De­sign of new spa­ces lag­ging

Modern Healthcare - - SPECIAL REPORT - —An­dis Robeznieks

Although the econ­omy may be slowly re­cov­er­ing and un­cer­tainty over health­care re­form is lift­ing, health­care con­struc­tion is lag­ging be­hind as or­ga­ni­za­tions as­sess what they need to do and can do next in an in­dus­try that is chang­ing be­fore their eyes.

As a re­sult, there might not be as much ac­tiv­ity as sys­tems con­tinue to work on lon­grange plans and strate­gies.

“I think it’s go­ing to be fairly flat at best,” says Chip Cogswell, na­tional health­care di­rec­tor for Turner Con­struc­tion Co. “From a sales per­spec­tive, 2012 was a very good year and ex­ceeded our ex­pec­ta­tions.” But, he says, there are very few big projects or new hos­pi­tals be­ing built on un­de­vel­oped sites.

In­stead, there are “a lot, a lot, of ren­o­va­tions” and sev­eral ex­pan­sion projects, he says. While Cogswell says Turner saw $2 bil­lion in sales in 2012, most projects were in the $9 mil­lion-to-$12 mil­lion range.

Peo­ple would pre­fer to build new, Cogswell says, but they’re ren­o­vat­ing what they have as they as­sess what fa­cil­i­ties are needed in a value-based health­care sys­tem rather than what was tra­di­tion­ally de­sired in the fee-forser­vice, vol­ume-based world.

“The elec­tion is over, so I don’t think there is as much un­cer­tainty about what the rules are go­ing to be,” Cogswell says. But the in­dus­try is in a state of flux and or­ga­ni­za­tions in tran­si­tion are find­ing them­selves with “one foot on the dock and one foot on the boat.”

Joey Kragelund, health­care prin­ci­pal in the Los An­ge­les of­fice of HGA Ar­chi­tects and Engi­neers, says clients are tak­ing a step back and re­think­ing what to do and re-eval­u­at­ing their plans.

Some con­struc­tion is be­ing driven by new tech­nol­ogy, he says, ex­plain­ing that build­ings de­signed as re­cently as the 1990s are not suited to house mod­ern med­i­cal equip­ment.

One trend Kragelund sees con­tin­u­ing in 2013 is de­sign­ing health­care spa­ces to have more flex­i­bil­ity. For ex­am­ple, fa­cil­i­ties de­signed for use for only four hours a day might be re­placed with space de­signed to be used eight to 12 hours a day. With those de­signs, hospi­tal-based physi­cians could see their pri­vate of­fices be­ing re­placed with an open, shared fa­cil­ity, he says.

Kragelund sees clients get­ting “real ag­gres­sive with sus­tain­abil­ity” on fu­ture projects with a fo­cus on en­ergy ef­fi­ciency or re­new­able en­ergy gen­er­a­tion us­ing wind tur­bines or so­lar pan­els. There are no spe­cific el­e­ments that ev­ery­one will adopt, he says, but each project is be­ing as­sessed as to what its site can uniquely ac­com­mo­date.

“I think it’s an ‘all-of-the-above’ strat­egy,” Kragelund says.

He also sees more use of prefabricated con­struc­tion el­e­ments. That method calls for com­po­nents such as pa­tient bath­room or util­ity pipe units be­ing as­sem­bled else­where and then brought on-site, which can lead to sig­nif­i­cant over­all sav­ings.

“We are def­i­nitely look­ing to do that with a ma­jor­ity of our con­trac­tors,” Kragelund says. “I think it’s def­i­nitely help­ing, and it speeds de­liv­ery.”

The en­vi­ron­men­tal sus­tain­abil­ity trend is ex­pected to con­tinue in 2013, and it is typ­i­fied by the De­fense De­part­ment’s $160 mil­lion Fort Ir­win Re­place­ment Hospi­tal in San Bernardino County, Calif.

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