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Trends And Challenges To Watch In Post-Pandemic Health-Care Construction

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A year ago, predictions indicated a spike in health-care construction planning and development across the country.

However, the post-COVID-19 shift is trending away from the traditional model to an emphasis on outpatient care to offload pressure from hospitals’ main campuses, according to Richard Simone, CEO & president of Central Consulting & Contracting, a construction management and general contracting company that specializes in health-care facilities.

In an interview with Commercial Property Executive, Simone explains why health-care construction is trending toward smaller outpatient care facilities and clinics and discusses challenges within the sector.

CPE: How has the initial health-care construction model changed since the onset of the pandemic? 

Richard Simone: The factors causing changes in health-care construction are largely due to labor shortages, limited or slow-to-get resources and new operational requirements. Since the start of the pandemic, we continue to do more tracking of workers and data logs on construction sites. For example, we’ve implemented contact tracing logs of when workers enter and exit work sites, temperature checks, cleaning logs, social distancing, no gathering for breaks etc., some of which affects the length of time now needed to complete certain projects.

Also, supply chain issues with closed factories due to COVID-19 have affected completion times and many of the issues persist as manufacturing struggles to keep up with demand, and attract and retain the workers required.

During the height of the pandemic, we saw the need for rapid deployment of resources to build emergency bed units on very short notice, which required a total integrated project delivery approach. Because of the speed in which it was done and the necessary collaboration, we are starting to see more property owners and project decision makers who want to explore this delivery method on their regular projects, not just emergency.

CPE: What is fueling change in health-care construction?

Richard Simone: Projects that were on hold during the pandemic now need to get online as quickly as possible. As such, clients are considering ways to speed up the process via design assist, design build and/or off-site manufacturing. While these options have been around for a fairly long time, adoption has accelerated due to their proven efficacy during the pandemic.

In terms of COVID-19-influenced design, where possible, hospitals are considering the creation of a mass casualty incident entrance at the emergency department. Basically, adding a third entrance to the ED, in addition to the regular walk-in and ambulance entrances, would allow patients to be quickly triaged and separated, moving infected patients into the MCI/COVID-19 unit.

Also, the redesign of waiting areas has increased to allow for social distancing, more room between chairs, low-height walls with glass separation panels, more compartmentalization and minimal wait times. There are also design changes happening in ways most lay people can’t see, such as catering to the need to add more ability or flexibility to change air flows to decrease the spread of future viruses. Many health-care systems now require larger, more robust, high-efficiency particulate air filtration systems, with MERV 16-level protection which captures more than 95 percent of particles within a specified range.

CPE: What types of health-care facilities are we starting to see more often and why? 

Richard Simone: We are starting to see much more activity for behavioral health facilities. Before the pandemic, there was a great need and after the pandemic there will be an even greater need. Substance abuse has been on the rise since the pandemic, as COVID-19 and post-COVID-19 anxieties are all real issues many people are dealing with. Treating patients with behavioral and mental health needs requires a long-term solution that incorporates brick-and-mortar and telehealth-equipped facilities.

Micro-hospitals—whereby health-care systems are bringing health care closer to its more remote patients in, for example, rural areas—is a rising trend as well.

CPE: Are these impacting main campus hospitals in any way? 

Richard Simone: The rise in micro-hospitals and specialty centers is not impacting main campuses negatively, but rather, they are filling a very important need by supplementing main campus care and reach by providing the support and specialty care that patients need.

CPE: What about telemedicine-influenced spaces? Will these be integrated into construction? 

Richard Simone: We are not seeing a significant increase in telehealth spaces yet, as many facilities are using existing spaces for this purpose. I think specific spaces will need to be designed and built in the future, especially given the fact the 2022 guidelines for design and construction will incorporate specific acoustical treatment requirements for noise reduction, interior noise and speech privacy for telehealth spaces. I believe future design will have to consider telehealth-specific spaces, disbursed throughout the facility, with easy access for doctors and staff.

CPE: What are the infrastructure and operational considerations developers should take into account when building health-care facilities in a post-COVID-19 world?

Richard Simone: Considerations should focus on flexibility, including the ability to quickly change HVAC systems from positive to negative and vice-versa. Developers should also efficiently design in possible surge capacities, which would require the ability to quickly change private patient rooms to semi-private and the option to add more patient beds in urgent cares, ICUs and ED settings.

