Avoid construction nightmares by taking charge of the process and setting rules

Some disruption inevitable, but careful planning can make it bearable

Sooner or later, your emergency department will be the site of some type of construction project, whether it is a full-scale renovation or a relatively small repair job. If you think your ED is hectic now, just imagine a bunch of construction workers tearing out walls with sledgehammers and sawing lumber while your physicians and staff try to continue with patient care.

That’s what the staff encountered most days when Pocono Medical Center in East Stroudsburg, PA, renovated its 18-bed ED into a 36-bed department two years ago. Pete Favini, MD, medical director at Pocono, says the yearlong experience was a real challenge for everyone working in the ED.

"It is said that surgery is like working on a car with the engine running," Favini says. "Working in an emergency department under renovation is like working on that car while it is racing at full speed."

Not a pretty thought? Some of that scenario always is going to be unpleasant, but it doesn’t have to be a complete nightmare, says Jon Huddy, managing principal of FreemanWhite, a firm in Charlotte, NC, that specializes in health care facility design. Huddy has overseen many ED construction projects, and he says there are specific ways to keep the disruption to a minimum.

Favini agrees and says planning and ingenuity are necessary if you are going to make the best out of a construction project. You might have to come up with novel ways to work around the disruption, but he says you can make the experience a positive one in the end.

"At one point, we were working out of two separate areas because of the construction, and our ED staff communicated by walkie-talkies," Favini continues. "Renovation and construction are great opportunities for process change for ED management and a wonderful pickup for staff morale once you get finished."

Most likely, your hospital’s facilities department will be in charge of finding the contractor and working directly with that company. Thus, it is important for you to convey all of your concerns to the facilities department and establish good communication, Huddy adds.

Start early if you want to keep your ED running during the construction, he explains. When the architect and engineers are putting together a plan, they must incorporate phases of construction and come up with alternatives to normal operating conditions, such as temporary entrances for ambulances and other patients. Don’t wait until all those plans have been made to get involved, Huddy says.

Once construction starts, make sure you understand who is in charge of the construction. For starters, it’s not just a single construction company. There may be one company that your hospital contracted with, but that company then hires other subcontractors to do specific jobs. This arrangement matters when you’re trying to maintain control of the department.

"If you want construction halted because you have a trauma, it’s not as easy as turning to the first guy you see hammering nails in the wall and telling him to stop everything," Huddy continues. "That guy may be a subcontractor with no authority at all. You need to know who is in charge of the job site and deal directly with that person." Planning can make all the difference, he says. For instance, make sure there is specific language in the contract that allows the ED manager to temporarily halt construction. The contract should specify that you can, within reason, halt all work for short periods.

"If that language is not in the contract, every time you stop work, they can say you have caused them a delay and charge the hospital extra money over and above the contract," Huddy explains. "And you can give them excuses for falling behind schedule."

Savvy contractors will charge more for a contract that allows you to stop work temporarily, but he adds that is a fair exchange and better than paying penalties.

One potential problem with construction projects is having so many nonhealth care personnel in your ED. With the facilities department and the contractor, you should establish what is acceptable behavior by the construction crews. Can they play music while they work? What type of clothing is acceptable? Can they curse? Construction workers these days don’t all fit the boorish stereotype, but many also aren’t used to working in a clean environment such as your ED.

"You have to be careful if you get a contractor who hasn’t done work in a health care setting before," Huddy says. "If they’re used to working in a half-finished office building with no one else around, you might not be happy with how they act in your ED."

But is it reasonable to think that you can control the behavior of construction workers? Absolutely, says Bob Buckner, head of the construction department at FreemanWhite. Don’t just assume that you have to put up with a loud, rowdy crew until the work is done.

"Our contracts usually require acceptable dress that prohibits shorts, T-shirts with offensive language, and working shirtless," he says. "We also specify things like the hospital being a smoke-free campus, the use of embarrassing language, or harassment. It’s entirely reasonable to expect a certain level of decorum from the contractor, and if they can’t meet that standard, you’re dealing with the wrong contractor."

You also should specify how you expect the construction crews to leave your ED when they go home for the day. Some mess is to be expected, but you can require that certain areas be cleaned, tools put away, and no hazards be left behind. (Infection control will be involved with the construction planning as well and will have their own requirements, such as sealing off areas with plastic film.) "It will be a tough experience, but you can have very high expectations of the people who will be working there," Huddy says.

Though you must exercise control, you shouldn’t look at the construction crew as an invading army, he stresses. To the contrary, he encourages the ED manager to introduce the crews to the ED staff and develop some rapport. You’re going to be working side by side for a while, so things will go more smoothly if you know each other’s names.

"You can have a lunch with the contractors before they start so that everyone knows the name of the guy who’s hammering on the wall," Huddy says. "It sounds kind of hokey to have a big picnic with name tags and all, but it really does help."

Patients tend to take construction in stride, he adds, but staff can be a different matter because it interferes with their daily surroundings and lasts a long time. Huddy says he has seen success with letting the ED team get involved with some of the demolition during the project.

"Letting a nurse or physician take a few swings with a sledgehammer can be a fun way to establish camaraderie and participation in the project, as opposed to just feeling that the contractors are in the way all the time," he states.

Sources

For more on surviving construction in your ED, contact:

Jon Huddy, Managing Principal, FreemanWhite, 8001 Arrowridge Blvd., Charlotte, NC 28273. Phone: (704) 523-2230. Web: www.freemanwhite.com.

Bob Buckner, Principal, FreemanWhite, 8001 Arrowridge Blvd., Charlotte, NC 28273. Phone: (704) 523-2230.

Pete Favini, MD, Medical Director, Pocono Medical Center, 206 E. Medical Center, East Stroudsburg, PA 18301. Phone: (570) 421-4000.