In healthcare planning, design, and construction, document coordination is where projects quietly succeed or quietly fail. This article is for healthcare owners, owner’s representatives, architects, engineers, and construction managers working through the design phase of a complex capital project. The take-away: clarify roles across the four key stakeholders during design and treat document coordination as a creative, team-owned process, not a back-office task.

In healthcare planning, design, and construction, project team members should always be mindful of the project’s intended impact rather than just the technical aspects of project delivery. The project aligns with a specific strategic and functional purpose, such as improving patient care, enhancing the well-being of healthcare staff, or optimizing operational efficiency. The project's design phase is the critical time when the team translates these objectives into the building's physical design. While the architectural team carries much of the responsibility during the design phase, many of the most successful project’s stem from collaborative, interdisciplinary teams where project members know when and how to contribute.

So let’s consider the key stakeholders involved during the design phase of the project—the owner, the owner’s representative, the architectural team, and the construction facilitator—and how their roles and expectations can contribute to the design phase and overall project success:

The owner’s role during design

The owner should endeavor to have a project champion who attends all meetings, has decision-making abilities, and can communicate directly with all end users and department heads. The owner needs to be diligent about timelines and budgets while keeping the overall project program and objectives needs in mind. As the project evolves, changes are inevitable but get substantially more expensive as the timeline progresses. It is understood that the owner has many other responsibilities they are dealing with outside of the project, and the team must be aware and mindful of these constraints.

The owner’s representative role during design

The owner’s representative is an extension of the Owner to help facilitate decision making and manage the daily project schedule activities to provide for executive leverage. The owner’s representative will work daily with the project team to ensure that team members required to address any given topic are aware of and are given ample time to address accordingly. They will collaborate with all team members to disseminate information with the team, key stakeholders, and the community. They will coordinate meetings with the Authorities Having Jurisdiction (AHJ) and develop with the Owner the enabling activities and strategy to support successful delivery once design is complete. The owner’s representative can look at the overall project and fill gaps where needed, maintain schedule and budget, ensure that the owner's requirements are being met, and keep the entire project team focused on the end goal.

Architecture & Engineering (AE) Team: The AE team has the toughest assignment during the design process. They must assimilate all information directed towards them, including verbal directions, and put them to paper. The AE team must ensure all their team members are hearing the same things and getting all design criteria coordinated on the working documents. Again, changes are inevitable, but collaborating with the entire team reduces the potential for scope gaps and mistakes. The AE team is tasked with creating the documents—the final product—that is presented to the owner and used by the entire team. The architect should be completely transparent with the team if they are delayed. If more time is needed to complete a specific deliverable, whether due to a delay in decision making, AHJ approvals, a project delay brought on by unforeseen circumstances, or an internal workforce delay, open communication will help inform the team and determine how best to work around it. It is better to have complete documents rather than risk delays in the project budget and schedule due to a lack of coordination and thoroughness for all parties to respond to.

The construction facilitator and pre-construction partner role

The design and engineering documents produced during the design phase are critical to establishing a solid foundation for the project. These documents ensure that the project team stays aligned, safeguarding the project's impact, budget, and timeline. Design documents clearly define the requirements, bringing the conceptual design to reality by detailing the civil, architectural, structural, mechanical, electrical, IT and plumbing solutions. Once the owner approves the design development package, changes to the drawings should be limited to comply with construction or code requirements to minimize cost impact.

Coordinating design documents presents an opportunity to innovate by leveraging the principles of creative problem-solving across the entire project team—the owner and/or owner’s representative, architects, engineers, and construction professionals. Project team members should be wary of working in silos rather than tapping into the collective experience, expertise, and perspectives of the broader project team. All team members should have a sense of ownership of and responsibility for the design documents, just as they should the project’s overarching vision and mission. Team members should proactively ask the right questions at the right time to ensure the documents are complete and sufficiently detailed. Taking these steps can help avoid problems down the road and reduce the tendency to point fingers, or worse, delay the project.

Four elements of a collaborative document coordination approach

A collaborative approach to document coordination during the design phase could involve the following elements:

1. Collaborative Project Team Workspace Design: The coordination process can benefit from utilizing collaborative, live workspaces that facilitate effective communication and idea exchange among the project team. These workspaces can enhance the efficiency of document coordination and foster a culture of creativity and innovation within the team by creating a shared sense of place and community around the project.
2. Design-Thinking Principles: Infusing the design process with design-thinking principles can enable engineers and designers to co-create documents that meet technical requirements and address user needs, usability, and the overall experience of the healthcare facility. A human-centered approach can lead to more cohesive and impactful coordinated documents.
3. Agile Project Management: Adapting agile project management methodologies can inject flexibility and responsiveness into the coordination process. This can facilitate iterative document refinement, rapid problem-solving, and continuous improvement, ultimately leading to more dynamic and effective design and engineering coordination.
4. Impact-Driven Engineering: Aligning engineering efforts to significantly enhance healthcare delivery can be a driving force behind the coordinated documents. This involves seeking innovative engineering solutions that improve patient outcomes, optimize operational efficiency, and enhance the overall healthcare environment.

By synthesizing these diverse elements, the coordination of healthcare design and engineering documents can evolve from a purely technical endeavor to a creative, purpose-driven process that aims to maximize the potential impact of the healthcare facility on patients, staff, and the broader community.

The deliverables list in the attached appendix can help ensure expectations are aligned around the level of detail required for each set of document drawings and, ultimately, a better outcome with coordinated documentation.

Wade Milligan is a Regional Vice President with Hammes Healthcare. He has more than 30 years of experience in healthcare facility development, including large-scale hospital expansion and renovation projects. His experience as a business owner, general contractor, and owner’s representative brings unique strengths in developing optimal design and construction solutions for healthcare development projects.