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 long-range 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-for-service, 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.”