Refurbishing wards while care continues is one of the toughest tests for any project team. Patients still need quiet nights and clean air, clinical teams need safe routes and access to services, and estates need a programme that holds together under real-world pressure. Over the last few years we have delivered a large number of live ward refurbishments and upgrades across the UK.

This piece shares five practical lessons from those projects. None of them are complicated on paper, but together they make the difference between a stressful experience for everyone and a controlled, predictable piece of work that clinical teams would be happy to repeat.

1. 1. Treat decant and temporary capacity as the first design problem

   It is tempting to start with finishes, layouts and MEP changes. In live hospitals, the first question is always: where do patients and staff go while we work? Decant plans, temporary bays, swing wards and short-term bed moves should be tested and agreed before the rest of the scheme is allowed to harden.

   The best experiences we have seen involve estates, clinical and bed management teams agreeing a phased plan that everyone can live with for the duration. When decant is left vague, every change on site becomes painful and every delay has a human cost.

2. 2. Design the sealed zones as carefully as the finished ward

   The quality of hoardings, anterooms and routes is very visible to staff and patients. Poorly thought-out hoardings and temporary doors undermine confidence in the project, even if the final finishes are excellent. We now treat sealed zones as design elements, not just something the site team will “sort out”.

   That means drawing hoarding lines, agreeing door positions, setting out anterooms and negative pressure kit, and planning services penetrations. IPC and clinical teams should review these as seriously as the final room layouts.

3. 3. Programme around clinical rhythms, not just construction logic

   On paper, night works and weekend windows can look like a silver bullet. In practice, each ward has its own rhythm. Theatre lists, clinic slots, visiting hours, cleaning regimes and staffing patterns all affect what “out of hours” really means.

   Our better programmes are built around those patterns. Noisy works are aligned with natural lulls, deliveries avoid shift changeovers, and infection control holds are planned against real cleaning cycles. This requires more up-front conversation but far fewer arguments once work starts.

4. 4. Make isolation, IPS/UPS and gases a project within the project

   Mechanical and electrical changeovers in live wards need the same level of planning as the civil and architectural work. Isolations, changeovers, temporary supplies and rollback plans for IPS/UPS, gases, nurse call and medical equipment must be worked through and rehearsed on paper with estates and clinical engineering.

   We have learnt to treat these as mini-projects: they get their own programme strips, risk registers, rehearsals and communications rather than being a footnote at the end of a task list.

5. 5. Communicate more than feels necessary

   Even a well-planned programme will cause anxiety if people do not know what is happening next week, tomorrow or tonight. Short weekly briefing notes to ward managers, simple route maps, daily check-ins with nurse in charge and quick updates on any changes go a long way.

   We have also seen the value of being honest early when something is not going to plan. Clinical teams can often absorb change if they are told in time—what they cannot manage is being surprised at the last minute.

Live ward refurbishments will never be “easy”, and nor should they be treated as routine. But with the right decant strategy, well-designed sealed zones, programmes built around clinical reality, robust MEP planning and honest communication, they can become a predictable part of running and improving a hospital estate rather than a once-in-a-decade drama.