Forty three states have adopted some edition of the FGI Guidelines for Design and Construction, the most widely recognized standard governing how hospitals, outpatient facilities, and residential care settings get built in the United States.
Healthcare facility construction is one of the most heavily regulated and technically demanding categories of commercial building, and Arizona is no exception.
From infection control requirements to specialized ventilation systems, a healthcare project has to satisfy a layered set of standards that most other commercial buildings never have to consider. Here is what actually goes into building a healthcare facility from the ground up.
What Makes Healthcare Facility Construction Different From Other Commercial Projects?
Healthcare buildings are built around patient safety, infection control, and continuity of care in a way that other commercial buildings simply are not. This shows up in requirements most people never think about until they are actually planning a project, like minimum ventilation rates for operating rooms, specific pressure relationships between clean and contaminated spaces, and dedicated infection control risk assessments that have to happen before construction even begins.
These requirements come from the FGI Guidelines, published by the Facility Guidelines Institute, which consolidate program, space, risk assessment, infection prevention, and building system requirements into a single set of standards. States adopt specific editions of these guidelines into their own regulations, and facilities that want to remain accredited generally have to follow either their state’s adopted edition or the current FGI Guidelines for new construction and major renovations.
What Approvals Does Healthcare Facility Construction Require in Arizona?
Beyond the standard building permits that apply to any commercial project, healthcare facility construction in Arizona goes through an additional layer of review specific to health care institutions.
The Arizona Department of Health Services requires architectural plans and specifications for new health care institutions, and modifications to existing ones, to be submitted for review and approval before a facility can be licensed to operate. This review happens in phases throughout construction, with the department and the Licensing Bureau notified of progress and any compliance issues identified along the way.
This process exists because a health care institution cannot simply be built and then inspected at the end. The department’s licensing division needs to confirm that a facility meets the applicable health and safety standards before patients are ever treated there, which means the architectural review has to happen in step with construction rather than after it.
How Long Does the Architectural Review Process Take?
This depends on the scope of the project and the completeness of the initial submission, but it is worth building meaningfully more time into the schedule than a standard commercial permit would require. Incomplete submissions or non-compliance items identified during preliminary review can trigger a meeting between the health care provider, the architect of record, and the licensing bureau to resolve the issue before the review can move forward, which adds time if the original plans were not fully coordinated with the applicable guidelines from the start.
What Are the Key Design Considerations for a Healthcare Facility?
A few categories of requirements shape healthcare facility construction more than any other factor:
- Ventilation and air pressure relationships. Operating rooms, isolation rooms, and other sensitive spaces require specific air change rates and pressure relationships to adjacent areas, governed by ventilation standards incorporated directly into the FGI Guidelines.
- Infection prevention. Surfaces, finishes, and even construction sequencing have to account for infection control, particularly in occupied facilities where construction happens near active patient care areas.
- Space and clearance requirements. Patient rooms, corridors, and clinical spaces have minimum size and clearance requirements built around both patient safety and equipment access, including for behavioral health and mental health treatment spaces added in more recent editions of the guidelines.
- Life safety and egress. Healthcare occupancies carry stricter fire and life safety requirements than most commercial buildings, reflecting the reality that patients may not be able to evacuate quickly on their own.
- Flexibility for future change. Healthcare needs shift quickly, and modern guidelines increasingly build in design flexibility, like treatment rooms that can convert to secure holding spaces, so a facility can adapt without a full renovation.
Each of these categories intersects with the others in practice. A change to a room’s clearance requirements can affect ventilation design, and a change to infection control protocol during an active renovation can affect construction sequencing and even which trades can be on site at a given time. This interconnection is exactly why healthcare facility construction requires a design and construction team experienced enough to see how these pieces fit together, rather than addressing each requirement in isolation.
What Is an Infection Control Risk Assessment?
An infection control risk assessment, often called an ICRA, is a formal evaluation performed before construction begins on or near an occupied healthcare facility, identifying the risk that construction dust, airborne particles, or disruption to ventilation systems could pose to patients, particularly those who are immunocompromised.
