Risky Business – Common Risks Encountered on Healthcare Transition and Activation Projects

By: Ali Broders, PMP

Risks are an inherent part of any Transition and Activation project. The complex nature of new healthcare facility projects presents a variety of risks, both controllable and non-controllable, that organizations should assess and plan for along the way. At Yellow Brick, our team has helped activate more than 100 healthcare facilities across North America. Through our experience, we have encountered common risks to project success that often arise.


Recently, the top risk that is plaguing our projects is the inability to fill the number of required staffing requisitions in time for Day 1. Healthcare has been hit hard by staffing shortages. Many departments are already impacted by a large number of open requisitions in existing operations, and the expansion of services and/or increased footprint only exacerbates the pressure department leaders and the recruitment team feels to fill the open positions. Activating a new facility also demands staff time to complete the required orientation and training and fit-up activities in the new space, which requires creative resource planning to maintain operations in the existing facility while allowing staff to complete their assigned activation activities.

Mitigation Strategies: To help mitigate this risk, we recommend identifying the required positions early, then developing a hiring and onboarding plan with a timeline and critical milestones. The plan should include timing for posting open requisitions, recruitment, hiring, onboarding, and training. We suggest working with department directors/managers early to identify difficult-to-fill positions or those that require a long lead time to find the right candidates.

Some positions may require lengthy training before the employee is qualified to work independently in the department. There may also be certain positions that need to be hired during certain seasons when candidates are available, for example, immediately post-graduation. Ensure the hiring plan includes adequate lead times and build a buffer into your hiring, onboarding, and training timeline. Build float time into the schedule to cover any unexpected challenges or delays that may arise.

Develop a contingency plan in the event that all positions are not filled by the planned Day 1 Activation. Identify the minimum required staffing levels to support operations consider slowly ramping up departments by increasing the number of beds open on each unit as staff is onboarded. This risk should be tracked and closely monitored with metrics provided regularly on the status of open requisitions.

Equipment and Supply Delays

Another risk recently plaguing projects is equipment and supply delivery delays. Supply chain issues around the world have impacted all industries. Items that previously took a couple of months or less to procure can now take over a year. Some items we have recently seen increased procurement times on include automated medication dispensers, radiological devices, surgical instruments, printers, and even badge readers.

Mitigation Strategies: We advise identifying the required systems, equipment, devices, instrumentation, and supplies early, then reviewing the list with department representatives for validation. Typically, there is a significant span of time from design to the transition and activation period, so revisiting planned equipment with clinical end-users is highly recommended. We have utilized Tabletop Exercises as a method to review planned workflow and operations early in the transition and activation process to identify gaps that may not have been included of the original design but are now essential to support clinical workflow. Budget for the appropriate fiscal year so that items can be ordered early. If necessary, secure a contract with a warehousing company and have items delivered there if adequate storage is not available onsite.

Compressed Building Readiness Period

Another risk is also related to available resources. The activities required to ‘fit up’ or outfit the building with the required furniture, fixtures, equipment, devices, and supplies demand a great deal of staff resources. Often, due to construction delays, organizations make the difficult decision to compress the building readiness period to still maintain a targeted Day 1 Activation.  Compression of the schedule has a significant impact on the teams tasked with getting the space ready for Day 1. To learn more about the Building Readiness Period, click on the video below.

Mitigation Strategies: Develop a detailed project plan of the activities that need to occur, the sequence in which they must occur, and the resources required to complete each activity. Pull planning is a helpful method to evaluate the required activities for each department. For example, IT cannot deploy and install computers until the space has been cleaned and furniture is in place. If internal resources are not available to complete an activity within the required timeframe, evaluate the opportunity to contract a vendor specializing in the required activity.

When embarking on a healthcare Transition and Activation project, a structured risk management process is imperative. Risks should be anticipated as part of any project; therefore, we recommend implementing a proactive approach to identify, evaluate, and respond to risks. The early identification of project risks allows organizations to prepare well-planned risk responses in the event those risks are triggered.

For more information on risk management, please read Christina Olivarria’s recent blog article on risk and issues management.