process. 

It is important for project managers to not only carry some contingency to manage scope creep but to be diligent and mindful of changes that are outside of the original program and be a good communicator with stakeholders about potential budget or schedule implications.

The best time to respond to scope creep is the moment it is requested. Examples of scope creep requests are an additional room or piece of equipment or a different model or brand of material. 

One way for project managers to handle additional scope or program requests is to break them out during design and bidding as project alternates. Alternates require the general contractor and their subcontractors to assign a cost to these items that can easily be tracked, managed and included if the budget allows or removed if not.

Ashley Mulhall, AIA, EDAC, LFA, LEED AP BD+C, WELL AP, is senior associate at Orcutt | Winslow in Phoenix. She can be reached at mulhall.a@owp.com.