Healthcare Facilities Network

Transition to Hospital Operations: Avoiding Costly Mistakes

• Peter

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A failed transition to operations can cost hospitals millions in lost revenue, delays, and rework. In this episode of Healthcare Facilities Network, Stephen W. Van Ness joins hosts Peter Martin and Patrick Murphy to discuss why transition planning must begin as early as the design phase and how it can make or break the success of new hospital spaces.

Stephen unpacks the high stakes of hospital transitions — from commissioning and supply chain challenges to the role of AI, data, and increasingly complex equipment. He also shares how workforce trends, such as an aging employee base and evolving skillsets, impact a hospital’s ability to manage these critical transitions effectively.

Whether you’re involved in hospital design, facilities management, or operations planning, this episode offers actionable strategies to avoid costly mistakes and ensure new spaces are fully optimized for patients, staff, and the bottom line.

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SPEAKER_00:

You you need to start thinking about it, quite frankly, uh once a project has been sort of identified, uh gone through a feasibility stage where you understand what the scope of the project is, what the goals of the project are, and what your um what your timeline is, what the facility's timeline is to get this project implemented, to have that first uh patient in a bed. Um you need to start early on thinking about the commissioning, is certainly one of those one of those aspects that once you develop your systems, you've got to be thinking about what you're who you're bringing on to do the commissioning and what the extent of that commissioning is going to be. And during selection of those systems, the BAS system in particular, you need to understand, you know, where are you gonna get the most banged for the buck and do you have, uh, and you see this in rural systems also, do you do you have a workhorse that is able to manage that, uh, the technology that you're gonna need to run this facility?

SPEAKER_01:

There's a major crisis facing healthcare facilities management. We have aging employees, aging buildings, and aging infrastructure. We've created the healthcare facilities network, a content network designed specifically to help solve for these three pressing issues in healthcare facilities management. We bring on thought leaders and experts from across healthcare facilities management, all the way from the C-suite to the technician level, because at the end of the day, we're all invested in solving the aging issue. Thanks for tuning in. Look at our videos, you will find that is a theme across our content. This is the Healthcare Facilities Network. I'm your host, Peter Martin. And I'm actually joined today by two of my Kreft colleagues. We are going to be talking about transitioning to hospital operations. That's our topic. But before we delve into that area, I'm gonna ask my two guests to please introduce themselves to you. All right.

SPEAKER_02:

Thank you, Peter. Again. It's a pleasure to be on the show again. Uh Patrick Murphy, I'm the regional president here in the East for Kreft.

SPEAKER_00:

Thank you. I'm Steve Ben Ness. I'm Vice President of Planning, Design, and Instruction for the Eastern Region of KREF.

SPEAKER_01:

Excellent. Here on the Healthcare Facilities Network, we've made it a uh a mission to help try to solve our three full problems aging buildings, aging infrastructure, and aging employees. And as we talked about transitioning to operations, these two gentlemen are out there on the front lines working with clients, dealing with the issues that come up on a daily basis, and that's why there's no better guests to have on than Steve, who's been an architect for more than 40 plus years, Patrick, who's been in project management, construction, leadership, development. So let's just start. It's a huge topic, and we're not going to cover everything in a day. I mean, transition to operations, but let's tie the transition to operations directly into not only aging employees, but the lack of people coming into the field with hospital experience. When you have people who are not experiencing project management and healthcare and transitioning in a hospital to operations, what are some of the ramifications for that? And I throw that out to either one of you who wants to pick the ball and roll.

SPEAKER_02:

