Top Questions Clients Ask Before Starting a Hospital Project

Before a single drawing is made, every hospital owner in Pakistan has the same set of questions: what will it cost, how long will it take, which approvals are needed, and who should design and build it. Good hospital project planning starts by answering these questions honestly, in the right order. This guide collects the questions doctors, investors and healthcare groups most often ask ACCO before starting a hospital project, and gives clear, practical answers for 2026-27.

Why the Right Questions Matter Early

Most problems in hospital projects are decided in the first few months, long before construction starts. A bed count chosen without a market study, a site bought without checking zoning, or a design started without an equipment list can each add months and a large amount of money later. The questions below follow the order in which decisions should be made.

• Strategy first: what services, for whom, and at what scale.
• Site and approvals second: can this plot legally and physically hold the hospital.
• Design and cost third: drawings, BOQ and programme built on fixed decisions.
• Construction and commissioning last: building, testing and handover.

Questions About Scope and Feasibility

What size of hospital should we build?

The right size comes from demand, not ambition. A feasibility study looks at the population in the catchment area, nearby hospitals, the specialities in short supply and the number of doctors who will practise there. A 20-bed specialist facility that is fully used is usually a better investment than a 100-bed general hospital with empty wards.

Which departments do we need on day one?

Most private hospitals start with OPD, emergency, diagnostics (laboratory and imaging), operation theatres, a small ICU or HDU, and inpatient wards. Specialities such as cath labs, dialysis or radiotherapy can be added later if space and services are reserved in the master plan. The complete list of hospital departments is a useful checklist.

Can we build in phases?

Yes, and many owners do. Phasing works when the structure, plant rooms, lifts and main service routes are designed for the final size from the start, so later phases connect without demolition.

Questions About Site and Approvals

Is our plot suitable for a hospital?

Check four things before buying or committing a plot: permitted land use (commercial, institutional or hospital use), road access for ambulances, plot size for the required covered area and parking, and the availability of electricity, water and sewerage capacity. Corner plots with two road frontages make separate emergency and public entrances much easier.

Which permissions are needed?

Requirements vary by city and province, but a typical private hospital project in Punjab needs:

• Building plan approval from the relevant development authority, cantonment board or local government
• Structural design approval and, for taller buildings, additional safety clearances
• Fire safety clearance for the building design
• Environmental approval from the provincial EPA where the project size requires it
• Registration and licensing with the provincial healthcare commission before patients are treated

Licensing standards affect the design itself, so they should be read before drawings start. See our guide to Punjab Healthcare Commission hospital requirements.

Questions About Cost and Budget

How much will the hospital cost?

There is no honest single figure. Cost depends on covered area, number of floors, departments, finishing level, HVAC and medical gas scope, fire systems, external works and whether medical equipment is included. ACCO prices every hospital through an itemised bill of quantities (BOQ) prepared from the actual drawings. For current cost drivers and how the budget is split, read the hospital construction cost guide for Pakistan.

What usually causes budgets to rise?

• Changing the brief after design has started
• Under-estimating MEP, HVAC and medical gas systems
• Equipment chosen after the rooms are built, forcing changes to structure or services
• Upgraded finishes selected during construction
• Delayed approvals that extend site overheads

How should the budget be split?

Think of the budget in five parts: land and approvals, building construction (civil and finishing), engineering systems (MEP, HVAC, gases, fire), medical equipment and furniture, and working capital for the first months of operation. Owners often focus on the first two and are surprised by the last three.

Questions About Design and Standards

Do we need a specialist hospital architect?

A hospital is a clinical machine, not just a building. Patient flow, infection control, pressure-controlled ventilation, medical gases and fire compartmentation all need specialist knowledge. A general architect can produce an attractive building that fails licensing inspections or works poorly for staff.

Which standards apply?

In Pakistan the Building Code of Pakistan sets structural and seismic requirements, while provincial healthcare regulators set minimum service standards. For areas not fully covered locally, designers commonly refer to international guidance such as NFPA for fire and life safety, ASHRAE 170 for healthcare ventilation, HTM 02-01 for medical gases and WHO guidance on infection prevention.

What to Settle at Each Stage

Questions About Time and Delivery

How long does a hospital project take?

Time depends on size, approvals, funding flow and the delivery model. Design and approvals can take months on their own, and construction of a multi-storey hospital takes considerably longer. ACCO prepares a project-specific programme after feasibility; the hospital project timeline guide explains the stages.

Should we use turnkey or separate contracts?

With separate contracts the owner manages the architect, structural engineer, MEP designer, contractor and suppliers, and carries the coordination risk. With a turnkey contract one company takes responsibility for design, construction and commissioning. Turnkey usually suits owners who are doctors or investors without an in-house project team.

Questions About Choosing a Contractor

When comparing hospital contractors, ask for:

• Completed healthcare projects you can visit, not only renderings
• In-house or named MEP and medical gas specialists
• A sample BOQ showing how items are measured and priced
• Their testing and commissioning procedure for HVAC, electrical and gases
• Warranty terms and after-handover support

Our guide on how to choose a hospital construction company covers this in more detail.

Questions About Operation After Handover

What running costs should we plan for?

Electricity for cooling and equipment is usually the largest utility cost in a Pakistani hospital, followed by diesel for standby generation, water treatment, medical gases and maintenance contracts. Decisions made during design, such as wall and roof insulation, efficient chillers, solar PV and LED lighting, reduce these costs for the life of the building. Ask your designer to show the running-cost effect of major choices, not only the capital cost.

Who maintains the systems after opening?

HVAC, generators, lifts, medical gas plant, fire systems and the building management system all need planned maintenance. Before handover, the contractor should provide as-built drawings, operation and maintenance manuals, test certificates and training for your facility staff. Many owners also sign annual maintenance contracts for critical plant during the first years.

How do we keep space for growth?

Reserve land or a structural zone for future wings, design columns and foundations for extra floors if vertical growth is likely, and size the electrical substation, water tanks and main risers with spare capacity. Expansion is far cheaper when it is planned on day one than when it is forced into a finished building.

Frequently Asked Questions

Conclusion

A successful hospital starts with good questions answered in the right order: scope, site, approvals, design, cost and delivery. Owners who settle these early avoid the most expensive surprises and open on a realistic timeline. For a structured start, contact ACCO on 0322-8000190 or info@acco.com.pk to discuss a feasibility study for your project.