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Hospitals can reduce avoidable construction costs by finding design and workflow problems before work begins, involving infection prevention and clinical teams early, and evaluating operating and maintenance effects alongside initial cost. Safety measures such as infection-control risk assessment (ICRA), dust and moisture containment, worker education, and monitoring belong in the project scope—not on a list of optional cuts. One 2024 study estimated $90 million in costs avoided on a specific children’s hospital project, but that result is not a general savings forecast.
How can hospitals lower construction costs without compromising safety?
Focus cost control on preventing rework and poor operating decisions, not on removing protections whose consequences have not been assessed. The strongest opportunities are usually upstream: test clinical layouts before construction, involve the people who will deliver care and maintain the building, and compare design alternatives across their full operational and safety effects.
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Construction in or near an occupied healthcare facility also creates risks that must be planned and managed. The Centers for Disease Control and Prevention (CDC) identifies design and function, airborne-disease risk, and dust and moisture containment as core considerations before construction or repair. Its recommendations also call for staff education, adherence monitoring, communication, and contingency planning. Those activities require time, assigned responsibilities, and project resources; treating them as late additions can create disruption and rework.
There is no defensible universal percentage by which hospitals can cut construction costs. Costs depend on the project, location, scope, existing conditions, delivery approach, and applicable requirements. The evidence supports better decisions and earlier problem-solving—not a guaranteed savings rate.
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What costs should a hospital project compare?
A low first-cost option is not automatically the least costly or safest option over the facility’s life. Compare alternatives across the initial construction price, expected operating and maintenance effects, safety and infection-control risks, clinical workflow, and the disruption and schedule risks of construction.
| Decision dimension | Questions to ask |
|---|---|
| First cost | What is included in the price, and what scope, assumptions, or exclusions could lead to later changes? |
| Operating and lifecycle cost | Could the option affect ongoing operations, maintenance needs, or the cost of serving patients? |
| Infection control and patient safety | What risks could the design or construction activity create, and what mitigations does the project-specific ICRA call for? |
| Clinical workflow | Does the layout support the intended care process, staff movement, and relationships between departments? |
| Cleaning and maintenance | Can environmental-services and facilities teams reach the relevant areas and equipment to clean, inspect, and service them? |
| Disruption and schedule | Could the work interfere with occupied areas, require a change in sequence, or need contingency time for an environmental-control issue? |
| Applicable requirements | Does the choice meet the codes, standards, and other requirements that apply in the project’s jurisdiction? |
Use these dimensions to structure a project-specific comparison, not as a universal scoring formula. The available sources do not establish standard prices or weights for each factor. The Facility Guidelines Institute’s 2022 benefit-cost analysis illustrates why a broader view matters: some changes may improve flexibility, reduce risk, improve flows, eliminate duplicate functions, or lower operating costs, while some facility types may see small capital-cost increases. Confirm which edition and requirements apply to the project rather than assuming that a cited edition governs everywhere. See the FGI 2022 benefit-cost analysis.
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How can simulation and early design review prevent expensive changes?
Walk through care scenarios while the project is still at a stage when layout changes are feasible. A planned room or department may look workable on a drawing but still create conflicts for care delivery, movement, or safety. Reviewing those conditions with affected staff can reveal problems before they become costly construction changes or enduring operational compromises.
Simulation-based hospital design testing can involve clinicians and other relevant users in examining how a proposed space will function. In a prospective study of a new hospital with more than 400 beds, researchers examined 15 clinical areas and reported identifying 722 latent conditions. They said design changes mitigated 57% of those conditions; 117, or 28% of the total, would have been cost-prohibitive to modify after construction. The authors estimated $90 million in costs avoided through preconstruction architectural changes, and reported a simulation cost of $1.6 million, or 0.01% of that project’s overall cost.
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These figures describe one project, not an industry benchmark or an expected return for another hospital. The study supports considering structured design testing where the project’s complexity and decisions warrant it; it does not prove that every simulation program will achieve similar results. Read the 2024 study of simulation-based hospital design testing for its project-specific methods and findings.
For a project review, invite the people who understand how the proposed space will actually be used: frontline caregivers, facilities and operations staff, environmental-services staff, infection preventionists, and other affected teams. The ASHE quick guides describe an interdisciplinary approach that can also include architects, engineers, human-factors specialists, and contractors. Ask participants to examine realistic workflows, identify unsafe or inefficient conditions, and record what design change or further review each issue requires. Resolving a conflict on paper is generally preferable to discovering it after a room or system has been built.
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An infection-control risk assessment, or ICRA, is a project-specific assessment used to identify infection risks associated with facility design, construction, or renovation and plan suitable mitigation. Treat it as part of early project planning and keep it relevant as the work, affected areas, or conditions change.
ASHE recommends performing an ICRA when designing, renovating, or constructing a healthcare facility. A multidisciplinary team should consider which patients and departments may be affected, potential airborne and waterborne pathways, construction impacts, and appropriate mitigations. The team should span relevant clinical, infection-prevention, facilities, and environmental-services expertise, together with design and construction participants as appropriate. The ASHE quick guides provide an overview; the project’s responsible specialists should determine the applicable assessment and controls for its circumstances.
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Start before key design and construction decisions are locked in. Revisit the assessment when scope, sequencing, conditions, or the affected environment changes, and carry its relevant measures into project documents, responsibilities, and schedules. A document that is completed early but not connected to execution will not, by itself, control risk.
How should a hospital control dust and moisture during construction?
Set containment and environmental-control responsibilities before work begins, then monitor whether the agreed measures are being followed. Dust and moisture can affect an occupied healthcare environment, so the project needs a plan for prevention, communication, corrective action, and response if controls fail.
