Building More Care, Not Just More Buildings
Canadian hospitals are being asked to deliver more care with finite operating, capital, energy, and staffing resources. For Operations, Clinical, and Facilities leaders, a new facility is not only a capital project. It is a long-term operating commitment.
Decisions made during planning, design, procurement, construction, commissioning, and transition directly affect operating cost. Escalation, labour availability, procurement risk, phasing, and construction-market pressures are real. But a quieter cost driver is uncertainty around staffing models, workflows, maintainability, logistics, energy performance, digital systems, and resilience.
Every dollar spent compensating for uncertainty is a dollar that cannot be invested in patient care, staff support, or capacity. The question is not “How do we deliver the building?” It is “How do we make sure the investment produces the performance the hospital needs?”
Start with Operational Intent
The answer starts before design. Hospitals need a clear operating intent that is documented, tested, and managed throughout the project with the same discipline as the budget and schedule.
A useful operating intent defines what the facility must do, not just what it must contain. This shared framework helps clinical, operations, facilities, IT, security, logistics, finance, and capital-planning teams evaluate trade-offs consistently. It also helps prevent value engineering from becoming performance erosion.
An effective operating intent includes:
- Care model
- Staffing assumptions
- Patient and material flows
- Reslience and maintainability
- Energy performance
- Digital enablement
- Performance objectives
Design the Whole Operating Platform
A hospital is a coordinated operating platform. Mechanical, electrical, vertical transportation, communications, security, IMIT, digital, logistics, and building automation systems shape care delivery and operations.
Modelling (e.g. energy, CFD, digital twin) tests options before they become embedded costs. Mechanical and electrical decisions influence reliability, comfort, infection control, resilience, and maintainability. Vertical transportation affects patient movement, staff response, emergency flows, and service efficiency. IMIT and digital systems support communication, wayfinding, patient flow, and decision-making.
This is where operational readiness becomes the strategic connector. It is the discipline that connects the hospital’s vision to decisions being made during the capital project. It asks: how will choices affect staffing, downtime, energy use, response times, maintenance access, user training, activation, and the first year of operations?
Treat Logistics and Technology as Operational Infrastructure
Hospitals are logistics-intensive environments where people, supplies, equipment, waste, food, specimens, and information flow continuously. Yet decisions about elevators, pneumatic tubes, automated guided vehicles, storage, loading docks, adjacencies, and service corridors are often made in isolation. Greater value comes from treating them as an integrated operational network.
The same principle applies to digital infrastructure. It begins with operational questions: What decisions need to be made? Who needs the information? What action follows when a metric falls outside tolerance? Building automation analytics optimize energy performance, while real-time locating systems improve equipment utilization, staff safety, and patient flow. Without accountability, data becomes noise.
On a large acute care hospital redevelopment project, logistics systems were evaluated as a coordinated operational network rather than as individual infrastructure components. Integrating conveyance systems, storage strategies, vertical transportation, and departmental adjacencies helped align material movement with planned clinical workflows to support operational readiness.
Commission the Hospital, Not Just the Systems
Substantial completion does not mean a hospital is ready to operate. Generators, air-handling units, elevators, and nurse call systems can all perform as intended while the operating model remains untested.
Day One readiness depends on more than completed building systems. Infrastructure, technology, workflows, logistics, maintenance, life-safety processes, wayfinding, training, and activation planning must work together. Hospitals should validate the operating model through integrated systems testing and scenario-based commissioning that simulates utility failures, logistics disruptions, staffing constraints, and clinical surges.
The objective is to uncover operational gaps while they can still be addressed. Prior to opening one of Canada’s first fully integrated smart hospitals, commissioning, simulation and activation exercises brought together infrastructure, clinical technologies, workflows, and staff to validate the intended operating model. This helped identify operational gaps before occupancy, supporting a smoother Day One transition.
Close the Loop After Occupancy
The first year of operation is the first real performance test. Establishing a post-occupancy optimization plan before move-in, with regular performance reviews, helps hospitals measure performance against operational intent and make adjustments as needed. Performance should be assessed across several areas, including facility performance (energy use, equipment downtime), operational efficiency (work-order trends, elevator wait times, bottlenecks), and user experience (response times, staff feedback).
Lessons learned should be captured to inform future projects. A disciplined feedback loop turns one capital project into organizational intelligence for the next.
Five Questions Hospital Leaders Should Ask Before Scope Is Fixed
- What operational outcomes must this project deliver?
- Which decisions will most affect staffing, patient flow, resilience, maintainability, energy performance, and operating cost?
- Where are we spending capital to compensate for uncertainty?
- How will the operating model be tested before occupancy?
- How will performance be measured and optimized after opening?
Conclusion
Success must be measured by more than occupancy, budget, and schedule. The better measure is whether the facility delivers the capacity, resilience, efficiency, maintainability, staff support, and patient experience it was intended to provide.
This is where HH Angus’ depth in healthcare matters. Operational readiness is stronger when informed by teams that understand mechanical and electrical systems, IMIT, vertical transportation, commissioning, energy modeling, logistics, sustainability, and clinical operations. By connecting services around a shared operating intent, hospitals make capital decisions that support their vision, reduce avoidable operating costs, and help facilities perform as intended.
Have Questions? Contact:
Kelly Henderson, B. ASc, MBA
Associate Director, Angus Connect | Principal
HH Angus & Associates Limited Consulting Engineers
Email: [email protected]
