Communication is Key to Maintaining Patient Safety During Hospital Infrastructure Modernization

Healthcare facilities across the country are facing the need to upgrade aging mechanical, electrical, and plumbing (MEP) systems. Yet these projects can put a strain on staff and carry risks for patients. Even the simplest hospital infrastructure modernization projects carry the potential to disrupt patient care if not appropriately managed.

One of the most effective ways to move these renovations forward is through phasing. Breaking projects into smaller components makes it easier to advance projects within a fixed budget. It also allows renovation teams to minimize the construction impact to clinical operations. At its most effective, project phasing also facilitates input from a wide range of stakeholders whose perspectives help inform construction teams about potential project impacts.

Communication with all departments that might potentially be impacted by a project is an often overlooked, yet absolutely essential, part of construction phasing. With the right partners involved, construction teams better understand how to mitigate risks to patients. It can also drive more effective project planning. But knowing who “the right partners” are can be tricky for hospital infrastructure renovations. A project management (PM) team that recognizes healthcare infrastructure modernization as an operational planning challenge, not just a construction challenge, can help.

Experience Informs Effective Project Planning

As construction costs continue to escalate, hospitals must balance necessary infrastructure modernization projects alongside clinical investments. Phasing helps healthcare facilities advance projects as the budget allows. However, phasing is only effective when the PM team has a clear sense of potential project costs.

An experienced PM team can bring to a project their knowledge of the many factors that can inflate a renovation budget. For example, many hospital infrastructure modernization projects are scheduled for low-activity times in order to minimize the impact on patients and staff – yet project planners don’t always account for the expectation that construction partners work during overtime hours. An experienced PM team will know to account for these easily overlooked nuances.

Similarly, experience can help a PM team better plan for the unexpected. What happens when the HVAC system replaced in one area of the building impacts the pressure in another part of the hospital? Or installing new medical equipment puts an unexpected strain on existing infrastructure? Insight into variables like this can help create a budget and build contingency planning that accurately reflects project needs.

Of course, the PM’s experience should not be the sole factor shaping the project. Proactive and candid discussions with hospital leadership regarding schedule and budget alignment are critical to mitigating risk, as is the expertise and input of the experienced design and construction partners engaged on the project. If unforeseen conditions, such as overtime requirements or extended phasing, result in costs that exceed the available budget, those realities should be communicated early to facilitate informed decision-making and minimize project risk.

Let Stakeholder Feedback Influence Planning Frameworks

Construction teams have access to proven methods for identifying and mitigating risks associated with construction activities in an occupied healthcare environment. The Infection Control Risk Assessment (ICRA), Pre-Construction Risk Assessment (PCRA), Interim Life Safety Measures (ILSM), and Service Interruption Response (SIR) processes provide healthcare project teams with structured frameworks to guide activities.

• ICRA focuses on identifying and mitigating risks related to infection prevention, including dust generation, airflow disruptions, water intrusion, and other activities that could increase the risk of healthcare-associated infections.
• PCRA evaluates the broader operational impacts of construction, including patient safety, noise, vibration, utility disruptions, emergency access, security, and clinical operations.
• ILSM establishes temporary measures necessary to maintain life safety when construction activities affect fire protection systems, means of egress, compartmentation, or other life safety features.
• SIR (Service Interruption Response) planning addresses the risks associated with planned or unplanned utility outages, including impacts to electrical, medical gas, HVAC, water, telecommunications, and other critical infrastructure systems.

The American Society for Health Care Engineering (ASHE) has advanced these practices through tools and resources such as ICRA 2.0, which provides a standardized methodology for assessing and managing construction-related risks in healthcare facilities. These tools are most effective when used collaboratively by project managers, design teams, contractors, and hospital stakeholders. For example, ICRA planning should involve infection prevention specialists and/or industrial hygienists, while PCRA, ILSM, and SIR planning should include facilities management, operations, safety, security, clinical leadership, and other departments responsible for maintaining hospital operations and patient care continuity.

While these frameworks provide structure for managing construction-related risks, they cannot identify every operational dependency without meaningful stakeholder participation. This is why the success of a hospital infrastructure upgrade is often determined less by the technical execution of equipment replacement and more by the rigor of operational planning, communication, and interdisciplinary coordination. Risk assessment workshops should not be viewed simply as compliance requirements, they should be used as opportunities to gather stakeholder feedback that helps define project parameters, outage strategies, communication plans, and mitigation measures before work begins.

