CHFM Domain 2: Planning, Design, and Construction (14%) - Complete Study Guide 2027

CHFM Domain 2: Planning, Design, and Construction Overview

Domain 2: Planning, Design, and Construction represents 14% of the CHFM examination, making it a significant component that requires thorough preparation. This domain focuses on the critical skills needed to manage healthcare facility projects from initial planning through construction completion and occupancy. Given that CHFM pass rates hover around 63%, mastering this domain's concepts is essential for exam success.

This domain encompasses the complex world of healthcare construction projects, from small renovations to major expansions. Unlike Domain 1's focus on regulatory compliance, Domain 2 emphasizes practical project management skills, design coordination, and construction oversight specific to healthcare environments.

Project Planning and Management

Effective project planning forms the foundation of successful healthcare facility projects. This section covers the essential elements of project initiation, scope definition, and strategic planning that CHFM candidates must master.

Needs Assessment and Programming

Healthcare facility managers must conduct thorough needs assessments before initiating any construction project. This process involves analyzing current space utilization, identifying operational deficiencies, and projecting future capacity requirements. The programming phase translates these needs into specific design requirements and functional specifications.

Key considerations during needs assessment include:

• Patient volume projections and demographic changes
• Technology requirements and future expansion capabilities
• Workflow optimization and adjacency requirements
• Regulatory compliance and accreditation standards
• Budget constraints and funding sources

Project Delivery Methods

Understanding various project delivery methods is crucial for CHFM exam success. Each method has distinct advantages and challenges that affect project outcomes, timelines, and risk allocation.

Delivery Method	Characteristics	Best Applications	Risk Level
Design-Bid-Build	Traditional sequential approach	Well-defined projects with stable requirements	Medium
Design-Build	Single entity responsibility for design and construction	Fast-track projects with time constraints	Lower
Construction Manager at Risk	CM provides pre-construction services and guarantees maximum price	Complex projects requiring early contractor input	Medium
Integrated Project Delivery	Collaborative approach with shared risk and reward	Large, complex projects with innovative requirements	Shared

Budget Development and Cost Estimating

Accurate cost estimation and budget development are critical skills for healthcare facility managers. Projects must account for unique healthcare requirements such as specialized equipment, infection control measures, and operational continuity during construction.

Budget components typically include:

• Construction costs (60-70% of total project cost)
• Professional services fees (8-12%)
• Furniture, fixtures, and equipment (15-25%)
• Technology and telecommunications (5-10%)
• Contingencies (5-15% depending on project complexity)

Design Standards and Codes

Healthcare facilities must comply with numerous design standards and codes that ensure patient safety, operational efficiency, and regulatory compliance. This knowledge is fundamental to understanding all CHFM exam domains, as design decisions impact maintenance, operations, and safety outcomes.

Facility Guidelines Institute (FGI) Standards

The FGI Guidelines for Design and Construction of Hospitals provide comprehensive requirements for healthcare facility design. These guidelines are adopted by most states and form the basis for design review and approval processes.

Key FGI requirements include:

• Minimum room sizes and clearances for various healthcare functions
• Handwashing and infection control requirements
• HVAC performance criteria for different space types
• Electrical and technology infrastructure specifications
• Accessibility and life safety provisions

Code Compliance and Jurisdictional Requirements

Healthcare facilities must comply with multiple codes simultaneously, creating complex design challenges. Understanding code relationships and conflict resolution is essential for project success.

Primary codes affecting healthcare facility design:

• NFPA 101 Life Safety Code: Egress requirements, fire protection systems, and compartmentation
• NFPA 99 Health Care Facilities Code: Medical gas systems, electrical systems, and equipment requirements
• International Building Code (IBC): Structural requirements, accessibility, and general safety provisions
• Americans with Disabilities Act (ADA): Accessibility requirements for patients, visitors, and staff

Sustainable Design and LEED Requirements

Sustainable design principles are increasingly important in healthcare facility development. Many organizations pursue LEED certification to demonstrate environmental stewardship and achieve operational cost savings.

Healthcare-specific sustainability considerations include:

• Energy-efficient HVAC systems that maintain required air changes and filtration
• Water conservation strategies that don't compromise infection control
• Material selection balancing sustainability with cleanability and durability
• Indoor environmental quality optimization for healing environments

Construction Management

Managing construction in operational healthcare facilities presents unique challenges that don't exist in other building types. This section covers the specialized knowledge required for successful healthcare construction management.

Infection Control Risk Assessment (ICRA)

ICRA is a systematic approach to evaluating construction-related infection risks and implementing appropriate control measures. This process is mandatory for most healthcare construction projects and directly impacts project planning and execution.

The ICRA process involves:

1. Risk Assessment: Evaluate patient populations, construction type, and proximity to patient care areas
2. Classification: Assign risk levels (Type I-IV) based on construction complexity and patient vulnerability
3. Control Measures: Implement appropriate containment, air filtration, and monitoring protocols
4. Monitoring: Conduct ongoing air quality testing and visual inspections

ICRA Type	Construction Activity	Control Measures Required
Type I	Inspection and non-invasive activities	Basic precautions, hand hygiene
Type II	Small-scale, short-duration projects	Dust control, containment barriers
Type III	Work generating moderate dust/debris	Rigid barriers, negative pressure, HEPA filtration
Type IV	Major demolition and construction	Complete isolation, anteroom entry, extensive monitoring

Phasing and Sequencing

Healthcare construction often requires complex phasing to maintain operational continuity while completing necessary improvements. Effective phasing minimizes disruption to patient care and maintains essential services throughout construction.

