APPROACHES AND TOOLS FOR IMPROVING THE QUALITY CONTROL SYSTEM AT THE INTERFACE OF CONSTRUCTION STAGES OF COMPLEX SOCIAL FACILITIES (THE CASE OF MEDICAL FACILITY RECONSTRUCTION)

ABSTRACT

The article is devoted to the problem of ensuring quality at the interface of stages in the construction and reconstruction of medical facilities. The specific features of medical buildings that determine their heightened sensitivity to design, engineering and organizational errors are characterized. Modern approaches to quality control are presented, including technical supervision, contractors’ internal quality management systems, BIM technologies, lean construction tools and external quality audits. The main types of risks arising at the transitions between design, construction, installation of engineering systems and commissioning are described. A mechanism for improving quality control at these interface stages is proposed.

АННОТАЦИЯ

Статья посвящена проблеме обеспечения качества на стыках этапов строительства и реконструкции медицинских учреждений. Охарактеризованы особенности медицинских зданий, определяющие повышенную чувствительность к проектным, инженерным и организационным ошибкам. Представлены современные подходы к контролю качества (технический надзор, внутренние СМК подрядчика, BIM-технологии, Lean-инструменты и внешний аудит). Описаны основные виды рисков, формирующихся на переходах между проектированием, строительством, монтажом инженерных систем и вводом объекта в эксплуатацию. Предложен механизм совершенствования контроля качества.

Ключевые слова: контроль качества в реконструкции медицинских учреждений, система менеджмента качества в строительстве, BIM-технологии, бережливое строительство, внешний аудит.

Keywords: quality control in medical facility reconstruction; quality management system in construction; BIM technologies; lean construction; external audit.

Introduction. At the present stage, there is a clearly pronounced trend toward the large-scale development of social infrastructure, accompanied by the expansion of healthcare facilities, which serves as one of the key mechanisms for improving the accessibility and quality of medical services. An important indicator of these ongoing processes is the positive growth dynamics of the global healthcare infrastructure market (Fig. 1), which is projected to exceed USD 87.22 billion by 2023, with an average annual growth rate of 9.70%. Notably, this market encompasses only the design, construction and modernization of medical facilities; therefore, the broader construction market associated with social medical infrastructure is potentially even more extensive and dynamic.

Figure 1. Healthcare infrastructure market, compiled by the author based on the HTF Market Intelligence report

At the same time, for example, in Russia, most medical facilities were built before the 1990s and currently require major repairs or reconstruction associated with the modernization of engineering systems, the reconfiguration of interior spaces, and the integration of high-technology medical equipment. Against this backdrop, the role of ensuring construction quality becomes particularly significant, since the outcomes of social-infrastructure projects are traditionally subject to heightened sanitary and hygienic, engineering and infrastructural, and operational requirements.

The issue of ensuring quality at the interface of life-cycle stages of a facility becomes particularly critical, since errors arising at these transition points become major sources of defects, failures and operational risks. As emphasized by M.A. Seryapin and O.D. Grinik, shortcomings in the quality management systems (hereinafter QMS) of construction organizations, insufficient documentation control, and a low degree of process regulation lead to significant cost increases, a higher probability of defects, and reduced reliability of facilities, which affects both construction outcomes and the performance of construction organizations [1]. In turn, according to O.N. Borovskikh, the construction of socially significant facilities, including medical institutions, is impossible without adhering to specific approaches to quality assurance due to the high social importance of construction outcomes and the stringent regulatory requirements governing construction processes [2]. Naturally, the modernization of healthcare infrastructure is often complicated by the need to carry out construction work while medical facilities continue to operate, which imposes additional constraints on construction technologies and process organization.

With all the above taken into account, the role of a systemic, integrated quality control framework becomes increasingly important, as it ensures manageability of design decisions, process transparency, and coordination among all stakeholders (designers, contractors, technical supervision bodies and facility management services) at the interface points between stages in the construction of complex social facilities. The existing challenges and issues predetermine the need to develop scientifically grounded approaches and tools for improving quality control, which has defined the purpose of the present study.

The aim of the study is to compare approaches and tools for improving quality management systems at the interface of construction stages for complex social facilities (using the reconstruction of medical institutions as a case example) and to develop a mechanism for enhancing their effectiveness.

