TEAM APPROACH It takes a team of professional advisors to raise a surgical facility.

The biggest challenge in converting a savings and loan into a surgery center? "Getting the bank vault out," says nurse consultant Leslie Mattson, RN BSHM, the CEO of ALM Surgical Solutions in Macon, Ga., of the quirk in her latest development project. But there's a contractor for that, so you can add vault excavation and extraction to the list of the many small and not-so-small things a development consultant can do during the months of complicated planning, design and construction before you get those doors open and get those first patients on the table.

It takes a team
Whether you're building new from the ground up or retrofitting an existing building, it takes a team of professional advisors to raise a surgical facility. "Architect, attorney, general contractor — there's lots of moving parts," says Ms. Mattson. No matter the size and scope of your project, you know you've crossed the finish line when you've secured a certificate of occupancy, state licensure and Medicare certification.

Your development consultant should see you all the way through, managing every aspect of the project, from construction to policies and procedures, from equipment planning to recruiting staff, from installing sprinklers and fire alarms to installing phone cables and gas lines. "Hire someone who has expertise in surgical construction and can manage the project to get you up and functioning as soon as possible," says Ms. Mattson.

When should you hire a consultant? "The sooner the better," says Ms. Mattson. "It's such a tight timeline once you start the process." In her home state of Georgia, once you apply for a state license to build a new facility, you have only 6 months to complete the timeline. "When that trigger gets pulled, you want to hit the ground running," she says. "It's important to have the right people in place early on."

The management team must be assembled early in order to provide the necessary guidance, preparation and strategic design for your facility. "They begin working on the center's success even before the center is built," says Cecilia Kronawitter, president of HDA Enterprises of Delray Beach, Fla., which designs, develops, manages and markets healthcare facilities. "A strong management team is not an 'add-on' to be considered after the other required planning. Instead, it's a component of that planning."

ADVISORS WITH VISION Surround yourself with architects, developers and consultants who know what it takes to succeed in the new surgical economy.

Line up your vendors early on, says Ms. Mattson: biomedical engineer, anesthesia group, supply and equipment vendors. "Get all those people in place," she says. "If you think about what it's like to run a center, it's 10 times more difficult to build one because you're starting everything from scratch." Keep in mind, says Ms. Kronawitter, that it can take months to get an inspection from the state department of health.

An experienced healthcare builder

Some early decisions can cause delays and costly problems down the road. For example, the location of power supplies, vacuum pumps and suction lines must be included in early architectural drawings, says Ms. Mattson. This underscores the importance of hiring an architect who understands the business of surgery and has a lot of healthcare design experience, one who knows which city permits to pull, where the nurse call lights should go and why it's a good idea to replace those cabinets with a small autoclave.

"A contractor that builds homes can't build a surgery center," says Sherry Pace, RN, BSN, director of the Southern Eye Surgery Center in Hattiesburg, Miss., which expects to open a second ophthalmology ASC 30 miles away on May 1. "Make sure they've done this type of construction in the past, because, if they have, they're going to make it go so much smoother for you."

Southern Eye hired the same contractor, architect and builder that built the original 2-OR facility in 1994. The new 3,700-square-foot facility, a combined eye clinic and surgery center, is about 70% done. It will have 1 OR; a second operating suite is a knocked-down wall away on the blueprint.

"Don't overbuild. You'll be stuck with a big loan and with areas that are never utilized," says Ms. Kronawitter. "You can always design to expand down the road."

If, as expected, Southern Eye's satellite facility opens in May, the project will have taken 11 months — a little too long for Ms. Pace's liking. "We should be finished by now," she says. But a couple of hiccups courtesy of Mother Nature delayed construction. The project endured a terrible rainy season, during which it rained every day for a month, and "bad dirt," which forced contractors to cut down the hill the property sits on and truck in thousands of yards of clay to build it back up before they could pour the slab foundation.

"We had a slow start," says Ms. Pace, "but we kicked it into gear after that."

Generally speaking, it takes about 18 months to complete a construction project if you're building from the ground up and about 9 months to retrofit an existing facility, says Ms. Kronawitter. "When we go into an existing building, it's like Pandora's box," she says. "You don't know what you're dealing with until you open it up."

One last thing a management company can do for you: help recruit, vet and train your new administrator. "Hire right or risk tanking your venture from the start," says Ms. Kronawitter. OSM