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- Identify affected areas and risks. Use the project ICRA and the facility’s knowledge of its patients, operations, and environment to determine what is at risk and what protections are needed.
- Write down responsibilities. Project documents should specify who maintains containment, who communicates changes or problems, who monitors adherence, and who can require corrective action. Align those duties with the facility’s ICRA, project specifications, contracts, and applicable requirements.
- Educate the people doing and overseeing the work. CDC guidance calls for education about airborne infection risks and fungal-spore controls. Make sure relevant workers and supervisors understand the project’s measures and reporting route.
- Monitor and respond. CDC recommends daily monitoring of worker adherence. Define how a deviation is reported, who assesses it, and how corrective action is documented; the project team should establish these details for its scope and local requirements.
- Plan for failures and changing conditions. Establish communication and contingency arrangements for issues such as HVAC or water failures, and review controls when work or site conditions change.
The CDC environmental-control guideline was originally published in 2003, and the page describes a web update in 2024. Recommendations should be read in context, and current state and local requirements must be checked: jurisdictions may adopt standards by reference, so requirements are not uniform. No particular air-cleaning device or model is endorsed by the cited guidance. Equipment and methods should follow the project’s ICRA, specifications, and applicable requirements.
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How can the finished hospital be easier to clean and maintain?
Include cleaning access and serviceability in design decisions, rather than assuming they can be solved after construction. A feature that is difficult to reach, clean, or maintain can burden day-to-day operations even if it reduces the initial price.
CDC’s environmental-cleaning guidance identifies designing patient-care areas for effective cleaning and disinfection as part of a broader set of six components. The framework also includes selecting appropriate technologies and products, standardizing protocols, monitoring, and feedback. For construction planning, that means involving environmental-services and facilities staff in reviewing surfaces, layouts, equipment access, and work practices before the design is finalized. See the CDC guidance on reducing risk through healthcare-facility surfaces and cleaning.
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Review alternatives for how they will be cleaned and maintained in routine operation, not only how they appear on a drawing or affect construction cost. Ask the staff responsible for the work to identify access constraints or workflow problems and make those findings part of the design discussion. The guidance does not provide a universal surface or layout prescription for every facility; choices should reflect the project’s needs and applicable requirements.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.How should teams turn cost-control ideas into project decisions?
Use a sequence of decision points so that cost, clinical function, and risk are considered before commitments become difficult to change. The precise process depends on project scope and delivery, but the following sequence applies the evidence without assuming a particular budget or jurisdiction.
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- Define the project and its constraints. Identify the intended functions, affected departments, occupied areas, relevant requirements, and decisions that could influence safety, workflow, or serviceability. Do not apply an assumed national cost benchmark: the available evidence does not establish one.
- Form the interdisciplinary team. Bring together the clinical, infection-prevention, facilities, environmental-services, design, and construction perspectives relevant to the project. Assign who owns the ICRA and who will communicate changes and concerns.
- Assess risks early. Complete a project-specific ICRA during planning and design, and identify how it will be updated as work changes. Make sure risk mitigations are reflected in the project’s scope and schedule.
- Review and test the design. Use scenario walk-throughs or simulation where appropriate to surface workflow conflicts, unsafe conditions, and latent design problems. Record issues and decide whether a design change, further analysis, or another response is needed.
- Compare alternatives on whole-life effects. Consider first cost together with operating and maintenance effects, patient safety, infection risk, staff movement, cleaning access, disruption, schedule, and compliance. Record assumptions so a low-price alternative is not mistaken for a complete or equivalent scope.
- Specify environmental controls and accountability. Carry dust and moisture containment, education, monitoring, communication, and contingency arrangements into the relevant project documents and responsibilities.
- Verify and adapt during construction. Follow the project’s monitoring and reporting process, correct deviations, and revisit the ICRA and affected plans when the scope or conditions change.
- Review readiness for operation. Before the project is treated as complete, confirm that the facility’s teams can clean, maintain, and operate the new or renovated areas in line with the intended workflows and applicable controls.
This sequence is a decision framework, not a substitute for the project’s licensed professionals, infection-prevention expertise, jurisdictional requirements, or facility procedures. The right cost-saving choice is the one that removes avoidable expense while preserving the controls and operating conditions the project needs.
How were the cost-control recommendations selected?
The recommendations follow the evidence in the cited CDC construction and environmental-control guidance, ASHE’s ICRA planning materials, the 2024 prospective study of simulation-based design testing, CDC environmental-cleaning guidance, and FGI’s 2022 benefit-cost analysis. Together, these sources support early interdisciplinary planning, design review, construction-phase controls, and evaluation of operating and safety effects alongside capital cost. They do not provide a universal savings rate, a standard cost model, or one scoring formula for all hospital projects.
Frequently Asked Questions
Does an ICRA replace a hospital’s infection-prevention procedures?
No. It is a project-specific planning tool, not a replacement for the facility’s infection-prevention program, professional judgment, or applicable regulations. The facility should connect its assessment and construction controls to its established procedures and responsible teams.
Can a hospital use the $90 million study estimate to set a renovation savings target?
No. The estimate concerned one new children’s hospital and the authors’ calculation of costs avoided through preconstruction design changes. A renovation has different scope and conditions, so the figure should not be used as a forecast or budget assumption.
Who should be consulted when planning construction in an occupied hospital?
Consult the teams whose work or patients may be affected, including infection prevention, clinical care, facilities, environmental services, design, and construction personnel. The relevant mix depends on the project and areas involved.
Does CDC require the same construction controls at every hospital?
Not necessarily. The applicable requirements can depend on jurisdiction and project circumstances, and standards may be adopted locally by reference. Confirm current requirements for the project location and align controls with the facility’s ICRA.
