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Planning a medical center construction project means connecting the care model to the building, approvals, construction controls, and operational readiness before the doors open. Start by defining the services and the owner’s requirements, then assemble the clinical, facilities, design, construction, and safety expertise needed to turn them into a locally compliant, buildable project. The sequence below applies broadly to new facilities, additions, and renovations; the exact codes, licensing steps, and approvals depend on the facility, project scope, and jurisdiction.
What should the owner decide before design begins?
Before architects and engineers fix a design, the owner should define what care the medical center will provide, whom it will serve, how much activity it must support, and how the facility will operate. These decisions form the basis for the space, equipment, staffing assumptions, systems, project boundaries, and approvals that follow.
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Clarify whether the project is new construction, an addition, a major renovation, or a change of use. Identify the services and patient populations, expected clinical activity and capacity, phasing needs, and owner decision-makers. A “medical center” can describe very different facilities, so do not assume that a plan or code path for one type of care applies to another.
Establish who can make project decisions and how clinical leaders, facilities and operations staff, designers, construction managers, and relevant safety or infection-control specialists will participate. Early agreement on decision authority and review responsibilities helps the team surface conflicting needs before they become late design changes.
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How do you turn the care model into a functional program?
A functional program translates the owner’s intent into the departments, rooms, relationships, equipment, and systems the design must support. Treat it as a working project requirement—not a one-time brief that can be left behind once drawings begin.
For each service or department, identify the functions it performs, room types and quantities, important adjacencies, patient and staff flows, equipment, and support needs. Consider staffing assumptions, patient populations, technology, communications, medical equipment, and the engineering systems needed to serve the planned activities. Document project size and stories, occupancy and construction assumptions, and relevant operating relationships where they affect the design. Use consistent names for departments and rooms across the program and drawings.
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Make changes traceable. When clinical operations, equipment, capacity, or technology assumptions change, assess whether the change affects rooms, adjacencies, utilities, approvals, construction sequencing, commissioning, or cost. Then update the relevant program information and design documents so the owner, designers, contractor, and operators are working from the same requirements.
Who needs to be on the planning and design team?
Healthcare projects require a multidisciplinary owner-side and technical team because clinical function, building systems, safety, compliance, construction, and future operations intersect. The right participants depend on project type and scope, but clinical users and facilities or operations representatives should have a meaningful role alongside leadership and the design and construction professionals.
Set out responsibilities for decisions and review: who approves the functional program, who confirms operational requirements, who coordinates code and licensing questions, who manages design changes, and who will operate and maintain the completed facility. Involve relevant safety, security, and infection-control expertise early enough for their findings to affect planning and design—not only construction procedures.
Engagement should continue through later phases. Facilities operators can flag maintainability and access concerns; clinical users can check whether room arrangements support intended workflows; and the owner can confirm that proposals remain aligned with the approved program. Assign actions and owners when reviews identify unresolved issues.
How do you confirm which codes and approvals apply?
Identify the authorities having jurisdiction and verify the project’s regulatory path before treating a generic guideline as a requirement. The applicable codes, standards, licensing reviews, inspections, and occupancy approvals vary with location, facility type, project scope, and the date an application is submitted.
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Map the likely approval milestones with the relevant authorities and qualified project professionals: plan review, permits, inspections, licensing steps, and the approvals needed before occupancy or operation. Confirm which editions of state and local codes, standards, and healthcare facility guidelines apply. The Joint Commission identifies NFPA 99, NFPA 101, and FGI guidance as examples to consider in planning and design; their applicability and adopted editions must be confirmed for the project rather than presumed.
Edition timing can matter. For example, the Indiana Department of Health’s healthcare engineering information states that Indiana’s 2026 FGI codes apply to applications submitted on or after June 1, 2027. That is an Indiana-specific schedule, not a national effective date. Likewise, the FGI website describes the 2026 edition as moving to Codes and Handbooks, with Codes setting minimum requirements and Handbooks adding commentary and technical guidance. Check the final published material and the local adoption and effective dates before relying on either.
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How should the team assess risk and carry it into design?
Use a multidisciplinary risk process to identify threats to patients, staff, visitors, operations, and the construction project, then convert findings into design requirements and assigned actions. Relevant topics can include patient and staff safety, infection control, life safety, movement through the facility, security, emergency response, utilities, and continuity of operations.
Risk review is not a single sign-off. The 2026 draft FGI hospital document describes a project safety risk assessment initiated and managed during planning and developed through design, construction, and commissioning. It also calls for infection-control risk assessment to be integrated with facility planning and construction mitigation. Because this is draft guidance, verify whether and how related requirements have been adopted locally.