Yeah, I mean, look, why don't I just start the framework? Because it is a very large topic. You know, like we were just talking before this, there's a lot of different work streams that you can focus in on. Um, but tying it to, you know, the pillars of what we think are the biggest crisis right now in healthcare, right? You know, the revolving door of people is very, very challenging for a project, as everybody knows, right? Uh, you know, if you're in a doing a college project and one of the kids flucks out in the middle, you can't you got to keep going on the project, or you might get a replacement, and that replacement needs to get kind of brought up to speed and it can be a disruption. And, you know, uh transitioning to operations people think starts, you know, when a project is getting near its completion, right? And that isn't when it starts. Uh, you know, it starts well before breaking ground on a project, oftentimes. The planning, you know, the the folks and the users that are involved with planning a project, uh, whether it's a big improvement, tenant improvement, renovation, ground up project in a hospital, you know, you need to start planning that very, very early. And a lot of times it takes multiple years. And we know, and we've talked about it in other episodes, that folks don't stick around at the same place for, you know, more than three or four or five years anymore. And oftentimes you're gonna get a big revolving door in these projects, and it affects all the work streams to transition to operations. Um, so I think that's one big one that we can focus on. You know, I have pet peeves, just like you said, we're on the flow line now, and you know, there's concerns that I didn't have 10 years ago when I see a project that we do now, um, based on other factors, right? You know, the way partnerships are currently being created to create more creative funding sources, um, you know, brings developers into the picture more and more in the hospital world today than it did even five or ten years ago. And oftentimes those development proformas, which are basically the budget to get stabilized to move on to the next development, don't always align with the amount of training, the amount of planning for move management, getting equipment installed, training on the equipment that was installed. All of that, all of that can become problematic. Commissioning, you name it, it becomes very, very problematic when you have stakeholders that don't necessarily have the same end goal. They may have the initial goal together, and the charter could be aligned. But if you if if one stakeholder is focusing on not just the first patient, but the next 10 years of patients, and another constituent is focused on finishing what they've needed to be part of that development phase, you can get into a trick from a funding perspective and just staying on site to make sure that things are done. And so that's one side of the the coin. And then the the other side of the coin is the operators themselves. Like we said, it's a revolving door. And I think all work streams associated with transition to operations are impacted by that.

SPEAKER_00:

Yeah, so just taking off on what uh what Patrick had to say, there's when I look at it, I look at um look at this specific aspect of the transition to the operations. There's sort of two different focuses here. One is the the clinical side of the operations, where um the design team has gone to a great deal of effort throughout the design process to design around an operational goal of how uh patients are going to flow, how they're gonna provide care, how uh how the supply chain works with that, how housekeeping works with that, how even food services works with that. And those goals may be not remembered during a transition to operations, largely because the staff who set up those operational workflows are no longer there, or they have a short memory. And and that always, so there's always in this full transition to operations, there's always a period of where if you really need to be sitting down and um uh maximizing the extent to which your actual operational flow is working with what the design intent and what the goals of the organization were. So that's that's where a couple of things come into play. One is staff turnover, the other is you need the time to actually orient um people and get the operational flow worked out. You need you need that time. Oftentimes with the developer, you're not going to get that time, so so that get gets cut uh short. On the operational side, um that becomes it's it's a more comp it's a somewhat more complex problem in that you've got a couple of things going on. One is the increasingly complex technology that that is being used in in building systems, building automation systems, and the aging workforce uh is sometimes not prepared to deal with that level of technology. The inexperienced workforce coming in maybe does not have the right training to adequately make use of that technology. So, uh in one sense, you've got that kind of staff turnover that makes the uh commissioning pays uh or makes the transition to operational pays a little more challenging. Um the other piece is a lot of the commissioning that happens right now really happens, it's it's sort of vendor specific. So you've got the the guy who installed the chiller system and the guy who maintains uh the existing plant. And the chiller system, the guy comes in and he explains the system and how it works, and maybe, maybe, if you're lucky, how it ties into the building automation system. Well, what you don't get is that overview of how everything is working together, and that ends up resulting in operational costs, inefficiency, breakdowns, all of that. So it's really in that whole process, you need to have both the design engineer involved to help keep that overview of the system and the commissioning agent involved. It's not just the vendors that should be doing the training uh for the operational set.

SPEAKER_02:

Yeah, I totally agree. I mean, the old adage is the last 10% of a project takes 90% of the time. Yeah. This is kind of one of the reasons that old folk folklore came up, is there is so much to do in that short period of time.

SPEAKER_01:

Let me ask a baseline question that I should have asked first. We have the um traditional design phase, right? SD, the schematic design, I mean conceptual into schematic into um DD design doctors. Where in wait, for somebody who's new to healthcare, maybe new to project management, because as you guys have said, they're out there. Where should the uh transition to operations, where in the traditional project management timeline should folks start to think about this? And Patrick, I know you said up front, start to think about the transition to operations, and more than that, start to plan for the transition to operations. I'm assuming it's not in the last 10% of the project work.

