The Cost of a Poor Transition: Why Hospitals Stumble Between Construction and Operations
After the Ribbon Cutting, the Real Work Begins.
In healthcare, the project doesn’t end when the last piece of equipment is installed. It begins when the building must actually function, and that’s where many hospitals struggle. Cref’s healthcare Transition to Operations (T2O) program is designed to close that gap.
As Patrick Murphy, President of the East Region for CREF, and Steve Van Ness, Senior Vice President, Planning, Design, and Construction, CREF, discussed on the Healthcare Facilities Network, “A failed transition to operations can cost hospitals millions in lost revenue, delays, and rework.” Patrick and Steve agree: The real danger when opening a building lies in what isn’t visible: Unfinished commissioning, missing data, and untrained staff stepping into complex new spaces.
The Hidden Cost of Poor Handoffs
Most hospitals budget precisely for design and construction but rarely for the operational ramp-up that follows. That’s where the cracks appear.
“If you treat the handoff as simply, ‘we built it, now you run it,’ you’re already behind,” says Patrick.
Without a structured transition plan, facilities teams inherit equipment without maintenance data, and clinical teams face spaces that don’t match their workflows. The cost isn’t just financial, it’s regulatory, reputational, and human.
Readiness Is Its Own Discipline
Steve urges leaders to view hospital operational readiness as a defined project phase, not an afterthought. “Budget for the transition as you would for construction. This is a distinct phase, not just a footnote,” he says.
That phase should include:
• System commissioning and workflow testing
• CMMS data integration and asset verification
• Facilities staff training and role ownership
• Clinical validation for compliance and safety
Hospitals that invest in this step open faster, safer, and stronger and significantly, reduce post-occupancy surprises. Patrick and Steve outline a practical roadmap that a hospital can apply immediately to plan for the transition from construction to operations:
1. Define clear milestones and metrics: Include track commissioning progress, staff training, and CMMS data readiness.
2. Establish governance: Bring Facilities, Clinical, Compliance, and Operations leaders into a steering group.
3. Simulate workflows: Run mock patient traffic flows and emergency scenarios before opening day.
4. Transfer knowledge and data: Load manuals, PM schedules, As-builts, and asset data into digital systems before the building is occupied.
5. Engage Facilities early: Eliminate destructive organizational silos and design for maintainability from day one.
“The hand-over is not complete until the people who operate the space own the space,” says Steve.
Facilities at the Center of the Story
Facilities professionals often arrive late to the process, and that’s too late. “You can’t wait until the equipment is installed to figure out how and who is maintaining it,” says Patrick.
When Facilities leaders are part of design and commissioning, they ensure accurate asset tagging, preventive maintenance schedules, and long-term sustainability. It’s also a direct boost to Joint Commission readiness and survey performance.
Shifting the Mindset
Hospitals that view operational readiness as strategic, not logistical, open on time and with confidence. They minimize rework, enhance patient safety, and strengthen collaboration across departments. As the episode concludes, Steve cautions project planners to “budget for the transition as you would for construction. This is a distinct phase, not just a footnote.”
That mindset turns projects into performance and buildings into hospitals that heal.
The Takeaway
Transitioning to operations isn’t about flipping a switch. It’s about ensuring every team, system, and process is ready for day one. Hospitals that plan for this moment protect themselves from the most expensive phase of all, the one they thought was already finished. And that is a tough sell to a C-Suite that wants patients and results, not change orders and excuses.
Watch the episode: Transition to Hospital Operations: Avoiding Costly Mistakes