Facilities – Building Project / Construction

Service: Risk Management
Subject: Facilities
Setting: Property
Type: Risk Profiles

Building project / construction issues can lead to safety risks for patients; staff and visitor 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.

Key Controls / Mitigation Strategies

  • Internal Policies and Processes:
    • Policies and procedures (e.g. Human Resources, Facilities) to/for:
      • Appropriately manage contracted services for construction and equipment maintenance
      • Clarify contractor requirements when working on hospital property (e.g. contractor credentialing prior to starting work, required expertise, certificates, Workplace Safety and Insurance Board (WSIB) coverage, professional liability insurance)
      • Off-site storage  and security
    • Hospital Capital Planning and Policy Manual
    • Master plan for building and infrastructure
    • Capital planning process and long-term plan for anticipated infrastructure needs 
    • Project priority setting and harmonization across organization 
    • Continuous risk identification and prioritization process for infrastructure upgrades
    • Committees and associated approval structure
    • Strong project management governance including senior leadership accountability
    • Robust process for submission and oversight by committee/board
    • Infrastructure and facility align with the organization’s strategic priorities
    • Safety and security of staff and Patients/Residents/Clients are always at the forefront when making decisions related to capital planning and equipment purchases
    • Inventory of equipment and infrastructure assets maintained
    • Ongoing building envelope failure assessments with experts to identify potential problem areas and understand impact (e.g. asbestos flooring, potential mold, locations of heat loss, air leaks at windows)
    • Inspections to identify potential problem areas (e.g. fire inspections, infrastructure risk assessments, life safety assessments, environmental assessments, etc.)
    • 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 
    • Outsource services to meet Accreditation standards related to equipment inspection
  • Funding / Budget:
    • Strategic planning and budgeting to sustain service delivery
    • Continuous monitoring of available funding and budget
    • Develop financial strategy for development/redevelopment (engage Hospital Foundation if appropriate)
      • Capital budgeting for development/redevelopment plans, anticipated maintenance and utility costs (e.g. cost increases)
      • Annual capital planning for major equipment plans
    • Foundation/Community fundraising role
    • Fundraising plan
    • Applications for grant funds
    • Insurance (building/construction)
  • Stakeholder Engagement / Communication:  
    • Regular reviews with key project stakeholders
    • Extensive user group consultation process ensures that users are engaged throughout operational readiness and move-in planning/implementation
    • Infrastructure renewal program  
    • Strong relationship with the Ministry
    • 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 to minimize the impact of the development/redevelopment on the neighboring community (e.g. secure third-party parking)
    • Engage with engineering firm to design long-term solution
    • Establish agreement with potential land donors 
    • Ongoing discussions for potential partnerships/collaboration to secure decanting capacity and/or other sites
    • Internal and external communications plan/strategy (e.g. external website)
  • Project 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 
    • Mandatory stakeholder meetings and sign-off during project planning phase
    • Construction safety plan
    • Involve experts where necessary, work closely with construction team, consultants and contractors, and clarify responsibilities
    • Hiring experienced consultants
    • Contingency plans (e.g. alternate domestic water supply to building)
    • Review of code grey outage to mitigate risk for loss of backup power
    • Accountability measures developed
    • Space reallocation plan (including off-site storage plan)
    • Detailed risk management plan and risk mitigation strategy maintained throughout the entire project
      • Project risk identification and controls
      • 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 Execution:
    • Ensure regular monitoring and project status reporting processes are in place
    • Continuous communication between construction and site staff
    • Expertise and bandwidth of staff to supervise contractors and hold accountable for deliverables
    • Effective project management through completion of construction and stabilization post-occupancy
    • Review of construction documents and ongoing participation and support during capital project construction
    • Tender documents specify processes for the review and approval of all changes
    • Fix issues as identified (strategically targeting updating when we are doing other work in the area) 
    • Advocating for approval of each stage submission
    • Work with clinical teams to identify possible alternatives for supply chain shortages discovered during ordering
    • Expanded hours of operation
    • Comprehensive user technology instructions/training ensures that occupants are well prepared and supported during operational readiness and move-in process
    • Operational readiness and move-in team dedicated to communicating and managing issues leading up to occupancy and post-occupancy periods
    • Project closeout to ensure project deliverables are transitioned to owners
    • Building commissioning
  • Contractor Responsibilities:
    • Primary 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
      • Submit detailed construction schedule
      • 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: 
    • Key milestones achieved/missed
    • Budget review/tracking
    • Final cost vs. initial contract value
    • Schedule review/tracking
    • Final time duration vs. initial time estimated
    • Earned value analysis
  • Building envelope infrared thermography inspection results
  • Construction site inspections (e.g. visual inspections), toolbox safety huddles 
  • Project risk register maintained by the project’s steering committee (e.g. monthly status reports, including decisions log, action plans, etc.)
  • Accreditation results
  • Land transfer status
  • Patient, family and staff satisfaction survey results (during construction projects)
  • Patient huddles to identify any concerns from the patient perspective
  • Workplace Safety and Insurance Board (WSIB) claims
  • Monthly Occupational Health and Safety (OHAS) environment audits (e.g. environmental risks)
Date last reviewed:
This is a resource for quality assurance and risk management purposes only, and is not intended to provide or replace legal or medical advice or reflect standards of care and/or standards of practice of a regulatory body. The information contained in this resource was deemed accurate at the time of publication, however, practices may change without notice.