Use design reviews to find issues while there is still time to resolve them in the documents. The Joint Commission describes an advisory approach that can include design and construction document review, risk-assessment review, issue lists and action plans, field reviews at multiple stages, and pre-occupancy review. These are useful planning concepts, not a substitute for required authority reviews or the owner’s own responsibilities.
For each identified concern, record the issue, its design or operational implication, the responsible person, the action needed, and how closure will be verified. Revisit open items as the project advances, especially when the scope, construction sequence, equipment, or operating assumptions change.
How do you plan construction without compromising care?
For a project in an operating facility, construction phasing must protect ongoing care as well as meet the building schedule. Plan how work areas will be separated from patients and staff, how air quality and utilities will be maintained, and how emergency access and procedures will function during each phase.
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Coordinate infection-control isolation and mitigation, interruption notifications, utility continuity, emergency procedures, and controls for noise and vibration. Build these constraints into the phasing plan, construction documents, contractor responsibilities, and communications with affected departments. Confirm which controls are required by local authorities and project-specific assessments; the draft FGI provisions are not automatically binding.
New construction also needs a coherent interface plan. Coordinate construction sequence with equipment and technology procurement, room completion, system installation, testing, and training. A late equipment decision can affect room design or engineering interfaces, while an unclear change process can leave the built facility inconsistent with the owner’s requirements. Define submittal review, change control, documentation, and responsibility for resolving conflicts in the project’s procurement and contract arrangements.
What should procurement and construction management cover?
Procurement and contracts should carry the owner’s requirements through construction rather than treating them as separate from design. Align scope, schedule, quality expectations, submittal review, testing, commissioning, documentation, training, and change control with the project’s goals and approval path.
Coordinate long-lead equipment and technology with the rooms, utilities, and interfaces they depend on. Clarify who confirms equipment requirements, who reviews submittals against the program and design, and how substitutions or scope changes are assessed. The owner should also establish expectations for construction records and the information operators will need at turnover.
Compare delivery or design options against project-specific criteria instead of choosing by label alone. Consider fit with the care model and patient population; regulatory and approval risk; capital and lifecycle operating costs; disruption and infection-control risk; utility continuity; maintainability and system resilience; commissioning complexity; flexibility for future services; and clarity of responsibility across the owner, designers, contractor, and commissioning provider. The available sources do not establish that one delivery method is always superior or provide comparative cost and schedule benchmarks.
When should commissioning begin, and what should it verify?
Commissioning should be planned early, with scope and responsibilities established before systems are installed. Define the owner’s project requirements, the basis of design, which systems will be commissioned, what successful performance means, how tests will be documented, and how deficiencies will be tracked through resolution.
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The 2026 draft FGI hospital document identifies systems such as HVAC, automatic temperature control, domestic hot water, fire alarm and fire protection integration, essential electrical power, and security systems for commissioning under the conditions it describes. Treat that list as draft-source guidance and confirm the systems and commissioning obligations applicable to the actual project.
Set up a commissioning plan that assigns responsibilities, identifies installation and performance verification, provides for issue reporting and closeout, and includes operator training. The HHS Facilities Manual says commissioning should begin in early programming and extend through the warranty phase for projects within the scope of its federal policy. It describes an experienced commissioning provider, construction-document requirements, a plan, installation and performance verification, reporting, and training. That policy example is not a universal rule for all medical center projects.
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Commissioning is not simply a final inspection or a pile of test forms. It is a process for checking that specified systems are installed and perform as intended, recording results, resolving problems, and preparing operators to run the building. Plan for this work early enough that system access, test conditions, documentation, and staff participation can be built into the schedule.
What must be ready before the medical center opens?
Opening readiness requires both building closeout and operational preparation. Before occupancy or operation, confirm the approvals and inspections required by the authorities having jurisdiction, resolve compliance issues, and verify that the people responsible for operating the facility have the information and training they need.
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Prepare a handover package that fits the project and applicable requirements. It should include record drawings, equipment operation and maintenance information, parts and procurement information, system testing and commissioning records, and operator training records. The draft FGI document calls for record documents at occupancy and equipment manuals and instructions at contract completion; confirm binding requirements and timing locally.
