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As the U.S. emerges from the COVID-19 pandemic, healthcare construction across the country remains strong. Healthcare capital programs and projects that were delayed to accommodate pandemic related emergency work are now beginning or resuming work, and the overall push for more and/or newer healthcare facilities continues. However, the long-term impacts of COVID-19 on healthcare construction are sure affect the market for decades to come.
Hill International supports healthcare projects around the world and across the U.S., including in the busy Mid-Atlantic and Midwestern healthcare markets. To cite just one data point, a 2021 survey of industry players from the Associated General Contractors predicted double-digit growth in Midwest hospital facilities for the next five years, while overall U.S. healthcare construction spending is expected to nearly $52 billion in 2022, according to data from the St. Louis Federal Bank. Led by a team of veteran healthcare program and project management experts, Hill’s teams are helping to realize this growth first-hand, and are also helping owners to adopt the COVID-19 trends influencing healthcare construction.
New Lessons Learned
“The pre-pandemic best practices of healthcare construction still apply,” says Hill Senior Program Manager Peggy Cowan LEED AP. “We still need to protect the patient experience, decentralization is continuing, and adaptability and flexibility are the norm.” However, Cowan adds that the pandemic has added new lessons learned to healthcare construction. “During the worst of the pandemic,” she explains, “hospitals relied on disaster and emergency preparedness plans and resources from organizations like the American Society for Health Care Engineering (ASHE).” These immediate projects included critical issues like improving ventilation, constructing isolation spaces, expanding emergency areas, and building temporary structures to handle overflows.
In the short term, ASHE reports, this surge of work delayed ongoing capital work: a 2021 survey showed that 76% of 200 surveyed hospitals delayed one or more construction projects due to COVID-19, while 29% canceled at least one project altogether. For projects started before the pandemic, renovations were overwhelmingly the project type delayed or canceled.
Cowan, with more than 40 years of construction management experience with such high-profile healthcare clients as the Children’s Hospital of Philadelphia, the Johns Hopkins Health System, and Essentia Health, says that the post-pandemic situation has resulted in projects that are catching up or kicking off after long delays, but that now also need to integrate new best practices. “The systems and layouts designed pre-pandemic may have been state-of-art before COVID-19, she says, “But now we know so much more about, for example, how make air handling system design and construction cost effective, easy to install, and highly efficient. It’s a lot for any project to absorb. Especially one that paused midway and is now ramping back up.”
Specifics and Examples
Hill Vice President Therese Shearer, PE, serves as Program Manager for one of Hill’s most for-reaching healthcare assignments in the Midwest: the Allegheny Health Network’s (AHN) Capital Improvement Program in Western Pennsylvania. In her role, Therese is the manager for all Hill employees performing staff augmentation services for the management of AHN’s $2 billion capital improvement program, which encompasses more than 200 projects to date. Therese is responsible for initiating scope, schedule and budget, A/E selection and management, and coordination with user groups throughout construction and final acceptance.
The program includes cancer centers, outpatient facilities, hospital renovations, pharmacy upgrades to USP 800, NICU expansion, behavior health unit upgrades, imaging unit renovations, and many additional renovation, IT, security, and maintenance projects. Therese reports to AHN’s executive committee and is involved in pre-planning of major capital projects before they receive the go-ahead to proceed. As program manager, she provides oversight of the project managers, who are responsible for tracking the scope, schedule, and budget for each project, while overseeing the A/E team and working with various user groups and hospital leadership.
Says Shearer: “I think you can identify four specific areas where the lessons learned of the pandemic have had the greatest impact. The projects we see today are considering adding some or all of these ideas into their designs.” Shearer details these areas below:
Entry: Pre-screening everyone who enters a hospital is the new norm. Some facilities are installing technology that screens everyone automatically, so front desk staff knows immediately if someone has a fever, for example. We’re also seeing physical barriers in some places to help control the speed of entry, such as turnstiles. Shearer also notes that some facilities are building new “third entrances” that connect to the emergency department but allow patients to be handled separately from the main department entrance.
HVAC Systems: Medical facility designs have long stressed containment of airborne pathogens and patient isolation, but there is new emphasis on having the flexibility to change air flows to decrease airborne risks. For example, before the pandemic, UV lighting in HVAC systems was rare, now it’s almost standard. Similarly, many healthcare systems now require bigger, strong HEPA filtration systems with MERV 16 level protection.
Common Areas: Waiting rooms were already undergoing a re-imagining in many hospitals and other facilities to be more welcoming and accommodating and less institutional. Now, that trend is continuing but with steps taken to ensure social distancing, like more space between chairs, low height walls, and separation panels. In the healthcare provision spaces, the move towards uniform room design is continuing as well, with medical gas, additional power, and other fixtures now installed in standard patient rooms as well as in ICU spaces. Similarly, anti-microbial finishes in high-touch areas, like sinks and door handles and elevators, are becoming standard.
Specialty Facilities and Micro Faculties: The move out of large, centralized healthcare facilities to more specialized and smaller facilities is not new, but what is new is the way many clients are now looking to deliver these facilities. This includes the use of alternative delivery methods, like design-build and CM-at-Risk, as well as using modular products built off-site. These trends offer several potential benefits, from reduced schedules to having a standardized controlled environment. COVID-specific units, for example, urgent care centers, and single-story and low-rise facilities can great candidates for design-build, modular healthcare construction—provided the owner understands the compromises involved.
Demographics and Decentralized Facilities
In Ohio, the pandemic’s impact on healthcare construction appears to have spurred growth in the sector both in terms of COVID-19 specific projects and ongoing capital programs, as new, hundred-million-dollar hospital projects and programs launched from Columbus to Cincinnati and everywhere in between.
Hill Senior Project Manager Adrienne Sraver, CCM, PMP, says this unbroken growth was due to several factors. “Demographics plays a key role,” she explains. “Ohio has a growing population as well as an aging population in many, more rural areas of the state. Ohio’s healthcare owners are also very sophisticated and understand the trends at work in healthcare design and construction and know how to integrate them into their projects.”
Sraver’s experience includes managing healthcare assignments for OhioHealth, Ohio State University, and Mount Carmel Health—three of the largest healthcare providers in the state. “For OhioHealth,” she says, “the projects we’re working at Marion General Hospital embody a lot of these trends, like making certain facilities have the flexibility to handle patient surges and providing cutting-edge care in more rural locations.” For example, Sraver is currently helping to deliver a new, multi-million-dollar cancer center facility built within an existing office building in Marion, a smaller city located about an hour from Columbus. Notably, work is happening while the Center is still fully operational, including conducting surgeries.
“To make this happen with all of the different departments and other stakeholders involved requires close coordination with everyone,” Sraver says. “This includes nurses, maintenance, and the doctors and surgeons as well as all the contractors, utility providers, and suppliers.” The goal, Sraver says, is to deliver the facility with zero impacts to the patient experience, while integrating the new norms of isolation, specialty support, and air filtration all while providing topflight cancer care close to home for patients.
The pre-pandemic driving factors of healthcare design construction—growing populations, decentralized services, and improving the patient experience—all remain post-pandemic. However, new standards and increased opportunities—and risks—have changed the market for good. “Supply chain issues and procurement challenges are certainly the immediate issue,” says Cowan. “But those factors will inevitably work themselves out, and we have management tools and techniques that can help owners plan for those risks. For the long term, clients that integrate the lessons learned of COVID-19 into their new projects, from ASHE standards to new design and construction ideas, are going to be the best prepared to care for their patients, no matter what comes next.”
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