Methodology of the study. The theoretical basis of the research is formed by scientific publications in the field of social infrastructure construction, which served as the foundation for identifying the key stages, specific features, constraints, and potential approaches to quality management within the construction process. The methodology employed includes theoretical methods of analysis, comparison, juxtaposition, synthesis and generalization, as well as modeling techniques.

Results and discussion. The construction and reconstruction of medical facilities represent one of the most complex areas of activity for construction organizations due to the high technological sophistication of such buildings, the multilayered structure of their engineering systems, and the presence of specific requirements for ensuring sanitary and epidemiological safety. As noted by O.N. Borovskikh, socially significant facilities are characterized by an increased regulatory burden, which necessitates stricter compliance with quality standards compared with conventional civil construction projects [2]. In the case of medical facilities, this specificity is expressed to the greatest extent and can be conceptualized as a system of constraint-based influences (Fig. 2). As V.E. Morozova and co-authors rightly point out, social infrastructure facilities exhibit an elevated level of regulatory conformity, and the volume of regulatory documentation for such facilities is substantially greater than in residential construction. This is driven by the need to ensure infection control, the separation of patient and staff flows, and the alignment of engineering systems with medical technological processes [3].

Figure 2. Specific features of medical facility construction and reconstruction, compiled by the author

On the other hand, the engineering systems of medical facilities are extremely complex and often include sterilization and medical gas supply systems, supply-and-exhaust ventilation, infectious isolation systems, and guaranteed power supply. In addition, each room is prepared with consideration of the type and technical characteristics of the equipment to be installed. Accordingly, as E.S. Karnyukhina rightly notes, reconstruction requires the coordination of design and construction decisions, since even minor deviations during installation can compromise equipment compatibility and generate elevated operational risks [4].

In addition to the factors described above, there are also constraints related to the continued operation of a medical facility during reconstruction, as well as the overall complexity of design solutions and the high likelihood of errors. In this context, it is relevant to highlight the findings of K.A. Lyakhovsky and A.V. Arkhipov, who identify the main groups of design and construction risks in medical facility projects arising from:

– inconsistency between medical technological solutions and the construction component;

– the need for precise equipment placement and coordination;

– the dependence of room configurations on medical process flows;

– the involvement of a large number of contractors and engineering-system suppliers.

Moreover, in their view, it is precisely at the interfaces between design and construction that most critical defects arise, ultimately exerting a significant impact on the safety and operational readiness of the facility [5]. Therefore, it is advisable to examine the interface stages of construction processes and the associated quality risks in greater detail (Table 1):

Table 1.

Interface stages and key quality risks in the reconstruction of medical facilities

Drawing on Table 1, it should be noted that the fundamental quality risks are systemic in nature, as they accumulate over time, arise from insufficient coordination among project participants, and relate primarily to engineering, sanitary, and technological aspects—while manifesting more acutely in medical facilities. Naturally, managing these risks is impossible without a multi-level quality control framework, which must rely on modern approaches and tools for ensuring construction quality.

The most effective and widely applied approaches at present include technical supervision, the contractor’s internal quality management system, BIM technologies, lean construction tools, and external quality audits, as these approaches make it possible to establish a multi-level quality management framework encompassing design, construction, installation of engineering systems, and facility commissioning.

For example, according to A.V. Kazakov and M.S. Egorova, technical supervision—as a traditional and highly effective quality assurance tool—is essential for managing the processes involved in supporting design and construction decisions and for organizing daily verification of compliance between the performed work, regulatory requirements, and the design documentation [6]. Accordingly, the core functions of technical supervision include: (1) monitoring the conformity of construction work to design documents and regulatory standards; (2) assessing the quality of concealed work and engineering communications; (3) documenting deviations and issuing corrective orders; and (4) participating in the testing of engineering systems. Moreover, at medical facilities, the role of technical supervision is expanded, as specialists additionally verify compliance with sanitary requirements, check the proper preparation of rooms for medical equipment, and take part in inspections of engineering and technological systems.

On the other hand, a fundamental approach to ensuring and improving the quality control system is the implementation of an internal quality management system within the enterprise, based on ISO 9001 and relevant industry standards. The introduction of a QMS helps reduce defect risks, optimize processes, and ensure the reproducibility of quality at all stages of construction. A QMS involves the implementation of an extensive range of improvement measures related to the standardization of operations and procedures, the introduction of work-control checklists, strict network-based planning, nonconformity management with the application of corrective and preventive actions, and the regulation of interaction among project participants. An integral component of modern QMS frameworks in the construction of medical facilities is digitalization, particularly through the adoption of electronic document management systems combined with structured project-data storage and the incorporation of advanced construction technologies.