SPEAKER_02:

Where should it, though? No, it's funny. Steve and I were chatting about it this morning. And Steve, if you uh you're you're welcome to to chat through this because as the planner, uh, he's gonna probably, I'm not gonna go early enough, and he's gonna be able to probably give you where it should start.

SPEAKER_01:

And Steve, I would ask you to do that, but also at the end, have you seen this timeline slip over the years where it happens later than it should? What have you kind of seen as far as this transition to operations timeline staying, slipping, moving up? What have you compare it historically, if you would.

SPEAKER_00:

So you you need to start thinking about it, quite frankly, once a project has been sort of identified, uh, gone through a feasibility stage where you understand what the scope of the project is, what the goals of the project are, and what your um what your timeline is, what the facility's timeline is to get this project implementated, to have that first uh patient in a bed. Um you need to start early on thinking about the commissioning. It's certainly one of those, one of those aspects that once you develop your systems, you've got to be thinking about what you're who you're bringing on to do the commissioning and what the extent of that commissioning is going to be. And during selection of those systems, the BAS system in particular, you need to understand, you know, where are you gonna get the most banged for the buck, and do you have, uh and you see this in rural systems, do you do you have a workhorse that is able to manage that uh the technology that you're gonna need to run this facility? Um so, yes, I have seen this slip numerous, numerous times uh where not enough time is has been devoted to thinking about that up front, where you get to the end of the project and everybody's focused on move management, which is certainly a component of transition operations, but it is only one component. It's really having the staff trained and understanding how they're going to use the facility, how they're going to use the equipment, how they're going to maintain the equipment, how maintenance of that equipment ties into the regulatory requirements in terms of reporting versus MS and whenever, uh, and understanding the regulatory end of the licenses and certifications that are required. Um the construction manager at a large project, he's going to want to know that from what I recently was talking to a construction manager, and he he had the best experience it ever had on an accelerated project because at the very outset they started thinking about what it what the process for transition to operations came to be. Things that he had never thought about. You know, um, you they had a nuclear medicine facility in there uh and uh they had to get rid of uh nuclear waste, so you need a special license for that. And nobody had ever thought of that. So it's thinking through all of those issues as well uh up front. So I I think the sooner you can get started the better. Obviously, maybe not day one, but yeah, yeah.

SPEAKER_01:

But up front, I know you're gonna jump in before you jump in. Uh you know me well. I know. I I I had to I had a beat the punch. Steve, you mentioned something that's near and dear to my heart coming out of the recruiting world a year and a half ago. You talked about people and the ability of local staff to manage during the operational phase. Do you think that um it does it number one, does it happen, but do you think that more hospitals need to consider this? You know, when you're in that transition to operation, what equipment are we getting? What's the capacity of our staff to handle it? Can we get the staff to handle it? Is that does that need to be a consideration very early on?

SPEAKER_00:

It needs to be a consideration very early on, and and where you want to go with your facilities management program in terms of increasing automation, increasing you know, the use of AI, uh, increasing technology, uh, you need to have those goals very clear and how to get to this goal very clear in your mind as you get into the design phase. Because if you don't, then you're gonna end up with a mismatch between you know this beautiful new building and people who don't have the skill sets to to manage that building and operate that building.

SPEAKER_01:

And to you, Patrick, how often do you find, you know, you go into a client and they might have this great technology, but they're not using it because they don't know how to use it efficiently.

SPEAKER_02:

