Phased construction occupied healthcare facility work, and the swing space it needs

Phased construction occupied healthcare facility work has one binding constraint that is not construction at all. Before a department can be renovated it has to move somewhere, and where it moves is the owner problem.

The constraint is space, not sequence

A renovation in an operating hospital is described as phased, which sounds like a construction sequencing question. It is not, or not mainly.

Each phase requires the clinical function occupying that area to be somewhere else while the work happens. Somewhere else is swing space: a vacant floor, a leased suite, a modular building in the parking structure, or another department that agrees to compress.

The amount of swing space available determines how many phases there are. A facility with one floor of swing space runs the job in as many phases as it has floors. A facility with none runs it at night, in fragments, or not at all.

So the phasing plan is a function of an owner asset rather than a contractor plan, and the contractor prices against whatever plan it was given.

When the plan changes, and it usually does, the price changes with it, because the number of phases drives the setup cycles, the duration and the general conditions.

Everything below follows from that one relationship.

What phased construction occupied healthcare facility work has to solve

Swing space that actually works clinically. Not just square footage. A department moved into space without the right gases, power, drainage or adjacencies cannot operate, and the cost of making swing space clinically usable is frequently comparable to the renovation itself.

Temporary services. Every phase boundary cuts services that serve areas beyond it. Temporary power, medical gas, water, drainage and data have to keep the rest of the building running while the permanent versions are replaced.

Egress and life safety continuity. Corridors that are construction routes are also egress routes. Maintaining compliant egress through a phased renovation is a design exercise in its own right and it is frequently underestimated.

Infection control at every boundary. Covered separately, and it multiplies with the phase count.

Decant dates. When each department actually vacates. This is the item that slips most and it is entirely an owner obligation.

Return dates. When each department comes back, which drives what finished means for each phase and when the facility can accept it.

Why the decant date is the one that matters

Of the six, five are technical problems with technical answers. The decant date is an organizational one.

Moving a working clinical department requires the receiving space ready, the equipment moved, the staff informed, the scheduling system updated and, in many cases, a regulator notified. It depends on where the department is going, which depends on the phase before it finishing.

So the decant dates form a chain, and a slip at the start propagates through every subsequent phase.

They are also owner obligations under almost every contract, which means a slip is an excusable delay and the extended general conditions land on the owner side of the ledger.

On a nine phase renovation with nine decants, two weeks of slip on each is eighteen weeks of extension that nobody contracted for and that the contractor did not cause.

The fix is not contractual. It is to put the decant dates in the construction schedule as named owner obligations with a person against each, and to report on them monthly alongside the construction activities, which is the same discipline described in who owns float on a construction schedule.

A worked example

A $31 million renovation of four floors in an operating hospital, priced against a six phase plan using one floor of swing space.

Two changes arrive after the price is fixed. The identified swing floor turns out to lack medical gas capacity for the department that has to occupy it, requiring $340,000 of temporary infrastructure nobody priced. And the clinical plan is revised to ten phases, because two departments cannot be moved together.

Four additional phases mean four more containment setup cycles at $45,000 each, four more temporary service transitions at $60,000 each, and roughly eleven weeks of additional duration.

Setup and services $420,000. Extended general conditions for eleven weeks $390,000. Productivity effect of smaller work areas across the extended duration $520,000. Swing space infrastructure $340,000. Decant slippage of two weeks on five phases, a further ten weeks, $355,000.

Total roughly $2.2 million, none of which is additional finished work. It is entirely the cost of doing the same work in a different shape.

What the phasing plan should be tested against

Three tests, all answerable before the price is fixed.

Does the swing space work for the function that has to occupy it? Room by room, against gases, power, drainage, adjacency and regulatory requirements. This is a clinical question with a construction answer and it is frequently assumed rather than checked.

Has the clinical leadership of every affected department seen and agreed the plan? Not been informed. Agreed, in writing, with dates. A phasing plan that a department head has not signed is a plan that will be revised.

What does each additional phase cost? The contractor can answer this as a rate: so much per additional phase for setup, services and duration. Once that number exists, every subsequent conversation about adding a phase happens with a price attached.

The third test is the one that changes behavior. Clinical departments asking for a phase to be split are asking reasonably, and they are usually unaware that the request costs a specific amount.

Putting that amount in front of them does not stop the reasonable requests and it does stop the unconsidered ones, which is the correct outcome.

There is a fourth test worth running where the project is large enough. Ask what the job would cost with no phasing at all, built in one sequence in empty space. The difference between that number and the phased price is the cost of staying open.

That figure is occasionally startling and it is occasionally decisive. On some renovations it is cheaper to lease temporary clinical space for the whole duration than to phase the work, and nobody discovers that because the phased plan was the only one ever priced.

What to do before you sign

1. Identify the swing space and verify it clinically, room by room, against services and adjacency.
2. Price any work required to make swing space usable, and carry it as a line.
3. Get the phasing plan agreed in writing by every affected department head, with dates.
4. Put every decant and return date in the construction schedule as a named owner obligation.
5. Ask for a cost per additional phase, stated as a rate, before signature.
6. Establish who designs and maintains temporary services at each phase boundary.
7. Confirm that compliant egress is designed for every phase, not assumed.

Item four is the highest value item on the list and the easiest to arrange. Decant dates in the contractor schedule, reported monthly, turn a series of soft internal commitments into visible obligations with consequences attached.

Item two catches the item that recurs most. Swing space is chosen for availability rather than suitability, and the cost of making it clinically usable is a real number that belongs in the budget rather than in a surprise.

The scope options for this reading sit in the review packages.

What we do

We read the phasing plan against the swing space, the temporary services requirement and the decant calendar, and price what each additional phase costs. The output states which obligations sit with the owner and what a slip on each is worth. It is a commercial reading rather than a clinical plan, which belongs to the facility. The work is the schedule and procurement risk review.

Questions people ask