Melanie Viquez, FACHE, PMP, EDAC

Activating a new healthcare facility is a challenging and high-stakes endeavor for administrators. The activation phase, where a building transitions from construction to full operation, demands precise coordination, thorough preparation, and flawless execution. This article outlines common challenges encountered during this phase and offers recommendations on how to effectively address them.

Common Challenges

• Fragmented Communication: Early engagement with diverse stakeholders is often lacking, leading to operational inefficiencies and overlooked details critical for clinical workflows. Without established communication channels, stakeholders may lean on unreliable sources of information, resulting in confusion and frustration.
• Procurement Bottlenecks: Delay in acquiring essential equipment and supplies can create cascading effects, potentially compromising activation timelines.
• Staff Readiness Gaps: Insufficient training and orientation periods can leave teams unprepared for Day 1 operations, directly impacting patient safety and care quality.
• Complex IT Integration: Implementing new clinical monitoring systems and EMR on Day 1 introduces a high risk of technical issues, integration failures, and operational disruptions.
• Activation Disruptions: Poorly executed move plans and a lack of stabilization strategies during activation phases can lead to operational downtime and heightened staff stress.

The Complex Journey to Readiness

Consider the case of a newly constructed hospital that recently completed its build phase. As the operational activation phase approached, the leadership team faced several hurdles:

• User Input Oversight: Departments such as environmental services and laboratory were not included early in the planning process. This oversight resulted in gaps in design, such as poorly positioned utility closets and equipment layouts. Additionally, system water drains were not thoughtfully placed, necessitating late-stage construction repairs.
• Procurement Delays: Critical medical equipment, including ventilators and imaging devices, faced extended lead times and supply chain disruptions, leaving clinical areas incomplete just weeks before opening.
• Training Challenges: Staff orientation and training schedules were compressed due to competing priorities, leaving gaps in knowledge about new workflows and technology systems.
• New Systems and IT Integration: IT budgets doubled due to staffing challenges, and there was pressure from leadership to adopt and integrate a lot of new technology, which created a strain on care providers.
• Activation Coordination: The facility underestimated the complexity of reusing equipment, and the level of coordination required for a phased activation. This oversight resulted in delays, increased stress during departmental moves, and disruptions in system testing.

Streamlined Strategies for Seamless Activation

Drawing from best practices and lessons learned, hospital administrators can address these challenges with a structured and strategic approach:

1. Comprehensive User Input:

• Solution: Establish interdisciplinary activation committees with representation from all departments, including clinical, non-clinical, and support services. Host iterative design and workflow sessions during the pre-activation phase to identify and resolve potential operational inefficiencies before construction is finalized.
• Example: In a recent activation project, frontline nurses and respiratory therapists collaborated on the design of a critical care unit, ensuring that equipment placements optimized patient access and workflow efficiency.

2. Procurement and Assembly:

• Solution: Develop a procurement timeline aligned with construction milestones. Assign dedicated resources to track lead times for all owner-furnished, vendor-installed items and secure vendor commitments early. Many items, such as carts and shelving, come unassembled and require space and teams to build.
• Example: For a hospital expansion project, a dedicated team managed a comprehensive procurement matrix to monitor the delivery of essential items such as shelving units. By securing assembly space and assigning a team to build and deploy these items, they avoided delays in material management distribution.

3. Methodical Training and Orientation:

• Solution: Design a training program that includes role-based simulations with new equipment and walkthroughs of the facility. Ensure staff have ample time to familiarize themselves with workflows and IT systems before Day 1 operations.
• Example: During the activation of a pediatric hospital, staff participated in scenarios- from patient admissions to emergency code responses- to build confidence in new protocols and layouts. They also used checklists to guide room readiness.

4. Managing IT Transitions:

• Solution: Consider phasing in or implementing IT systems in the existing facility first while narrowing the scope of features for the initial launch. Instead, create an IT roadmap that introduces changes incrementally, minimizing the risk of technical issues, integration failures, and operational disruptions on Day 1.
• Example: In a recent activation, the hospital phased in a new EMR system over several weeks. They started with the ancillary areas in the existing facility before extending it to the inpatient units. This staged approach allowed staff to gradually become familiar with the system. As a result, ancillary areas could effectively report to the clinicians, leading to a thus smoother integration into clinical workflows.

5. Seamless Activation and Stabilization:

• Solution: Develop a move and activation plan that includes go/no-go decision points, contingency plans, and real-time progress monitoring. After the move, establish a stabilization task force to provide ongoing support and address emerging issues.
• Example: A phased activation at a large urban hospital ensured each department’s readiness through regular huddle check-ins and debrief sessions. This approach minimized disruptions and allowed the facility to reach full operational capacity within two weeks of opening. They used online platforms to track progress in real time.

Hospital activation is a complex journey that demands meticulous planning, robust collaboration, and strategic execution. By prioritizing comprehensive user input, precise procurement, thorough staff training, and seamless activation strategies, administrators can ensure a successful transition to a fully operational facility.