Are you about start a renovation for a healthcare facility, but need to keep the mechanical systems running? This is a challenge that I’ve come across when working with several hospital clients. Keeping a hospital functioning during a renovation, while continuing to provide care to patients during construction, requires thoughtful planning and innovative solutions. You want to avoid disrupting the existing facility as much as possible.

Before starting a large renovation project, let’s look at things to keep in mind from an engineering perspective. I’ll explain my points using examples from a hospital renovation and expansion at the Brockville General Hospital, in Brockville, Ontario, Canada.

In fall 2020, the hospital’s Phase II Redevelopment Project and the new Donald B. Green Tower opened. The inpatient tower provides care teams with the up-to-date facilities needed to deliver advanced medical care. The project merged services across three existing sites onto the hospital’s main campus. Our team provided full engineering, architecture and interior design services.

Our team brought the hospital’s existing infrastructure up to what’s expected in a modern healthcare facility. We made sure to provide resilience and sustainability for the new tower. We saw that the mechanical and electrical systems were future-focused and energy efficient.

Working with our client, we maintained all the infrastructure, such as HVAC, electrical, medical gas, and ancillary systems, to keep systems running during the project. Here are four key points that helped us accomplish this:

Figure Out What’s There

First things first: You need to determine what you have. Look at the existing infrastructure. What systems are going to be affected by the renovation? If you’re planning to replace part of a healthcare facility or build an addition, there’s a good chance that the existing parts of the facility are going to be impacted.

What do you do? Explore dusty storerooms. Unfurl rolls of old drawings. Dive into the history of the hospital. Be aware that you may not even find any drawings—or the drawings you do find could be inaccurate. In that case, it’s vital for the engineers and hospital facilities team to walk around the site and explore the operational systems. Talk about expectations around operations, maintenance, quality and redundancy.

These walkthroughs also produce little nuggets of information. For example, you may find equipment that doesn’t exist on the drawings or that hasn’t been used for decades.

I love that process of discovery that comes with learning about a building’s backstory. And while it’s important for any type of renovation, it’s especially vital for a healthcare setting, because these types of buildings tend to be more complicated.

At Brockville, we invested time early in the design to map out the existing systems. We took the time to understand the connections and inter-dependencies. The original hospital was built in multiple phases over many years—going back over 70 years. So, the design and construction team spent time on-site getting to know the multiple layers of systems that had amassed over the decades. We then spoke to the facilities team to validate what was there.

Determine How You’ll Mix the Old and the New

A key challenge in any renovation is the interface between existing and new systems. How are you going to stitch the old and new together? And how can you approach the integration in a way that doesn’t greatly impact patients and care teams?

It’s wise to deal with this challenge in a systematic way. Look at each system. Discuss the scope of what you’re planning to do. Examine the impact on operations. Consider the amount of notice that a hospital department needs before you work on a system. Think about the maximum amount of time that a system could be unusable. Consider what’s required for staging areas, decanting and swing spaces

Set up dialogs between the hospital, design team, and contractor early on. It’s important that everyone feels like they’re on the same page, and that you have mitigation strategies set up. If you need to shut down an oxygen tank to move it—a major disruption for a hospital—you need to all agree on the timing and backup plans. This might include bringing in temporary oxygen cylinders, for example.

Setting up these criteria early helps the contractor. It creates clarity. That way, the contractor knows what protocols and procedures need to be followed if they want to interrupt systems. They know that they can’t shut off the heating system in the winter. They’re aware of timing limits around key spaces such as operating rooms. For example, the hospital may determine that ORs can only be out of commission for no more than 48 hours and only on weekends. The hospital may require a minimum amount of notice if emergency diversion to other facilities is needed.

For the Brockville project, we created a shutdown-matrix tool to inform the hospital and the contractor what systems could be suspended or briefly shut down. We also designed temporary infrastructure, including containerized boilers, fuel storage and electric generators. This made the changeover between systems prior to and after construction seamless. It also meant the new installations could be built, tested, cleaned, and disinfected prior to bringing them fully online. This reduced the risk of downtime during the changeover.

Get the Phasing Right

When it comes to these sorts of renovation projects, I think a lot about phasing. Many projects must be done in multiple, smaller stages, rather than one single, standalone project. How can you best manage the various phases of the project?

For larger projects, phasing reminds me of the sliding block puzzles that I used to play as a kid. You can only move one block at a time in your quest to arrange 15 numbers in chronological order or to form a picture.

Build in Redundancy and Resilience

During a renovation, look for chances to add future flexibility, redundancy and resilience to the existing systems. That makes it easier for future upgrades. It may be cost effective to add extra elements now. For example, you can install a pipe from the old building to a new building. The disruption will be less in the middle of a renovation, compared to coming back and trying to install that pipe later.

On the Brockville project, we made sure that both the building and site design allowed for future flexibility and long-term expansion. We tried to build in redundancy and resilience where it made sense. For example, we provided connections between old and new hospital systems to allow the new to back up the old—creating redundancy where there was none previously. 

So, don’t just focus on the current renovation. Plan for the next decade, with one eye on the master plan, so that it’s easier to come back and extend systems later. Access for future equipment maintenance and replacement also needs careful planning.

I’m intrigued by the challenge of keeping mechanical systems running during any building renovations. I’m looking forward to the next opportunity. I hope my thoughts help prepare you for some of the interesting engineering puzzles hiding in your next renovation.

David Clark, is a principal at Stantec. As the practice leader for its Buildings Engineering group in Southwest Ontario, Clark is an award-winning mechanical and electrical engineer. He champions the expression of integrated design in the teams he leads and delivers holistic solutions. He is a member of the American Society of Heating, Refrigerating and Air-Conditioning Engineers and a Chartered Institution of Building Services Engineers fellow.