CPE: What can you tell us about the challenges arising in health-care construction?

Richard Simone: Many health-care systems and facilities suffered a tremendous financial impact over the past 15 months, and as a result, several projects are still on hold. The challenge is getting the systems back to feeling financially stable to get back to planning and building.

CPE: How do you see the sector going forward? 

Richard Simone: We still believe the health-care sector is the strongest market, with the greatest short-term and long-term growth potential. It appears to be rebounding quicker than other sectors. Although not as quick as we hoped, it shows signs of coming back stronger than before.

I believe the government—federal and state—has realized how fragile and out-of-date some of our health-care infrastructures are, and they will make the dollars available for hospitals to expand, upgrade and, in some cases, build replacement hospitals.

CPE: Are there any other trends we should keep an eye on? 

Richard Simone: Not a positive trend, but certainly impactful, is the challenge regarding the shrinking availability of skilled labor, as a large bulk of the workforce is aging and there is a lack of a new generation interested in learning the trade.

 

Source: CPE

The Pandemic’s Impact On Health Care Design: Smaller, Flexible Spaces With Great Adaptability

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The pandemic rocked U.S. health care facilities in 2020, leaving them with falling revenue from moneymaking surgeries and ordinary care as physicians and nurses shifted their attention toward patients infected with the coronavirus.

But the real change will come three to four years from now, when the impact of new designs implemented on existing and new healthcare facilities are deployed based on what architects and physicians have learned over the past nine months.

“Health care clients are already shifting their focus and asking for smaller footprints and more space flexibility along with additional isolated, negative air pressure rooms,” said Architect and EYP principal Miranda Morgan, while speaking at Bisnow‘s ‘The Future of DFW Healthcare’ webinar. “The smaller footprints are just more efficient and lean. We are still providing everything that is needed, and we are still doing big huge patient towers. But instead of big luxury, patient rooms, clients are asking us to be closer to code and to get what you need in that space and provide the patient with a good experience, but don’t go overboard.”

A large focus of future design will be on keeping healthy and sick patients separate rather than feeding everyone through the same access points and maneuvering the same hallways. Luxurious common areas have lost some favor as health care systems shift toward making sure more rooms are available to isolate emergency care and hospital inpatients while also better managing various points of access to segregate healthy and sick populations on-site.

“We are examining the way patients flow through the facilities,” said Dwain Thiele, UT Southwestern Medical Centersenior associate dean. “Some of the most challenging are imaging facilities or places that previously did not have a large amount of space, hallways or waiting rooms. It is something we will be looking at in the future.”

“What we have seen through the pandemic from a needs standpoint is more access points for people to be seen and to have access whether through telehealth or smaller, faster clinics where people can get in and out,” Transwestern National Managing Director of Healthcare John Huff said. “I guess we realize we don’t all want to sit in a huge long waiting room for an hour.”

In the future, waiting rooms very well could be a thing of the past, with that square footage allocated to more isolated treatment rooms, health care experts said.

“Other trends here to stay include the ongoing push for more outpatient care centers and ambulatory facilities that can take care of non-life-threatening illnesses while hospitals are hit with pandemics,” Huff said.

“Technology also will play a significant role in reshaping the future of health care, with telemedicine, or remote health care visits, allowing hospitals to keep healthier patients away from pandemic-stricken areas,” Methodist Health System Chief Operating Officer Pamela Stoyanoffsaid. “I would say prior to COVID, we probably saw about 1% of visits in the outpatient setting with telehealth. In April and May, when we saw the first surge, we were probably up to 80% to 90% of our visits. When some of the restrictions lifted, telehealth usage dropped back down to 15%, but it’s expected to have a place in the future of health care services. It is now a massive part of what we do, and it is here to stay.”

 

Source: Bisnow

2019 Forecast For New Research Labs: Construction Innovations Help Accelerate Scientific Discoveries

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Researchers and other scientists who have access to high-performance research laboratories are pioneering breakthrough discoveries in medicine, science and biotechnology.

From the medical solutions that are the hallmark of Washington University to the vital research that will take place at the National Bio and Agro-Defense Facility (NBAF) in Manhattan, Kansas, sophisticated lab environments support the region’s research-driven enterprises.

