Risks of Delaying Integration of Medical Equipment Planning in the Design Process

At what stage should the ‘medical equipment planning process’ commence during the design of hospital projects and what are the risks that result from delaying this process?

By Ahmad Jawhar, Managing Director and Co-founder of Healthcare Consulting and Planning (HCP), Beirut, Lebanon

Hospitals are unique buildings. They possess a very high level of complexity, requiring an extraordinary level of interdisciplinary coordination among a very wide range of planning and engineering disciplines. Design firms rely on internal resources for conventional disciplines, but may resort to external sub-consultants for specialty disciplines. A specialised medical equipment planning consultancy body is one entity that must be present, among many other specialised sub-consultants, to guarantee a healthcare project’s success. Whether internally housed by the A/E firm or outsourced, the role of such entity is to provide the design team with necessary data to design a facility that complies with international standards and guidelines and to ensure the facility’s readiness to receive the medical equipment systems upon construction.

Proper planning for medical equipment is an essential component of overall hospital project planning, design, management, and implementation. The risks accrued from poor or improper planning maybe very high in terms of cost, schedule, or both. In some cases the risks may go well beyond cost and schedule.

Medical equipment generally has two types of installation and/or functional requirements:

  1. Direct: These are utility connections required to operate the equipment such as power, IT, plumbing (hot and cold water, drain, etc.), medical and surgical gases (oxygen, vacuum, nitrous oxide, compressed air, active gas scavenging, etc.) and others. These utility connections are prerequisites that must exist at the installation site for the equipment to function properly and adequately.
  2. Indirect: These are the facility’s architectural (spatial) and engineering requirements needed to install the equipment and operate it in a safe and efficient manner. These include architectural attributes such as space and workflow, civil attributes such as static and dynamic load bearing, HVAC attributes such as cooling and compensation for large heat dissipating equipment systems, ducting for filtered air enclosures such as biological safety hoods, number of air changes per hour for a particular type of functional space (fresh and/or recirculating), etc.

The question raised very frequently by project owners and managers is: what is the ideal time to engage the medical equipment planner to ensure proper project planning and alleviate circumstances that may lead to unwanted cost or delay resulting from errors in design. The effect of absent or improper medical equipment planning can be very costly and increases exponentially as the project progresses from one stage to another in design and implementation. The effects of complementing direct requirements such as adding missing utility outlets using nearby networks or relocating certain types of outlets within the same functional space are considered minor to moderate works that do not impose a considerable delay or expense. Indirect requirements, however, contribute to a much higher risk when overlooked or improperly undertaken. This is mainly because modifying or altering building elements is extremely difficult and in some cases impossible during or after construction. Below is a list of examples that demonstrate the gravity of overlooking indirect requirements of medical equipment systems installations.

Indirect requirement

Example Problems

Effects and Remedies

Architectural – Space and Workflow

Area is too small or layout is unfunctional.

Door/corridor width for equipment access routing inadequate for equipment to reach installation location, etc.

Inability to install or operate equipment resulting in architectural redesign, partition removal, cancellation of adjacent functional spaces, etc.


Floor, wall, or ceiling design inadequate to sustain static or dynamic load of heavy equipment

Structural reinforcement required


High density of ferro-magnetic content in slab underneath MRI magnet

Very difficult and possibly very expensive to resolve

HVAC and Power

Power requirements and heat dissipation of major medical equipment systems are typically very high and directly affect the sizing of electro mechanical spaces such as power substations, emergency generators, UPS rooms, HVAC rooms, etc. as well as corresponding distribution networks, shafts, conduits, etc.

This is a critical indirect requirement since the effect goes beyond local attributes but extends to sizing of major infrastructure spaces which not only maybe too expensive to correct but could be impossible at times especially when large additional infrastructure spaces are required after the facility construction has ended

The intent of the above examples is to clarify the risks that may result from improper or lack of planning for medical equipment systems from the very early stages of design.

Although many international organisations have created standards, norms, and guidelines for the planning, design and construction of healthcare facilities, we are still witnessing unintentional, improper or erroneous interpretations of these guidelines, especially when sensitive issues are involved and when non-biomedical professionals undertake the interpretation process. In order to alleviate such risks and to ensure that the hospital design, construction and medical equipment installations take place with no or minimal disruptions and variations, the engagement of a medical equipment planning body should be seen as an essential project requisite and should typically happen at project inception.

The amount of information pertaining to medical equipment systems is enormous. Such information is required by the various design disciplines to conduct their works accurately and diligently. The contribution of the medical equipment planner starts by identifying, in coordination with project stakeholders, the medical equipment level of technology envisioned by the operator or end users. The goal is to identify the preliminary space and engineering requirements of such systems and to provide the design team with the corresponding data sets for use during initial programming, design, and preparation of the infrastructure of the facility.

This is done by presenting to the owner’s operational teams a comprehensive idea (at the systemic and non-specific level) about the various medical technologies available to-date, discuss those systems from different perspectives and provide a recommendation for the most feasible, efficient and coherent solutions and alternatives. The reason for such discussions at this early stage is to identify important design elements (architectural, electrical, mechanical and structural) that will be used by the design team in the consequent phases of the project and to guide in generating room and equipment data sheets.

For example, knowing that the lifetime cost of acquisition as well as the architectural and engineering requirements of 1.5 T MRI varies widely from those of a 3.0 T MRI, it would be the duty of the medical equipment planner to address this topic with stakeholders and reach a decision in parallel with concept design stage works.

Once the level of technology is identified for the various medical equipment systems, a detailed room-by-room data matrix, tailored to project decisions and specifics, is prepared and submitted to the design team. The data sets used in the process are based on nominal industry standards to ensure compatibility of the facility with state-of-the-art equipment with no bias to a specific manufacturer or supplier.

Finally, during the schematic and detailed design phases, the project drawings are loaded with medical equipment at various scales to validate the architecture and to place the engineering requirements of medical equipment at the designers’ disposal in useable engineering drawing formats.

To streamline the data transfer process, several meetings and debating sessions take place between the medical equipment planning team, the owner’s teams and the design teams at various intervals during the course of the project, to ensure that the transmitted data represents the owner’s vision, model of care, and corresponding budget, and that it is well received, comprehended, and properly incorporated in the design.

This approach contributes to the design of a functional and sustainable facility. It will not only ensure proper and accurate interpretation and implementation of international norms, guidelines and best practices, but would also ensure, to a high level of confidence, that the healthcare facility will function adequately, and that the medical equipment systems, once procured, will find their properly designed and implemented installation locations ready, and will be able to function safely, efficiently, and effectively.

Ahmad Jawhar is a panelist on the Equip Session titled ‘Planning equipment lifecycle and optimising total cost of ownership’ to be held on Wednesday, 13th September 2017, at the Building Healthcare Conference.