Complete operational preparations alongside technical closeout. The owner’s readiness plan should address staffing, policies, service workflows, equipment readiness, information systems, supplies, and emergency procedures. These workstreams need accountable owners and a way to identify unresolved dependencies. There is no single source-supported opening checklist or universal timeline for every facility, so tie the readiness plan to the services, licensing path, authority approvals, and operating model of the specific project.
The Joint Commission’s described advisory process includes pre-occupancy field review and review of final commissioning and owner documents. That can help teams think about verification and records, but it does not replace the approvals, inspections, licensing, or operational decisions required for a particular facility.
What are the key project gates from planning to opening?
Use project gates to ensure that decisions and evidence are in place before the next phase relies on them. The gates below are a management framework, not a universal statutory sequence; confirm local approval milestones with the relevant authorities.
| Gate | Owner and team should be able to confirm |
|---|---|
| Scope and care model | Project type and boundaries, services, population, capacity assumptions, decision authority, and stakeholder roles. |
| Program and design basis | Room and department needs, relationships, equipment and technology assumptions, support functions, and documented owner requirements. |
| Regulatory and risk basis | Authorities, applicable code editions and approval steps, identified risks, assigned actions, and the design responses to them. |
| Construction readiness | Coordinated documents, procurement and change-control responsibilities, phasing and continuity controls where care continues, and commissioning scope. |
| System verification and turnover | Completed testing, issue resolution, records, operator training, required approvals, and operational readiness for the planned services. |
At each gate, document decisions, unresolved risks, responsible owners, and what evidence will demonstrate closure. This makes it easier to distinguish a design preference from a requirement, and a completed task from a verified outcome.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.How should owners compare project options?
Evaluate alternatives against the owner’s requirements and local constraints, not a generalized claim that a particular option is fastest, cheapest, or best. The same decision can have different consequences for a new facility and an occupied renovation.
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- Care fit: Does the option support the services, patient population, expected activity, and staff workflows?
- Regulatory path: Which codes, review steps, approvals, and application dates apply, and what risks remain?
- Cost over time: What are the capital and lifecycle operating and maintenance implications? DHA guidance explicitly frames healthcare planning as balancing required features and standards with capital and operational costs while preserving care quality.
- Continuity and construction risk: Can current services, utilities, air quality, emergency access, and infection-control measures be maintained during work?
- Operations and resilience: Is the completed facility maintainable, appropriately resilient, and capable of supporting the owner’s future service or technology changes?
- Delivery accountability: Are responsibilities clear among the owner, design team, construction team, and commissioning provider?
Do not rely on a generic cost-per-area figure, typical duration, or savings percentage without a reliable published source that matches the facility type, location, and year. The sources supporting this guide do not establish a universal project cost, schedule, or savings benchmark.
Where can teams find additional planning guidance?
Start with the authorities and standards that govern the specific project, then use reputable technical guidance to support—not replace—local compliance work. The FGI website explains its 2026 Codes and Handbooks structure, while the Joint Commission’s planning, design, and construction advisory information describes ways to organize document review, risk review, field reviews, and pre-occupancy review.
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For teams seeking a broader reference, Joint Commission Resources describes Planning, Design, and Construction of Health Care Facilities, 5th Edition as covering facility design, equipment, furnishings, wayfinding, safety and security, planning and construction requirements, risk assessment, commissioning, and case studies. A reference book can help organize questions, but it cannot determine which rules a local authority has adopted.
Frequently Asked Questions
Who should approve the medical center functional program?
The owner should identify the decision authority in the project governance plan and involve clinical users, facilities and operations, and leadership in review. The appropriate sign-off structure depends on the organization and project; it should be settled before design decisions become difficult to change.
Can a medical center open before every commissioning issue is closed?
Whether an unresolved issue affects occupancy or operation depends on its nature and the applicable authority requirements. The owner should track deficiencies, document resolution or an approved disposition, and confirm with the relevant authorities and project professionals what must be closed before opening.
Does a medical center renovation need infection-control planning?
Renovations in operating facilities can affect patients and services through construction isolation, air quality, utility interruptions, noise, vibration, and emergency access. The project team should assess these risks for the specific work and facility, then establish appropriate controls and verify applicable local requirements.
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1Fix the driver behind crashes, sound loss and screen glitches2Repair Windows errors before they cause bigger problems3Scan for outdated or missing drivers - takes under a minuteWhat is the difference between an FGI Code and an FGI Handbook?
FGI describes its 2026 publication structure as Codes containing minimum requirements and Handbooks providing commentary and technical guidance. Confirm the final publication, jurisdictional adoption, and effective date before treating either document as governing for a project.