Key phasing considerations include:

• Maintaining emergency egress routes and fire safety systems
• Preserving critical utility services and redundancy
• Minimizing noise and vibration impacts during patient care hours
• Coordinating with clinical schedules and patient census fluctuations
• Managing material deliveries and construction traffic

Contractor Management and Quality Control

Healthcare construction requires contractors with specialized experience and qualifications. Effective contractor management ensures quality outcomes while maintaining safety and infection control standards.

Contractor qualification criteria should include:

• Healthcare construction experience and references
• ICRA training and certification for all personnel
• Insurance coverage appropriate for healthcare environments
• Quality control programs and inspection procedures
• Safety programs and incident tracking records

Commissioning and Move-In

The commissioning process ensures that all building systems perform according to design intent and operational requirements. In healthcare facilities, thorough commissioning is critical for patient safety and regulatory compliance.

System Testing and Validation

Healthcare facility commissioning involves extensive testing of critical systems that directly impact patient care and safety. This process typically takes 4-8 weeks for major projects and requires coordination between multiple stakeholders.

Key systems requiring commissioning include:

• HVAC Systems: Air flow rates, pressure relationships, temperature and humidity control
• Medical Gas Systems: Pressure testing, purity verification, alarm functionality
• Electrical Systems: Emergency power testing, isolated power systems, nurse call integration
• Fire Protection Systems: Sprinkler testing, smoke evacuation, fire alarm integration
• Technology Systems: Network infrastructure, telecommunications, clinical equipment interfaces

Regulatory Inspections and Approvals

Healthcare facilities must obtain multiple regulatory approvals before occupancy. Understanding inspection requirements and coordinating the approval process is essential for project completion.

Required inspections typically include:

• Building department final inspections and certificate of occupancy
• Fire marshal approval and fire protection system testing
• State health department licensure inspections
• Joint Commission survey (if applicable)
• CMS certification (for Medicare/Medicaid participation)

Move-In Coordination and Activation

Healthcare facility activation requires careful coordination to ensure patient safety and operational continuity. This process involves multiple phases of testing, training, and gradual capacity ramp-up.

Activation phases typically include:

1. Systems Integration Testing: Verify all building systems work together properly
2. Staff Training: Orient personnel to new spaces, equipment, and procedures
3. Operational Readiness: Conduct simulated scenarios and emergency drills
4. Soft Opening: Begin operations with reduced capacity to identify issues
5. Full Activation: Achieve full operational capacity with ongoing monitoring

This systematic approach to commissioning and activation helps ensure successful project outcomes and supports the broader goals outlined in our comprehensive CHFM study guide.

Study Strategies for Domain 2

Given that the CHFM exam presents significant challenges, developing effective study strategies specific to Domain 2 is crucial for success. This domain requires both theoretical knowledge and practical application skills.

Key Study Resources

Effective preparation for Domain 2 requires diverse study materials that cover both technical standards and practical applications:

• FGI Guidelines: Essential reference for healthcare design requirements and standards
• NFPA Codes: Focus on NFPA 101, 99, and healthcare-specific requirements
• Project Management Texts: Understand healthcare-specific project management challenges
• Case Studies: Review real-world examples of healthcare construction projects
• Professional Articles: Stay current with industry trends and best practices

Practice Application

Domain 2 questions often present scenarios requiring practical problem-solving skills. Regular practice with scenario-based questions helps develop the analytical thinking required for exam success. Consider using our practice test platform to experience the types of complex scenarios you'll encounter on the actual exam.

Focus your practice on:

• Project delivery method selection based on specific circumstances
• ICRA classification and control measure determination
• Budget development and cost estimation scenarios
• Phasing strategies for operational facilities
• Commissioning and testing requirements for various systems

Sample Practice Questions

Understanding the types of questions you'll encounter in Domain 2 helps focus your preparation efforts. These sample questions reflect the complexity and application focus of actual exam items.

Sample Question 1: A 200-bed hospital is planning a 50-bed expansion that will include 20 medical/surgical beds, 15 ICU beds, and 15 emergency department treatment rooms. The project must maintain full operational capacity throughout construction. What project delivery method would be most appropriate?

This type of question tests your understanding of project delivery methods, healthcare operational requirements, and risk management principles. The correct answer requires analyzing multiple factors including project complexity, timeline constraints, and operational continuity needs.

Sample Question 2: During renovation of a patient care unit adjacent to the ICU, what ICRA classification would be most appropriate for demolition work involving removal of ceiling tiles and partial wall demolition?

This question tests specific knowledge of ICRA procedures and risk classification systems. Success requires understanding both the construction activities and the healthcare environment factors that influence risk levels.

For more comprehensive practice questions covering all domains, visit our practice test site where you can experience the full range of question types and difficulty levels you'll encounter on the actual exam.

Question Analysis Techniques

Develop systematic approaches to analyzing Domain 2 questions:

1. Identify the Project Type: New construction, renovation, expansion, or equipment installation
2. Assess Risk Factors: Patient populations, operational requirements, regulatory constraints
3. Evaluate Options: Consider all viable alternatives before selecting the best answer
4. Apply Standards: Reference specific code requirements or industry standards
5. Consider Practical Implications: Think about real-world implementation challenges

These analytical skills support success not only in Domain 2 but also in related areas covered in Domain 3: Maintenance and Operations and Domain 6: Safety.