The 2020 pandemic set off a chain reaction of challenges for the healthcare construction community, altering the way hospitals and medical practices are being built and renovated.
Birmingham-based Robins & Morton recently unveiled a study, The State of Healthcare Construction, which highlights market trends and shows how building and design partners have responded to dramatic changes.
"In many ways, the past year has been even more disruptive than 2020, creating challenges that everyone in healthcare construction will face in the year ahead," said Bill Morton, CEO of Robins & Morton.
The report's findings underscore the importance of a collaborative approach in addressing escalating costs, supply chain issues and labor shortages. The report reviews how the pandemic accelerated changes in traditional approaches to healthcare construction, and how those best practice lessons are being applied to these challenges.
Managing Volatile Construction Costs & Supply Chain Disruptions
Soaring construction costs, severe labor shortages, chemical plant shutdowns, wildfires in timber forests and a record-setting residential boom have greatly hindered healthcare construction projects.
Supply chain bottlenecks are coupled with the doubling in demand of materials and labor. For example, more than one million construction jobs remain unfilled across the nation. These challenges, combined with a record-breaking surge of creating alternate care facilities to treat COVID patients in 2020, have put the industry in the lurch.
"Building these facilities so quickly showed everyone the benefits of a committed partnership and opened our eyes to questioning the status quo," said Patrick Duke, managing director of Dallas-based CBRE Healthcare. "That experience changed the notion of what was possible when everyone came to the table together to solve a daunting problem."
The report points out three practical, time-sensitive changes that have occurred to accommodate market fluctuations:
The siloed approach in healthcare construction has diminished. Instead, scenario planning across disciplines during pre-construction is essential.
The ongoing level of material shortage and resulting cost escalation requires changes in procurement strategy, including the strong consideration of early purchasing advantages.
Because disruption caused by spiking material pricing caught industry workers off-guard, it's become more important than ever to communicate with transparency.
"This recent shift requires a new mindset and includes the need to reset past practices," said Kevin Harney, AIA, vice president of New Jersey-based ESa Architects.
Moving Beyond Code with Resilient Building Envelopes
Over a decade ago, a tornado destroyed St. John's Regional Medical Center in Joplin, Missouri, ripping off most of the building's walls, windows, and roof system. Five patients died when ventilators lost electrical power.
The consequences of this tragedy and related natural disaster losses led to recently adopted wind-load standards. This year, a new and emerging edition of the energy codes require a higher level of thermal performance from the exterior envelope, including roofs, windows, and walls.
"Hospital owners realize the cost and risk attached to doing long-term constant maintenance," said Sam Burnette, AIA, principal at ESa's design firm. "We've learned that you can achieve a tremendous return on investment and a lower life cycle cost when you build with better quality exterior building envelopes."
Burnette has noticed a dramatic reduction in expense and patient disruption from repairing leaky glass to upgrading building exteriors to correct poor energy performance.
Parenthetically, noise mitigation is often an overlooked factor in building envelope decisions. "If the patient isn't getting a restful night's sleep or can't nap following medical procedures, they're not likely to give the hospital a positive score on noise management," Burnette said.
Building envelope decisions extend far beyond today's code requirements to include long-term opportunities for futureproofing hospitals.
Early in the process, the options for building envelope components should be considered by an integrated team of designers, consultants, builders, and hospital facilities staff.
A set of decisions with lasting impact on building resilience, patient and staff safety and service continuity for the hospital should be considered by the frequency and extent of natural disasters.
The strategic choice to avoid the need for costly revision and re-work years later should be supported by research, testing, and envelope mockups.
Increasing Trust-based Collaboration
When BayCare Health Systems expedited the opening of multiple patient floors on a new tower at St. Joseph's Hospital in Tampa, a host of players - the client, contractor, architect, engineer, trade contractors, vendors, city and state inspectors and city officials - forged new ways of collaboration.
"The important thing is to have people who understand what we're trying to accomplish with the project," said Larry Bagby, assistant vice president at AdventHealth Tampa. "It may be a little uncomfortable, but it's so important to go outside your comfort zone and seek out learning that's beyond your own day-to-day environment."
For example, when the Carilion Roanoke Memorial Hospital's expansion was underway for The Crystal Spring Tower in Roanoke, the team of players was extended to another level: including conversations with community residents.
"These conversations revealed the real purpose of the hospital expansion - not just build a hospital, but to help to take care of people for generations," said Josh Farr, a superintendent at Robins & Morton.
Duke said the pandemic experience of the past two years "makes the human side of the business more important. Company leaders and our clients are more willing to question past methods and ask how to do it better.
Bagby suggests team members observe the function part of the project. "Talk to the forward-thinking nurse manager or the maintenance workers and ask them what they dream about to make their work easier," he said. "When we find individuals who behave that way, everything else becomes easier to accomplish."