The building has been built. The keys have been turned over and the facility is now yours. Now what? This article will share a brief overview of the key planning considerations when developing a building fit-up and activation plan. Also known as the start-up or initial outfitting phase, the fit-up period is a very dynamic time and encompasses the duration between building turnover when the facility receives keys to the building from the project team and Day 1 of operations. During this time, there is a flurry of activity required to ensure that the building can be licensed for patient care. Many facilities underestimate the enormity of this phase and are caught off-guard by the deluge of activities required to turn the facility into a living, breathing medical facility.
Planning for fit-up actually starts well in advance of the facility getting the keys from the contractor. The largest and perhaps most obvious pieces of the fit-up puzzle are the furniture, fixtures, and equipment required to outfit the facility, collectively known as FF&E.
Equipment Planning & Procurement. Most projects start with a medical equipment list generated by an Equipment Planning firm. This initial list is based on the space programming work done by the architect and the owner, and often, the assumption is that all equipment will be purchased new. The facility will want to validate this list with department managers to ensure all equipment needs have been addressed based on current department workflow and facility operational expectations. In addition, the facility will also want to take into consideration any existing equipment known as “reuse” that could move to the new facility if certain departments are relocated as well as any annual capital purchases planned during the years prior to the new facility opening. These two considerations, reuse equipment and annual capital, can help reduce the total project equipment budget significantly, provided the items have a sufficient useful life and verified compatibility with the new facility.
Once the new purchase requirements have been defined (total equipment needed less any reuse, less any planned annual capital), a procurement schedule is generated to manage and track the equipment purchasing process. The facility should designate a resource to monitor this schedule to ensure quantities are accurate, installation vendors are coordinated, and items arrive at the appropriate time and location. A similar schedule must be prepared for IT devices (computers, laptops, printers, etc.). Typically, an agent or reseller is engaged to manage the purchase, delivery and installation of furniture in coordination with a project’s interior design professionals.
Receiving and Logistics. Once the volume of equipment is understood, most facilities elect to contract with an off-site warehouse to help manage the flow of incoming products since the organization’s loading dock and storage space may still support ongoing operations. Once all of the items have been received at the facility site and deployed to the appropriate rooms, the activation team conducts walk-throughs with the department managers in order to turn over the responsibility and ownership of the spaces to the operational team.
Not so fast….
Support Services and Early Access to the Building. Before the facility can begin receiving FF&E, and before staff can begin occupying the building, there are preparations that need to occur. There is a practical and logical sequence to the deployment of products throughout a facility. For example, before any desktop devices can be deployed, desks and systems furniture must be installed and configured. Before furniture can be installed, the floors should be cleaned and sealed. There are a number of support services departments that will likely need early access as soon as they can safely do so (in accordance with the general contractor’s schedule and protocols).
- Facilities Engineering. Long before anyone from the facility occupies the building or any FF&E is deployed, the Facilities Engineering department must spend a significant amount of time shadowing the General Contractor and their vendors during the commissioning period to ensure they have a very high comfort level with the key building systems, including the Building Management System (BMS), Fire Alarm System, Nurse Call System, P-Tube, etc.
- As equipment vendors gear up for the on-site installation of the larger pieces of medical equipment, for example, CT Scanners, physiologic monitoring systems, sterilizers, etc., Security will need to establish a presence. Security will need to monitor entry and exits from the building, periodically check secured storage spaces, patrol the floors, and enforce the guidelines that have been established for working in the building. In addition to performing a critical loss prevention role, this presence also ensures that staff and workers are safe, and that any issues with the building are identified and reported as quickly as possible. An odd smell or small puddle can quickly escalate to a large scale disaster.
- Environmental Services (EVS). In addition to becoming familiar with new cleaning processes and maintenance requirements for new flooring, furniture and other surfaces in the building, EVS will need to establish an ongoing maintenance schedule for the building.
- Information Technology and Systems (IT/IS). The facility’s network is the operating backbone for much of the new medical equipment and technology deployed in the facility. Due to lead time, complexity, and resources required to successfully install and troubleshoot the network, this work typically begins while the building is still under the ownership of the Contractor. Therefore, IT/IS resources will likely be among the first groups to have early access to the facility, often before the official building likely be amongst the first groups to have early access to the facility, often before the official building turnover date.
- Clinical Engineering. Clinical Engineering also plays an important role in the fit-up of a new facility. Clinical engineering technicians will need to supervise many of the vendor installation efforts, as well as conduct incoming inspections on all medical devices that typically come into contact with a patient.
As you can imagine, with all of these activities occurring simultaneously and involving various vendors and staff, an organization would benefit greatly from a comprehensive coordination tool. A best practice is to develop a comprehensive fit-up project plan by working with all responsible parties before the building is turned over. A project plan will help you organize, orchestrate and manage competing tasks and competing audiences all vying for the same access point, the same elevators, and the same staging areas. A detailed fit-up project plan will help you stay on track, bring greater visibility and accountability to your project, and will result in a smooth, predictable, and successful activation of your healthcare facility.