Well, that's uh it happens all the time. I mean, there's a big wave, right? There's two waves, right? There's the generational wave and there's a technology wave. And they're right behind one another. And new generations don't know, they don't have the right shift for either one of the swells right now. So, you know, I could even say, you know, oftentimes we we as CRAF uh we go in and we do a lot of asset validation and we digitize a lot of information. Uh, basically a big spreadsheet, a big database that we can then give back to the client or the organization to have them be able to utilize the software and the technology that they're oftentimes procuring through their information systems and technology budget through a different controller, right? And we're finding now that you know the facilities teams are the ones that are on that other's end of that rope. And oftentimes big decisions on what technology to purchase are done not in a vacuum. I wouldn't say it's in a vacuum, but without fully educating the folks that are going to be operating the train, you know, and it it kind of goes twofold, right? We we do a lot right now in existing facilities, occupied facilities, which takes a lot more time and effort to pop ceiling tiles in occupied rooms to be able to identify all of the data that actually doesn't harvest itself to get into these systems. But I think it's more pertinent today with the conversation we're having about transitioning to operations in a new program or or a new building, that you know, it it it's it's the same conversation. It's all right, well, we're we're installing all of this equipment, right? Some of the equipment's being furnished by the construction manager, some of it's being uh procured by a planner or by purchasing, right? It could be general equipment, it could be medical equipment, and all of that information goes into the building physically, and you know, not we aren't fully there yet, where all of that data, which is actually built into the building, like you know, new houses, if you buy a new refrigerator, you can get all of that metadata and you can load it into something. Maybe it's an app on your phone, like the little rental property I have in Wall Fleet, I can see it now.

SPEAKER_01:

I was gonna say you sound like you're speaking from experience.

SPEAKER_02:

If anyone would like, I do have time available in Wallfleet uh in September. You can cut that. I'm I'm not selling that right now or leave it in. But my point being that you have all of these assets, thousands of assets that come in on a new project. And nowhere in that process does that data go into their CMMS system, right? It may be in a brand new BAS building automation system, but very often this very highly technological building is basically left to the groups to you to operate in with a very short window of training. But all of those preventative maintenance schedules, all of that operational information, everything that the manufacturer would suggest is actually sitting there. And in transition to operations, yet another workflow is making sure all that information gets digitized into the brand new Ferrari of a software system that was purchased. And more often than not, today, that's overlooked.

SPEAKER_00:

One of the very frequent problems with any transition to operations is making sure that the ITT is on board and making sure that all of their systems and their brand new, uh, all the bells and whistles software packages are running properly, and that the people who actually have to use the assistants are trained, trained to use those and understand how they work and how they how they integrate. I think if if there's one single problem most often seen in the transition that slows this down, it's the IT folks weren't engaged early enough or as uh deeply engaged as they need to have been to get that uh that facility turned over quickly.

SPEAKER_01:

If you like this video, please like and subscribe to the network. And more importantly, share it with your colleagues in the healthcare industry. Together, we can solve the aging crisis that's impacting all of us. There are organizations we talk to where we'll talk to the FM team and they'll tell us that they still don't have a seat at the table. They're siloed. You have your PDC department who's running it, they're turning it over to FM. But FM's not getting that seat at the table. They're not invited. And I'm shocked that it still exists out there. But does you have no shot, do you, at a smooth transition to operations if you're bringing in facilities at the last moment? No shot at all.

SPEAKER_00:

I I'm seeing it less frequently now than in years past, uh, particularly as as the projects get more and more complex and as the reliance on EAS systems, for example, uh, but as the reliance on technology uh becomes greater and greater, um it's I think a lot uh more of the clients that I've been dealing with had realized that. Or perhaps it's because I insist on it.

SPEAKER_01:

Oh, that's why you bring in somebody even if they're doing.

SPEAKER_00:

But uh no, I it it has been a problem in the past, and as I said, I am seeing a little less of it now. But if they don't have a seat at the table during the design, I think um you're on your way to to having real challenges once you try to get the system. Once you try to get the building renovation, the department, whatever it is, who can run it.

SPEAKER_02:

I think the irony is they're the ones that only have a true seat at a table in the building, usually in their desk. Uh but yeah, I think ultimately Steve's right, you know, there there's I think as the process becomes leaner, I I think you're seeing a shift in how projects get delivered, where we're bringing in subcontractors, subconsultants, we're bringing in different members of the team during the team assembly phase earlier because of the just the the change, the pedagogy and how we actually build them. That's a word of take. Well, OVIP works, somebody fat check that. But the point is, you know, if you have a good facilitator that can literally bring the right people to the table at the right time, like make sure you have user meetings at the front end, right? Once you have a basis of design, Steve and I were talking about it today. You've got to make sure that you're you have a pointed agenda and you get the right people in early, just like we're starting to do, like again, we're bringing in you know, plumbing trades, mechanical trades, electrical trades in concept nowadays, with lean the lean approach. Um, we we've got to continue to do that, bring the technology fold to the table early, which is not just is the IT groups internally, it's also in some cases, again, with the aging issue and the rapid turnover and the revolving door, there are consultants out there that are out there, just like we help with representing owners to manage the project in its overall way. Uh, there's there's folks that can help augment where there's a short staff. IT facilities, gotta have the meetings, gotta have somebody that knows what it's gonna be like to sit in that desk. And again, like Steve said, it's it's very hard to operate a new building. It's even harder to have to operate a new building in an old building on two different systems with less people. So, yeah.

