Commonly Overlooked Hospital Construction & Renovation Costs

Hospital project owners and administrators often face expected hospital construction costs and ancillary project costs. It’s important to take into account the seemingly incidental and often overlooked ancillary costs of a project that can break budgets and lead to delays.

Whether renovating, adding on, or building from the ground up, the following unique requirements and considerations for healthcare facilities can easily result in missed details and mounting costs if the project isn’t properly managed.

Disruption of Operations

When renovating or adding on to an existing facility, project owners need to expect and account for potential disruptions for staff. While construction may technically take place on the 4th floor, for example, adjacent floors and departments will likely be impacted during certain construction phases. There may be times when a floor or zone will need to temporarily shut down to tie in plumbing, electrical, and other systems.  

Another hidden cost is lost productivity for displaced staff who need to adjust to working in another location, as well as the costs of relocating patients. Not planning and accounting for these disruptions as part of the construction process will result in rising tensions and labor costs, and may even delay a project. 

Involvement in Design Phase

The preconstruction planning and design phase of a project is potentially the most important aspect of minimizing cost overruns. While it’s common to have architects, engineers, contractors, construction managers, and project owners involved in developing a detailed plan, there are other critical stakeholders who need to provide their input and perspectives to avoid changes down the road: those who will actually use the facility. 

Lead nurses, doctors, and other physicians should be involved in the planning phase to provide input on workflows, traffic patterns, design elements, and more. It’s not uncommon for a project to be near completion and to have physicians raise concerns about the placement or configuration of a nurses station, for example. Ensure that all stakeholders are in agreement so things don’t need to be changed later.

RELATED: Hospital Construction & Renovation Examples

Infection Control Measures

Contractors who are experienced in working in hospital settings have strict protocols for minimizing contamination outside their construction areas. Even then, it may be difficult to completely eliminate dust from escaping into corridors or surrounding areas.

Project owners sometimes overlook the need to have more frequent cleanings and may even need to hire a full-time person for this task, depending on the scope of the project. They’ll often assign dedicated safety personnel to routinely measure particle counts outside construction zones as well. These labor costs can add up if not planned for early on.

Technology Integration

Advances in technology have surpassed what anyone could have imagined a few years ago. Planning for current IT needs is challenging enough, let alone trying to anticipate where technology may lead in the future. Once again, it’s critical to get people with the right expertise involved upfront to assess what wireless technology and other connections need to be installed and/or integrated with existing legacy systems.

Another overlooked cost is the expense of having new or existing equipment upgraded or relocated. Will your facility managers move it or set it up? Will it require an authorized vendor for installation to maintain any warranties? It’s these types of seemingly minor decisions that can lead to expensive consequences if not accounted for.


Another aspect of technology is the installation and switchover of new security systems, especially for renovation projects. Security systems are often integrated with door hardware, sensors, and magnetic locks, and many older systems are outdated. There will likely be times when systems need to be disabled when construction crews frame and hang doors.

It may take as long as 12 weeks to get a security system ordered and installed and, if timelines aren’t properly coordinated, a hospital may need to hire security guards to remain stationed near entries to secure areas, such as maternity wards and other restricted access zones. If fire detection systems are temporarily disabled, someone is typically hired or assigned to conduct fire watch inspections, continually patrolling the facility to watch for abnormal conditions when contractors aren’t on site.

Disposal of Building Materials

Another cost sometimes not considered up front is how construction material debris will be disposed. Seemingly simple factors can easily escalate these costs. Will debris be tossed down an exterior shoot and down to nearby dumpsters, or will workers need to take wheelbarrows of debris through corridors, down elevators, out the door, and away from the building? The labor costs for the latter will be significantly higher. Some hospital administrators don’t want unsightly dumpsters near the building, adding yet more costs for hauling debris across campus.

Compliance & Permits

It’s frustrating and costly when an inspector flags something that doesn’t meet code, requiring changes at the 11th hour and delaying occupancy. Working with local zoning authorities and state inspectors to review plans ahead of time helps minimize potential changes.

For renovation projects, a variance might need to be filed to allow existing systems or structural features to remain in place, and alterations will likely be required to bring them up to code. Understanding how permitting and approvals work in your area can help alleviate surprises, too. For example, is your plumbing permit based on overall square footage or on the number of fixtures in place? The cost difference between the two could be significant.

Anticipating these and other nuanced project requirements is nearly impossible without the expertise and insights of an experienced construction manager and supporting team who has helped others successfully plan and complete their hospital construction projects. The Samuels Group team helps clients through these challenges every day and is ready to answer your questions and help you identify your specific needs. Get in touch with us today and access the guide below for additional considerations.

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Image: © Jacob Juliet Photography

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