Navigating Hospital Inspections for Construction

Healthcare facilities are more regulated than other buildings because of the sensitive work performed inside— saving lives and preserving the health of people in the community. Construction contractors working on healthcare projects need to plan for numerous hospital inspections as part of the process. Hospital inspections involve specialized inspectors reviewing documentation and checking the site for compliance with regulations.

Periodic hospital inspections are required during the ordinary course of business to maintain accreditation for quality of care — including healthcare facility compliance. However, during healthcare construction, inspections for standard building code adherence are joined by hospital inspections by agencies concerned with healthcare building safety standards.

In this article, we will cover the various agencies that inspect healthcare construction, problem areas for compliance and offer best practices when preparing for inspections.

Who performs hospital construction inspections?

Construction professionals — from architects and engineers to project managers and site superintendents — need to be aware of the inspections required for healthcare projects. Numerous agencies may need to be involved, from approving drawings before a project goes out to bid to final closeout. For each jurisdiction, the exact agencies involved may differ. Here are the most likely agencies involved in inspections.

Department of Health

Most state health departments must inspect and approve the build at various stages. In most states, an agency within the health administration is tasked with healthcare facility oversight, such as California’s Department of Healthcare Access and Information or Michigan’s Health Facilities Engineering Section.

Centers for Medicare & Medicaid Services

Healthcare facilities that receive funding from the Centers for Medicare and Medicaid Services (CMS) are subject to CMS review for adherence to the National Fire Protection Association (NFPA) Life Safety Code (LSC) and Health Care Facilities Code (HCFC). CMS may partner with state fire safety agencies, health departments or accredited organizations to oversee and perform hospital inspections.

The Joint Commission

The Joint Commission regulates and inspects healthcare facility planning, design and construction. As the oldest accreditor of healthcare facilities in the U.S., the nonprofit, independent Joint Commission is primarily concerned with promoting high-quality and safe patient care.

Occupational Safety and Health Administration (OSHA)

Hospital construction work is subject to OSHA inspections to comply with federal safety regulations and prevent injury or death. Complaints, safety incidents, visible hazards or referrals by another agency can trigger inspections.

Environmental Protection Agencies

The Federal Environmental Protection Agency (EPA) and some state environmental protection agencies inspect hospitals to ensure compliance with waste disposal, emissions and resource use laws and regulations.

Food and Drug Administration (FDA)

The FDA regulates and inspects medical devices—including equipment like magnetic resonance imaging (MRI) machines—and laboratories. Construction companies may need to coordinate inspections for some hospital areas.

State and Local Government Agencies

Every state and many local governments have agencies responsible for enforcing building codes for all types of construction projects. These agencies issue permits and have inspection requirements for healthcare facilities beyond what the health department requires. 

For example, the Ohio Department of Commerce inspects structural, MEP and medical gas in buildings, while the Ohio Department of Health oversees public health concerns for healthcare facilities. Inspections may be performed by government or private inspectors approved by the agencies.

General contractors, subcontractors and facility managers working on hospital construction or renovation projects need to understand and communicate with all applicable agencies to determine inspection requirements.

Facility managers and hospital administrators may also need to coordinate the regular hospital inspections conducted by other health organizations, such as the Accreditation Commission for Health Care, the Center for Improvement in Healthcare Quality and the American College of Radiology. Because inspections may be annual, every three years or more frequent, they may impact scheduling and access for construction work.

Common Hospital Facilities Inspection Issues

Hospital facilities are inspected regularly and during construction for flaws or violations of regulations. Areas of concern can vary widely; the following are often listed:

• Fire safety, including smoke detectors, extinguishers, sprinkler protection systems and fire-rated walls
• Environmental and cleanliness compliance during construction
• Entrance and exit illumination and egress
• Building envelope and water seepage issues
• Roofing issues
• Proper pressurization for infection control
• Electrical hazards, including proximity to medical gas storage
• Conflicting codes requiring clarification

Best Practices for Hospital Inspection Readiness

Healthcare construction is complex and challenging, so following best practices when preparing for inspections can reduce the likelihood of problems that could impact scheduling or cause cost overruns.

Understand Regulatory Requirements

Familiarize yourself with specific national, state and local regulations, which involve stringent requirements for hospital construction.

Proactive Design Review

Review plans early to identify potential compliance issues. Submitting requests for information (RFIs) early can prevent delays caused by design conflicts or regulatory agency issues.

Incorporate Inspections into Scheduling

Include inspection milestones in your project schedule. Use strategies like a three-week look-ahead to break down tasks and align them with inspection timelines, ensuring readiness when inspectors arrive.

Build Strong Relationships with AHJs

Cultivate strong relationships with authorities having jurisdiction and inspectors. Regular communication and trust-building can lead to smoother project approvals.

Prioritize Communication with Hospital Staff

Manage relationships with internal hospital stakeholders, like facilities managers and charge nurses, to coordinate construction activities without disrupting hospital operations.

Develop a Skilled and Ethical Team

Hire team members who are passionate, ethical and eager to learn. Motivate the team by emphasizing the hospital's role in the community.

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Using Digital Tools to Facilitate Inspections

By integrating inspection schedules and milestones into digital construction project management tools, teams can anticipate and prepare for regulatory reviews and inspections, reducing delays. Capturing and analyzing data from past projects can identify recurring compliance issues, enable proactive problem-solving and lead to more accurate project planning.

Construction software also helps maintain transparency and accountability for stakeholders and simplifies data gathering for inspections. Given the technically complex nature of hospital construction, leveraging data tools to document compliance details for inspections and ongoing facility maintenance can impress clients and help companies earn repeat business in healthcare construction.

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