When Soliciting Feedback, Think Beyond the Scope of Work

Securing ample feedback proved to be a challenge for a freestanding emergency department (ED) undertaking the installation of new imaging equipment. As part of project planning, the project management team engaged facilities stakeholders, conducted site walkthroughs, reviewed available drawings, completed risk assessments, and performed appropriate testing to understand anticipated project impacts. Despite these efforts, an unforeseen condition emerged when it was time to isolate a local electrical panel. The team discovered that the panel supplied a telecommunications closet serving the entire ED, a connection that was neither reflected on the drawings nor accurately identified on the panel schedule.

While the project team quickly coordinated a response and minimized disruptions, the incident highlighted an important lesson: stakeholder engagement must extend beyond those directly associated with the visible scope of work. Involving IT and telecommunications representatives during the ICRA, PCRA, and SIR planning process may have uncovered the undocumented dependency in advance or provided contingency plans to manage the interruption. Their input could have influenced outage planning, communication protocols, sequencing, and risk mitigation strategies long before the work reached a critical stage.

Healthcare infrastructure systems are highly interconnected, and seemingly isolated modifications can create downstream impacts that are not apparent from drawings or field observations alone. Early stakeholder engagement, combined with thoughtful application of ICRA, PCRA, ILSM, and SIR processes, helps project teams identify hidden dependencies, validate existing conditions, prepare contingency plans, and align operational expectations. By allowing stakeholder feedback to shape project parameters from the outset, hospitals can execute infrastructure upgrades more successfully while maintaining patient safety, clinical continuity, regulatory compliance, and operational resilience.

Good Project Management Bridges Stakeholder Expertise

Communication breakdowns often result from an inability to connect to other construction projects to other departments’ priorities. Another advantage to hiring a PM team with healthcare experience is their ability to speak the same language as all project stakeholders.

The PM team must understand the concerns of each party impacted by a project in order to address these issues. This may look like reviewing ICRA elements with the facilities teams and relating that to the infectious risk assessments conducted with infectious preventionists and epidemiologists. It means accounting for life safety systems as project impacts are traced throughout the building. The ability to speak to these concerns allows the PM team to serve as a bridge that aligns departments and outside partners.

In one case, a hospital needed to replace an aging air handling unit serving an operating room (OR) suite and engaged a project management partner to lead the effort. As part of the planning process, the project team brought together stakeholders from facilities, infection prevention, safety, and clinical operations to identify potential risks and operational impacts. However, as discussions shifted to the downtime required to complete the upgrade, progress stalled. The surgical team was understandably reluctant to take an OR offline because of the potential impact on patient scheduling, clinical throughput, and revenue.

Recognizing that many stakeholders viewed the project primarily as a disruption, the PM team worked with hospital leadership to better communicate the “why” behind the investment. The team explained that the replacement was driven not only by the age and condition of the air handling unit, but also by recurring complaints from clinicians about elevated temperatures in the OR. Maintaining proper environmental conditions is critical for staff comfort, clinical performance, and most especially, patient care.

Once that context was shared, the conversation changed. What had initially been seen as a facilities-driven equipment replacement became a project with direct implications for the surgical staff’s daily work environment and patient experience. The project was no longer simply about replacing aging infrastructure: it was about addressing a long-standing operational issue. As stakeholders gained a clearer understanding of the project’s purpose and benefits, they became active partners in the planning process, helping to identify scheduling opportunities, develop contingency plans, and minimize disruption. The result was stronger alignment, more effective collaboration, and a clearer path to successful project execution.

Effective Communication Minimizes Patient Risk

Before beginning your next project, it’s important to recognize that communication is a safety tool. On the most successful projects, construction teams, facilities personnel, and clinicians operate as a single integrated team. While in-house teams can lead this communication, an experienced PM team brings the big-picture perspective that can garner cross-department support for a project and minimize unexpected impacts. Hospital infrastructure projects of all sizes can benefit from outside support, no matter how sophisticated the team leading the project.

Realizing these planning benefits requires a PM partner be brought onboard early enough to guide project planning and risk management. When the cost of not bringing an experienced partner onboard is measured in patient safety events, there’s no reason not to engage outside expertise.

RLB brings the healthcare experience and big picture perspective necessary to close any gaps on hospital infrastructure modernization projects. Deep expertise spanning healthcare cost management, scheduling, and project management gives our teams the insight needed to bring teams together and shape contingency planning that accounts for virtually every potential scenario.