In healthcare capital projects, reaching “substantial completion” is often celebrated as a finish line. But in reality, that’s when the most critical phase begins: transition to operations. Unfortunately, this phase is often unstructured, unowned, and unsupported, resulting in occupancy delays, revenue loss, and disrupted care delivery.
This blog explores the actual cost of poor transition planning and why leading healthcare systems are now treating Transition to Operations (TTO) as a core capital project phase, with governance, tracking, and accountability built in.
Why Substantial Completion Isn’t the End
The industry has long viewed “substantial completion” as a milestone to celebrate, and rightly so; it signifies construction is primarily done. But for hospitals, this is where patient impact and operational success begin. Clinical handovers, IT deployment, commissioning, licensing, and training remain critical.
The Hidden Costs of Delayed Occupancy
Delayed occupancy in health care buildings has repercussions that are long-term, beyond project schedules. These setbacks may not be visible in the budgetary projections, but they are quite expensive in terms of financial, operational, and reputational strain. Ranging as far as being unable to provide care to patients due to risk of lost revenue opportunities to a loss of community confidence in the health facility, the ripple effects can overwhelm the staff and delay the impact of the project significantly beyond the official completion date of the project.
- Missed service launches: New beds or ORs stay idle
- Lost revenue: Millions in deferred income every month
- Staff burnout: No clarity on go-live or readiness
- Public trust: Communities wait longer for promised care
Most of these costs aren’t in the budget, but they’re real.
Common Causes of Transition Failures
Transition failures in healthcare projects have little to do with any one thing; they are more likely recurring gaps in ownership, coordination, and oversight. Major readiness tasks may be lost without clear accountability, advanced planning, and transparent tracking of progress. Such pitfalls not only slow down activation but also cause very cumbersome delays that might have otherwise been prevented through the correct structure. Readiness tasks have no specific ownership
- Poor coordination between IT, clinical, and ops teams
- Licensing and inspections are left to the last minute
- Lack of visibility into transition progress or blockers
- Readiness is being treated as “someone else’s job.”
What TTO Governance Looks Like
Effective Transition to Operations (TTO) governance treats the move from construction to active use with the same rigor as any other project phase. Organizations with clear workstreams, defining who is accountable and what milestones should be set, make sure that nothing ends up by chance. This method will bring out transparency in the process, reduce eleventh-hour surprises, and prepare the groundwork for a clear and timely transfer of projects to working teams.
- A dedicated workstream with leads from all departments
- Readiness playbooks detailing what must happen and when
- Dashboards showing task completion, risk, and accountability
- Phase gates for move-in, inspections, clinical training, etc.
- Escalation paths and RACI charts
Dashboards Make Readiness Real
Real-time readiness dashboards operationalize complicated transition data to transform it into value-adding information for healthcare leaders. These tools allow quicker problem-solving by means of transparency of blockers, progress, and department duties, which leads to increased accountability. It leads to increased assurance in activation schedules, coordination between teams, and more reliable ordering of operations and revenue.
- Visibility into go-live blockers and mitigation efforts
- Department-level tracking of key milestones
- Accountability for commissioning, IT activation, and supply chain
- Confidence in transition dates and revenue forecasts
Case Insight: ICU Tower Delay
An extensive health system experienced a 3-month delay in opening its ICU expansion. The construction was complete, but IT wasn’t ready, and pharmacy inspections lagged. No dashboard flagged the issue. The result: $4.2M in deferred revenue, missed recruitment, and staff frustration.
Today, the system uses a centralized readiness model from OnIndus to avoid similar losses.
Making Readiness a Strategic Priority
For too long, hospitals have underinvested in the transition phase. But just like clinical operations or patient safety, it deserves rigor, governance, and transparency.
By creating a playbook-driven, dashboard-backed process for transition, health systems:
- Shorten the time to care delivery
- Reduce financial risk
- Improve staff coordination and morale
- Drive accountability across the org
Conclusion: Start Before the Finish Line
If you wait until substantial completion to plan for occupancy, you are already too late. Make the Transition to Operations part of your capital strategy from day one.
The organizations that lead in patient readiness and operational excellence don’t just build hospitals; they build the processes, governance, and visibility needed to bring them to life without delay. By embedding TTO planning early, you protect revenue, preserve staff morale, and deliver on your promises to the community. OnIndus can help you turn that vision into a repeatable, measurable reality.
Ready to see how your transition governance stacks up? Let’s walk through a readiness audit together.
