Facilities – Building Project / Construction

Service: Risk Management
Subject: Facilities
Setting: Property

Building Project / Construction issues can lead to safety risks for patients, staff injuries, loss of operations and damage to hospital property/equipment. These issues include construction project design and delays, aging infrastructure, funding (planning, delays, shortfalls) and inadequate project management and policies for contracted services.  The risk of asbestos present in some areas of the hospital, and the risk of the spread of infection to vulnerable patients are also included in this risk profile. This document contains information entered by HIROC subscriber healthcare organizations (acute and non-acute) in the Risk Register application to help you in your assessment of this risk.

Ranking / Ratings 

  • Likelihood – average score 3.50
  • Impact – average score 3.50

The Risk Register allows for risks to be assessed on a five-point likelihood and impact scale, with five being the highest.

Key Controls / Mitigation Strategies

  • Strategic planning and budgeting to sustain service delivery
  • Policies and procedures (e.g. Human Resources, Facilities) to:
    • Appropriately manage contracted services for construction and equipment maintenance
    • Clarify the requirements contractors have to meet when working on hospital property (e.g. contractor credentialing prior to starting work, required expertise, certificates, WSIB coverage, professional liability insurance)
  • Ongoing building envelope failure assessments and investigations with experts to identify potential problem areas and understand impact (e.g. asbestos flooring, potential mold, locations of heat loss, air leaks at windows)  
  • Consider alternate / innovative models of care and volumes / types of programs and services: 
    • Maximize utilization of existing spaces 
    • Create potential new operational and clinical spaces (e.g. adding a portable on site)
    • Explore opportunities for innovative care models, integration and partnerships 

Redevelopment / redesign / renovation plans

  • Develop financial strategy for redevelopment (engage Hospital Foundation if appropriate)
    • Capital budgeting for redevelopment plans, anticipated maintenance and utility costs (e.g. cost increases)
    • Annual capital planning for major equipment plans
    • Ensure regular monitoring and reporting processes are in place  
  • Engage and partner with key stakeholder groups
    • Regular reviews with key project stakeholders
    • Formal government and community engagement plan
    • Ongoing work with government to ensure project submissions are aligned and in compliance with future directions and priorities 
    • Consultation with community stakeholders during the planning process in order to minimize the impact of the redevelopment on the neighboring community (e.g. secure third party parking)
    • Ongoing discussions for potential partnerships/collaboration to secure decanting capacity and/or other sites
  • Detailed risk management plan and risk mitigation strategy maintained throughout the entire project
    • Extensive due diligence investigation of potential construction issues 
    • Ensure backup services in place
    • Develop active safety program, enforcement mechanisms including potential consequences for non-compliance
    • Provide regular training to increase awareness / knowledge of rules and regulations, construction-related health and safety issues, including infection control procedures

Project management planning 

  • Clearly define project scope, operational requirements, objectives, and timelines
  • Identify, in advance, potential construction issues and delays 
  • Plan, in advance, to minimize disruptions and to ensure immediate response 
  • Continuous communication between construction and site staff
  • Involve experts where necessary, work closely with construction team, consultants and contractors, and clarify responsibilities
  • Monitoring processes, including regular project status reports 
  • Contingency plans (e.g. alternate domestic water supply to building)
  • Accountability measures developed
  • Project closeout to ensure project deliverables are transitioned to owners
  • Building commissioning

Health and Safety Program

  • Prime contractors:
    • Responsible for maintaining the safety on the construction site
    • Knowledge of and compliance with relevant legislation
    • Set up an effective system to ensure everyone on the work site meets all health and safety obligations
    • Coordinate, organize and monitor the work on the project
    • Ensure reasonable and practical precautions are in place to effectively control safety and health hazards
    • Implement a safety and health program that meets statutory requirements
    • Compliant with the organization’s/facility’s health and safety requirements 
    • Work together with the organization’s/facility’s health and safety representatives to address any health and safety related issues / concerns
    • Report, investigate, and document injuries, incidents, and near misses 
  • Contractors:
    • Determine responsibilities in relation to the health and safety of all workers affected by their activities in the workplace
    • Cooperate with the prime contractors, other contracted employers, the Workplace Health and Safety Committees, and the Manager, Workplace Health and Safety in protecting the safety and health of everyone in the workplace
    • Conduct their work in a way that does not endanger anyone’s health and safety
    • Know of and follow the applicable parts of the contractor’s health and safety program
    • Knowledge of and compliant with the legislation
    • Report, investigate, and document injuries, incidents, and near misses

Monitoring / Indicators

  • Construction projects status reports, including financial status
  • Building envelope infrared thermography inspection results
  • Construction site inspections (e.g. visual inspections) 
  • Project risk register maintained by the project’s steering committee (e.g. monthly status reports, including decisions log, action plans, etc.)
  • Accreditation results
  • Patient, family and staff satisfaction survey results (during construction projects)
  • Patient huddles to identify any concerns from the patient perspective
  • Staff feedback survey results
  • Staff and patient safety incident reports 
  • Workplace Safety and Insurance Board (WSIB) claims
  • Monthly Occupational Health and Safety (OHAS) environment audits (e.g. environmental risks)