Among the latter, BIM technologies deserve particular attention as a tool for quality management and QMS implementation. The use of building information modeling (BIM) is recognized as one of the most effective and advanced approaches to quality assurance, since—as noted by N.E. Bulatnikov and L.S. Vyborova—it enables the creation of a comprehensive digital model of the facility, facilitates virtual clash detection, supports the assessment of engineering-system compatibility, and allows the monitoring of work quality at all stages of the facility’s life cycle [7]. For this reason, BIM is becoming a key technology whose application helps reduce risks at the interface between construction stages.

In addition to the approaches described above, it is advisable to implement lean construction practices and related tools in parallel, as well as to conduct periodic external quality audits performed either by in-house oversight units or by the client. This combination makes it possible to minimize the risks of unacceptable defects, increase project transparency, and strengthen the confidence of public-sector clients [8].

Summarizing the above, it can be noted that improvements in quality are driven primarily by the synergy of the approaches discussed, which together form a mechanism for enhancing quality control at the interface of construction stages (Fig. 3).

Figure 3. Mechanism for improving quality control at the interface of construction stages, formed through the synergy of QMS approaches, developed by the author

Thus, based on the analysis of the specific features, the identified interface-related risks, and modern approaches to quality assurance, it is advisable to develop quality-control elements and processes aimed at detecting and preventing defects specifically at the transitional points of the life cycle. The proposed mechanism should include four interrelated subsystems:

(1) design documentation review (effect: a substantial reduction in the number of errors that may emerge during construction and the installation of engineering systems);

(2) quality control of execution (effect: a reduction in the number of defects that emerge at construction interface points);

(3) interface verification (effect: a sharp reduction in the need for rework and the minimization of errors arising from nonconformities in work completed at the preceding stage);

(4) acceptance and operational readiness control (effect: ensuring guaranteed operational readiness of the facility and reducing the likelihood of engineering-system failures and risks to medical operations).

Each subsystem operates with its own set of tools and ensures the closure of the quality cycle. The proposed set of supporting subsystems functions as an end-to-end quality system in which each subsystem receives data from the preceding stage, eliminates defects characteristic of that specific transition, and creates the necessary conditions for the next stage of the construction process.

Conclusion. Thus, the proposed approach enhances the quality, reliability, and safety of healthcare facilities, reduces the likelihood of critical defects, and improves the efficiency of resource utilization. The development of such a mechanism and its integration into the activities of a construction organization is a necessary response to the challenges of modernizing social infrastructure and to the increasing requirements imposed on medical facilities. The application of this mechanism contributes to the creation of a standardized and manageable quality control system for the implementation of reconstruction projects.

References:

1. Seryapin, M.A., & Grinik, O.D. (2025). Rol' sistemy menedzhmenta kachestva v deyatel'nosti stroitel'noy organizatsii [The role of the quality management system in the activities of a construction organization]. Liderstvo i Menedzhment, 12(2), 413–428. https://doi.org/10.18334/lim.12.2.122669
2. Borovskikh, O.N. (2015). Osobennosti stroitel'stva ob"ektov sotsial'noy infrastruktury na sovremennom etape [Features of constructing social infrastructure facilities at the present stage]. Rossiyskoye Predprinimatel'stvo, 16(20), 3559–3568.
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5. Lyakhovsky, K.A., & Arkhipov, A.V. (2024). Rekonstruktsiya meditsinskikh uchrezhdeniy: organizatsionnyye osobennosti stroitel'nogo proizvodstva, otrazhennyye v issledovaniyakh uchenykh [Reconstruction of medical institutions: organizational aspects of construction processes reflected in scholarly research]. Inzhenernyy Vestnik Dona, 4(112), 37.
6. Kazakov, A.V., Egorova, M.S., & Prikhodko, A.N. (2023). Razvitiye organizatsionno-ekonomicheskogo mekhanizma stroitel'stva ob"ektov sotsial'noy infrastruktury pri kompleksnoy zastroyke [Development of the organizational and economic mechanism for constructing social infrastructure facilities in integrated development]. Upravlencheskiy Uchet, 2, 76–88. https://doi.org/10.25806/uu2202376-88
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