Planning, Design, and Construction
The facility manager as owner's representative
In planning and construction, the facility manager translates clinical and operational needs into a functional program, protects the capital budget, and safeguards ongoing operations and life safety during the work. Know the sequence of a capital project: strategic/master plan → facility condition assessment and space-needs analysis → functional (programming) plan → schematic design → design development → construction documents → bidding/procurement → construction → commissioning → activation and occupancy. Questions scramble this order. Design development is where scope and budget are essentially frozen; construction documents produce the drawings and specifications used for permits, bidding, and construction.
Codes and design guidance
Design is governed by the adopted building code and NFPA 101 (Life Safety Code), with the FGI Guidelines for Design and Construction of Hospitals and Outpatient Facilities used as the design reference adopted by many authorities having jurisdiction (AHJs) and referenced by CMS through the Conditions of Participation. NFPA 99 covers health care facility systems, including medical gas and electrical risk categories; NFPA 241 governs safeguards during construction, alteration, and demolition.
Two assessments you must not confuse
The preconstruction risk assessment (PCRA) is required before any construction, renovation, or demolition that can affect patients, and it drives interim life safety measures (ILSM) and infection control risk assessment (ICRA) decisions. The ICRA classifies the work type against patient risk groups to define barriers and ventilation requirements. Both are living documents updated as the work changes.
Traps and a rule of thumb
Trap: assuming a building permit or drawing approval substitutes for the PCRA/ILSM process - they are separate and continuing. Another trap: treating commissioning as a punch-list activity rather than a design-phase requirement tied to the owner's project requirements. Rule of thumb: budget commissioning and staff training at roughly 1–2% of construction cost, and plan it from design onward, not at turnover.