Healthcare Facility Commissioning - 5 Tips to Success: What Every Owner Needs to Know.

Constructing a new healthcare facility poses a number of unique challenges that must be addressed at every phase of the project. In contrast to other construction projects, modern healthcare facilities demand a higher level of technical knowledge from the project team. Hiring the right Commissioning Agent (CxA) for a project can help facilitate a smooth transition from construction to operations and prevent issues from occurring throughout the life of the facility. This can save the construction team and facility owner time and money.

1. How to Choose the Right Agent -

Recognizing Individuals Recognizing the differences between competitive teams proposing Commissioning (Cx) services for a hospital or other critical facility is crucial when selecting a firm. It is important to review not only the technical experience of the company as a whole, but also the technical expertise of the specific individuals that will be working on the project. After all, you don't work with companies during a project, you work with people. In addition to the primary CxA, it is a best practice to review every member of the Commissioning team. You need people who are your advocates that are looking out for your best interest. When you are working on a project, you want to hire a firm that has a solid track record and reputation with a team of seasoned staff who have successfully completed a similar scope of work. Hiring a CxA with hands on experience is invaluable and is the differentiator between a good CxA and a great CxA. The great CxA has already been exposed to the challenges that arise during the construction of a critical healthcare facility and is able to proactively negate issues as well as pull from their past experiences, methods to resolve issues as they arise. The next step in choosing a CxA is typically cost, and as with most things, you get what you pay for.

2. Don’t Let Pricing Fool You When hiring a firm,

The lowest cost proposal is not always the lowest cost provider. So how can that be? In some instances, Commissioning scopes of work may not be interpreted the same by competing CxAs. Some CxAs may have worked with the owner in the past and have a better understanding of what they are looking for, which may not be specifically identified in the project scope of work. Additionally, some CxAs may price based on a percentage of total project cost or some other benchmark criteria. Commissioning services pricing comes down to the tasks, hours associated with each task, and the labor rate of the individual being proposed to do the task. Even if both agents propose the same scope of work, and the billing rates are similar, there may be a significant difference in the total hours proposed. It is important to review proposals to ensure they are apples-to-apples. It is imperative for the owner to request a detailed pricing proposal that accounts for the labor rate and proposed hours for each task or provide a form to complete to be able to compare apples to apples. One item that can minimize the CxA cost is utilizing the following contracting structure.

3. Best Contracting Structure

If the owner has the ability to hire a CxA on a Time and Materials, Not to Exceed contract structure, this may be the best alternative. Depending on the owner’s insight as to the completeness of the project design, the use of technologies or control strategies they are not familiar with, the owner may want to select the qualified firm with the most hours. This gives maximum flexibility to fill any voids that arise during the different phases of the project as the owner is not billed for hours not used. This gives the owner the best of both worlds, they can feel confident that there will not be change orders and they will achieve the required attention that the project needs by allocating hours to tasks necessary for project success. Regardless of the Cx team chosen, one of the most valuable decisions an owner can make, is engaging the CxA in the process as early as possible to identify and mitigate issues.

4. Get the Commissioning Agent On Board Early

Buildings are increasingly being designed and built with environmental, sustainability, efficiency, and life cycle goals. With building systems becoming more complicated, the need for a CxA is amplified. This is especially true with Hospitals. To ensure that the owners’ goals are sufficiently defined and adequately & accurately reflected in the contract documents, owners need to think of CxAs as part of their core project team. The importance of this approach has been recognized by the U.S. Green Building Council’s LEED program and in Commissioning guidelines and handbooks (e.g. ASHRAE, ASHE, etc.). All of these publications advocate getting the CxA involved during the design phase of a project. This allows a second set of eyes by someone who is looking out for the owner’s interest, to ensure that project designs are robust and that equipment selection is matched to the project needs. As the Owner’s advocate, the CxA helps provide assurance that the basis of design achieves the owner’s project requirements. This is accomplished at the outset of a project during engineering based project document reviews where the CxA works with the design team to optimize the Mechanical, Electrical, Plumbing, Controls (MEPC) and Low Voltage systems and provide preliminary scheduling and budgeting. The CxA will continue to work with the project design team and contractors throughout the course of the project to address issues as they arise. It takes sound leadership skills to resolve issues that require the cooperation of many diverse parties, and arguably, the most important attribute of a “great” CxA is his or her ability to lead.

 5. Team Leadership

A critical requirement for a successful project is the primary CxAs ability to lead as part of a dynamic team. Throughout a project’s lifecycle there are several leaders who step to lead the team during their specific phase. During the design phase of the project the Architect typically provides leadership of the team. During the construction phase the general contractor leads the project team, with the Architect providing support. When the CxA is brought on board early he assumes a leadership role throughout the duration of the project. Initially to make sure the owner’s design intent and project requirements are met, then during construction to ensure the installed system function per the sequences of operation, and finally visiting the site 6-10 months into the warranty period for LEED enhanced commissioning or for opposite season testing. Individual experience and demeanor of the lead Agent is of utmost importance when deciding onthe right CxA for a project. The need to be process-focused and detail-oriented is magnified when it comes to commissioning a healthcare facility. When it comes down to choosing a CxA, everything depends on the lead agent’s experience and ability to lead. Moreover, it is important to choose a CxA that integrates well with the project team and culture, which goes hand-in-hand with leadership skills. When confronted with the additional challenges presented by a healthcare facility project, maintaining strong channels of communication is paramount to project success. Having a CxA you can count on makes the difference in ensuring a successful project.