Experts in the design and construction of lab spaces believe several factors are shaping the next phase of research environments in 2019 and beyond. Each trend supports the universal goals of accelerating innovation, attracting and retaining top talent, and bolstering an organization’s overall competitiveness.

McCarthy collaborates with world-class architectural and engineering partners in building the next generation of these advanced research facilities.

Innovative Visualization Streamlines Construction

The desire to bring new research space online as quickly as possible is driving a shift toward fast-track construction schedules.

Virtual design and construction technologies streamline the construction process and enable the offsite prefabrication of many building components — from exterior drywall or curtainwall systems to equipment racks, piping, ductwork and electrical conduit.

“Prefabrication helps us save time and optimize quality by assembling components in a controlled offsite environment vs. building them in the field,” says McCarthy Project Director Seth Kelso, who oversees construction of the NBAF project.

Visualization tools such as 3D modeling and virtual and augmented reality allow future users of a space to realistically experience it — and give valuable feedback to improve it — at an early stage when modifications can be made with minimal impact to the budget or schedule.

“It may be difficult for some users to understand two-dimensional drawings or even a 3D model, but with VR and AR, they can put on goggles and be immediately transported inside a space that we’ve modeled,” says Kelso.

In recent years, there’s been an evolution from the traditional design-bid-build method of construction to design-build and other methods where the construction manager is brought onboard at the same time or shortly after an architect is selected.

“I fully support bringing in the construction team as early as possible,” says Josh Meyer, managing principal at Jacobs Engineering. Under his leadership, Jacobs has been involved in more than 300 lab buildings totaling over 50 million square feet. I’m asked by clients all the time how much projects are going to cost, but I’m not a cost estimator. The earlier you bring in people that really understand construction costs and local market conditions, the better.”

Protecting The Health And Safety Of Researchers

Safety is a top priority within every lab environment, but it’s especially vital for public health labs that conduct research related to infectious diseases, biological agents and other sensitive areas.

“Building these high-containment research labs and vivarium spaces like those at NBAF requires specialized equipment and precise construction techniques, with very stringent requirements and no tolerance for deficiencies,” says Kelso.

Located within the Kansas City Animal Health Corridor, the state-of-the-art NBAF facility will study diseases that threaten both America’s animal agricultural industry and public health. To be operated by the U.S. Department of Homeland Security, it will be the only U.S. lab for large animals constructed to meet biosafety level 4 (BSL-4) — the highest containment level established by the Centers for Disease Control and Prevention.

“The NBAF facility is the only lab of its kind at that scale and complexity and, like most U.S. public health labs, it will be the best in the world,” says Daniel Watch, science and technology practice leader at Perkins+Will, the project’s lead architect.

Promoting Team-Based Research

A new era of team-based research has ushered in the need for flexible spaces with advanced technology to facilitate ongoing collaboration among colleagues who may be located down the hall or halfway around the world.

“Today’s organizations are thoughtful about setting up research teams that integrate people from a wide range of backgrounds and locations,” says Watch. “A researcher in St. Louis might be connected to a team in Jeddah, Saudi Arabia, or Beijing, China.”

A growing number of institutions are also building lab environments to accommodate unique collaborations with external partners.

“I’m seeing a lot more maker space, accelerator space and other innovation space that brings in partners from industry, which is exciting,” says Meyer. “If researchers can go from their lab to innovation space that’s really close — either in the same building or nearby on campus — it can help drive innovation.”

Because of the digital transformation of the R&D process, traditional “wet labs” are shrinking while flex space and office areas for computational science are growing. Smaller, more sophisticated lab and medical imaging equipment can be stacked and tied into the technology infrastructure to support data analysis within a compact footprint.

“With the number of high-quality projects that have come online within the last several years, it’s much harder to recruit and retain people in substandard space,” Meyer says. “The competition is fierce and it’s one of the biggest reasons we’re seeing an uptick in the number of new research facilities for institutional clients.”

Just as close collaboration drives successful research, it’s also a key component in the construction of new research facilities.

“Lab projects require ongoing collaboration between design and construction teams, together with the client, to align and achieve project goals,” says Kelso.

 

Source: St. Louis Biz Journal