SPEAKER_01:

So I like like simple things, people like simple things, and let's keep this at a high level. And Steve, you alluded to one, but um for somebody who's embarking on this journey or starting out, or maybe they're again new to healthcare, what do you see? Steve, you talked about IT, but what are the gutches that you have frequently seen clients or systems make? And when I say gutches, errors, gutches is a good word. What are the common, what are the most common, what are some of the most common errors that you see are made and what people should avoid?

SPEAKER_02:

I think commissioning is a big one. I think, I think after, like you said, after you have the basis of design, you gotta get going with your commissioning agent, you gotta get going with your facility staff, your IT staff. I think equally as important is planning medical equipment and planning specifically medical equipment, uh imaging equipment. You had mentioned earlier, Steve. You know, if you have if you have specific imaging equipment, there's a whole regulatory workflow that needs to go along with that. That's an that's a gotcha moment. I don't know how many times you've had to race to Watertown to get an X-ray tube certified, and that takes a long time. Um, I think ultimately it's the gotcha moment happens when you put the project on tilt. And what what I mean by that, and we started on this, is if you're going in very, very quickly and you're trying to maintain budget, you're gonna have a hard time transitioning to operations. Well, you know, it's what do they say? You know, there's scope, there's schedule, there's budget. You can really try to get two out of three, but one of them has to give. And if it's something that is is tight on budget, um, and the scope is very specific, you gotta give the time on the front end. And otherwise, you're gonna need, if it's a fast job, you gotta bring in folks to help do the work we just mentioned, both post-certificate of occupancy and well before certificate of occupancy, and then again, all the way back into concept.

SPEAKER_00:

Another thing that I did reminded of when you uh in your discussion, Patrick, is and it seems like it it should be very basic and everybody should know this by now, but I still continue to see it, which is you need to involve a lot of the operational departments at your user meeting and in your project planning up front. I I don't know how many times I've seen folks ignore housekeeping. You know, meetings with your environmental services staff are key because quite frankly, a typical user group in a hospital will consist of nurses, maybe an administrator, and a couple of doctors, provide um care providers. And they don't really, a lot of them don't uh pay attention to how the waste gets out, how the things get in. The the primary example I'll use is the doctor who uh wants to show up in the OR, and all he knows is his instrument table is right there, and it's all set for him. You know, what happens before or after it got to that position is really not his mistress. He's he just wants to know that. So um, you know, I think uh getting all of those support operational uh departments involved very early is key. I know it sounds really basic, but I still see it not happening in a lot of the sounds. Why does it still happen, Steve? Uh couple of reasons. Speed to market uh is probably the primary one. Oh, I don't want to have all these user meetings. I don't want to, we know how to design this. Typically led by, you know, a physician or an administrator who has a physician background. Um you know, they they they have a a sense, as I said, that uh they know how everything operates. They should know how to do it. If you're trying to get a project done passed, the user meetings take time. You're dealing with people who may not understand floor plans, so you have to take the time to explain to them. Sometimes you have to do mock-ups, but you need you need to have all those folks involved. Supply chain has become increasingly critical. Um, where before it wasn't, you would provide them with a couple of storerooms and you size them adequately according to the guidelines and your buy. Not anymore. Supply chain, given the situation right now uh in the country uh post-pandemic, it's uh it's a critical one to have evolved uh throughout.

SPEAKER_02:

No, I couldn't agree more.

SPEAKER_01:

Um commissioning. You guys mentioned it. Do you find that clients don't commission critical spaces as well, EDs, O Rs? And and why, when you see folks not commissioning, why don't they commission?

