Many healthcare systems are grappling with the combination of aging hospital infrastructure, evolving quality and safety standards, and technological advances in clinical practice. Additionally, healthcare entities must balance these upgrade requirements with limited budgets while also considering future growth. All of these variables can lead to a plethora of options for facility improvement. 

Infrastructure design assessments provide critical information to assist in the decision-making process for healthcare campus improvement projects. Along with offering concise scope-of-work expectations to enable accurate pricing and construction schedule estimating, assessments help owners confidently plan projects to renovate, maintain, and expand their facilities, reducing risk and enabling efficient project delivery.

Why Perform a Design Assessment?  

Ideas that seem simple may not be so straightforward once all aspects of a project are studied. Adding a second MRI machine next to an existing one is simple in concept, but if it wasn't planned for in the initial design, it might require extensive modifications. A design assessment can help owners understand facility constraints and possibilities before making a significant investment in upgrades. 

Design assessments are reports developed by engineers and architects to present the scope, risks, and potential costs of construction projects. The final report includes recommendations on design options and infrastructure upgrades, any limitations on the project scope, and project elements that are optional vs. required. They have a relatively short timeline, providing a quick overview of the road ahead.   

The main advantage of these reports is that they highlight risks, particularly in relation to structural, mechanical, electrical, and piping (MEP) components. They can identify existing infrastructure that lacks adequate capacity for a new function, extensive upgrades needed to support new equipment, or program requirements that don’t fit within the available floor space. By identifying potential issues early, a technical foundation can be established, allowing for more informed planning decisions.

This early understanding of existing conditions also leads to one of the most valuable outcomes of a design assessment: more accurate project budgeting. The design professional’s findings and recommendations enable the general contractor or cost estimator to prepare a more accurate cost estimate, rather than a simple cost-per-square-foot value. The owner can then review these estimates with a clearer understanding of project requirements, potential constraints, and available options.

Beyond improving planning and budget accuracy, design assessments can help minimize disruptions to ongoing operations by identifying optimal locations requiring fewer upgrades. In one project, a small infrastructure assessment reviewed 10 areas within an operating hospital to identify a suitable location for the replacement of a critical Category 1 medical air system. Because the existing mechanical room lacked available space, the equipment needed to be placed elsewhere in the hospital.

In addition to evaluating MEP and structural requirements, the owner considered the impact of repurposing program spaces from existing departments within the facility. Ultimately, a storage area was chosen for its proximity to the mechanical room, which limited infrastructure modifications, minimized disruptions to departmental operations, and reduced project costs.

When is an Assessment Needed?

Design assessments can cover a range of project sizes and types, from tenant improvements to the relocation of a program space to a new building or addition. Owners should engage assessment teams when they want to identify:

• The most cost-effective program for an unused area of the facility
• Required upgrades for replacing infrastructure equipment
• Ideal locations for new process equipment
• Required upgrades when renovating an older area of the facility
• Options for replacing equipment vital to facility services that cannot be offline

Design assessments are also an essential part of a campus master plan, which provides a high-level overview of the entire site, including the overall layout of campus buildings and the location of critical utilities. They can provide insight into sections of the campus to help guide decisions on future projects and campus growth.

For example, a master plan may include converting an existing area of the campus to a new program type. The design assessment can identify potential room layouts, determine an exiting strategy, confirm existing MEP infrastructure capacity, and identify any specific MEP systems the new program might require. This allows the master plan to determine which program types are suitable for the area.

What Does an Assessment Involve?

Before beginning an assessment, the project scope must be defined. This scope definition often includes a list of the required program space and functions, required infrastructure redundancy, allowable space shutdowns, and budget. After the scope is understood, consultants research relevant codes and standards and gather information on the existing facility. 

An essential part of the assessment process involves consultants reviewing record drawings and construction as-builts and walking the site. Drawings from previous projects may be unavailable or out of date, as renovations can occur without documentation. Site investigations are essential to determining the actual architectural and infrastructure layout of the space. 

It is also critical to develop an understanding of actual operating conditions in the space. A preliminary testing and balance (TAB) report and electrical panel metering can provide essential information on the capacity of existing systems. Interviewing facilities personnel can provide valuable insight into how the systems are operating and where there might be deficiencies. Delaying the pre-TAB and electrical metering may reduce the cost of the assessment but often results in greater cost during design.

The existing conditions are reviewed against new program requirements and any new code and standards requirements. Working closely with the owner, the design assessment team then develops narratives and sketches outlining the required changes for each system and offers any available design options. The price estimator then utilizes these documents to develop the estimated project budget. This budget is folded into the final report by the assessment team to provide a complete package for the owner.

Recognize the Value of Early Design Assessments

Healthcare systems must weigh numerous factors when undertaking construction projects at existing facilities. Well-executed design assessments provide owners with critical information needed to make informed, cost-effective decisions and enhance overall project delivery, ensuring that projects meet schedule and budget expectations.

By pinpointing infrastructure constraints and evaluating multiple design options early in the planning process, assessments reduce uncertainty and prevent costly surprises during design and construction, allowing organizations to invest confidently in the future of patient care.