The FGI Guidelines require this process for planning, design, and construction activities, and the American Society for Healthcare Engineering publishes the ICRA 2.0 Toolkit that most healthcare facilities and contractors use to carry it out.
This assessment determines what containment measures are required during construction, which can range from simple dust barriers on a small renovation to full negative pressure containment systems with HEPA filtered air scrubbers on a project near a high risk area like an intensive care unit or oncology floor.
What Happens If a Healthcare Facility Doesn’t Meet the Guidelines?
A facility that does not meet the applicable FGI Guidelines or its state’s licensing requirements simply cannot be licensed to operate, regardless of how far along construction has progressed. This is a far more consequential outcome than a typical commercial building failing a final inspection, since a healthcare facility that cannot be licensed cannot legally treat patients, which means the entire construction investment sits unused until the deficiency is corrected.
This is precisely why the Arizona Department of Health Services conducts phased reviews throughout construction rather than waiting until the project is finished. Catching a non-compliance issue during framing or rough in, when it might still be correctable with a modest change, is far less costly than discovering the same issue after finishes are installed and the facility is ready to open.
Owners who work with a contractor experienced in navigating this phased review process from day one significantly reduce the risk of a costly surprise late in the project.
How Do You Budget for Healthcare Facility Construction?
Healthcare facility construction typically costs more per square foot than most other commercial building types, largely because of the specialized mechanical systems, redundant power and life safety systems, and higher grade finishes required to meet infection control and durability standards.
Owners planning a budget should account for the architectural review and licensing process as its own line item, both in terms of the review fees involved and the schedule contingency needed if corrections or additional documentation are requested during the phased review.
It also helps to budget conservatively for contingency on any renovation to an occupied facility, since work happening around active patient care almost always takes longer and costs more than equivalent new construction, given the added containment, scheduling restrictions, and coordination required to avoid disrupting ongoing operations.
Do Renovations to Existing Healthcare Facilities Follow the Same Rules?
Largely, yes. Modifications to an existing health care institution in Arizona go through the same architectural plan review process as new construction, scaled to the scope of the renovation. This matters for facility owners who assume that a smaller project, like reconfiguring a wing or adding a procedure room, will move faster through approval than it actually does.
Any change that affects a health care institution’s licensed space typically needs the same phased review and sign off as new construction, which is one of the most common scheduling surprises for owners planning a healthcare renovation.
How Do You Choose a Contractor for Healthcare Facility Construction?
Experience with the FGI Guidelines and Arizona’s specific licensing review process matters far more here than it does for most other commercial building types. A contractor who has built retail spaces or office buildings but has never navigated a health care institution’s architectural review process is likely to underestimate both the timeline and the technical requirements involved. Ask directly about past healthcare projects, how the contractor coordinated with the state licensing review during construction, and how they managed infection control requirements if the project involved work near an occupied part of the facility.
It also helps to ask how a contractor handles the interaction between healthcare specific requirements and standard commercial building services, like structural, mechanical, and electrical work, since these systems have to be designed and installed to satisfy both general commercial code and the additional healthcare specific standards layered on top of it.
Building a Healthcare Facility the Right Way
Healthcare facility construction is not simply a larger or more expensive version of a standard commercial build.
It involves a distinct regulatory framework, a phased state licensing review specific to health care institutions, and design requirements around infection control, ventilation, and life safety that most commercial contractors rarely encounter. Getting these details right from the earliest planning stages protects both the project timeline and, ultimately, the safety of the patients the facility will serve.
Owners planning a healthcare project should treat the selection of an architect and contractor as a decision weighted heavily toward direct healthcare experience, not just general commercial credentials. The gap between a team that has navigated FGI Guidelines and Arizona’s licensing review process before and one that has not shows up early, often in how realistic the initial schedule and budget actually are once the full scope of requirements becomes clear.
If you are planning a healthcare facility project in Arizona, Canyon BD can walk you through what the process involves for your specific project, from architectural review through final licensing.