SPEAKER_02:

What's their reason for it? Well, I'll I'll try to thread it with the conversation we just had, which is the human condition is not one that is additive. So I you know I say the cupcake analogy. All the time. A cupcake is just egg, sugar, flour, water, vanilla extract. How hard could it be? It only becomes hard when you have to come back from SUP and shop three times. And then you'll realize that some of those ingredients you didn't think were important are important for the uh the cupcake to rise, right? So I think ultimately, you know, commissioning is very similar, where you you will oftentimes, at least the human condition, I believe, is it's a budgeted item, it's been in a pro forma, it's set and it's on rails. And if you don't have it in the budget, oftentimes you just commission what's called the big ire, which is the air handling units and the chiller system. Right? And that is not commissioning with a capital C, what we like to say. That's that's all systems that are either critical to our life safety. It could be security, it could be generators, it could be equipment. I mean, commissioning is a bigger word than what we've evolved it into in our business. Um, it is not something where somebody just comes out with a checklist and he just says, Yep, that started up. All right, let's go to the next one. Or she says, All right, I need you to show me the sequence of operations. It needs to be thorough and it and it oftentimes they're they're engaged in the planning. So as early as you can get them in there at spec level, which is when they specify it, you want to have them in there because they're gonna help inform you that the security system may be tied to the cooling system, right? So all that work to get like an echo, you know, an economizer or something that can create savings for electricity and things, it may be tied to occupancy, which are tied to lighting switches. You don't always know, you've got to know what you don't know in the front end. And and I think, again, we see specifically on not hospitals, big hospital systems that do have a facilities team, but where you're in a you know a freestanding AD or a micro hospital or a or a surgery center, oftentimes, and I don't mean to say this like you know, developers are are very vital to getting funding and partnering to get projects completed specifically today. But at the end of the day, those those specific components for commissioning require not only bringing the commissioning agent on, but also the users we just discussed, and doing it very early. And you that that takes time. You'd rather do it during planning because everybody is under pressure, you know, when you're trying to get all the right permits and building card sign-offs, and you're worried about the deliveries coming through the front door and where to warehouse all of the booms and the stretchers and the beds. That is not the time to be thinking about what needs to be commissioned or not. Because it all works together and it's all getting interwoven with all the sustainability initiatives we have now to try to, you know, reduce the amount of electricity we're using.

SPEAKER_01:

Steve, how have you seen the approach to commissioning change over the years?

SPEAKER_00:

Uh I think that um it's uh more um uh in-depth than it has been. I think it is still unfortunately um mostly vendor-driven, which tends to put it in silos rather than uh sort of an overview and an integrated look at at uh how a facility actually uh functions.

SPEAKER_01:

So that's a really good point. When you say it's mostly vendor-driven, what does that mean?

SPEAKER_00:

I I mean generally you'll have commit uh commissioning around the specific systems that you have, and uh but what happens when you get training? The training is the part that's vendor driven, okay? So you'll have uh Phillips Bender come in and show you how to how to run their uh their particular uh cath equipment, right? But how that ties into other pieces of equipment that are that are there, how it ties into um you know the BAS system, any of that is is sort of ignored. It's it's actually more um even more critical when you're talking about you know mechanical systems and BAS systems, because they might be two different yeah, uh two different vendors there. So you've got training, you know, on the one end by the guy who put the air handling in and the other end by the guy who has the BAS system, but you don't have sort of uh, well, how do these work, how do these actually work together?

SPEAKER_02:

Yeah, I think just think of the general term for commissioning, right? You can commission our work, you can commission uh uh uh an aircraft carrier. It's a point in time where you're I guess you're giving the reins over, and you need to feel really comfortable with giving those reins over, right? And I think that's the piece that we've lost. We we now are just checking to make sure a piece of equipment functions and a certain group were trained, but that is after the fact. There's a lot of learning that goes into the planning. Planning in itself is a way to help educate folks on what they're actually doing.

SPEAKER_01:

If you want to be a guest on a future episode of the Healthcare Facilities Network, go to healthcarefacilitiesnetwork.com and let us know who you are and what you want to talk about because together we can solve this critical aging issue.