Pandemic prompts flexible healthcare design

Adaptable and modular spaces will now be top of mind as healthcare providers retrofit and design their facilities, construction and design experts said.

The COVID-19 pandemic has given health system leaders a new perspective as hospitals have adapted to accommodate an influx of patients. To be better prepared, hospitals will invest in flexibility: convertible and expandable rooms, advanced air-filtration systems, built-in storage spaces, wider hallways and virtual compatibility, among other improvements, experts said.

“I don’t think we would’ve given as much attention to how flexibly we could use waiting rooms for patient care six months ago,” said David Huey, president of architecture firm Dewberry, noting that many emergency department waiting rooms are negative pressure rooms. “Before this, I don’t think any would say, ‘Go ahead and spend another quarter of a million dollars to upgrade those waiting rooms.’ That is prime real estate for treating infectious patients.”

COVID-19 has exposed the vulnerability of the healthcare industry’s emergency preparedness and infection-control infrastructure.

Healthcare workers, architects and engineers have assembled triage testing tents in their parking lots; set up entire intensive-care units and negative-pressure rooms for COVID-19 patients; strategically coordinated storage closets, entrances and exits to preserve protective gear; and outfitted rooms with cameras to limit exposure and control the virus’ spread.

The need for flexible space escalated when COVID-19 hit, said Robin Savage, president and chief operating officer at construction firm Robins & Morton, who expects providers to expand their inpatient capacity.

“A surplus of specialized patient rooms has restricted many systems’ abilities to serve a variety of patients,” he said. “Also, hospital administrators want versatility to use the limited space available on healthcare campuses to meet community needs.”
Broward Health in South Florida converted a portion of its standard patient rooms into temporary isolation rooms by retrofitting windows with negative air machines equipped with digital pressure alarms, the construction firm Skanska USA wrote in Modern Healthcare’s annual Construction & Design Survey.

Some survey respondents indicated that any new construction projects will look drastically different.

“COVID-19 has laid bare the inadequacies of our care system, and those shortcomings will need to be addressed through design, construction and strategy development,” Array Architects wrote in its survey response. “The U.S. healthcare system has been designed, operationally and physically, to be lean and very good at providing tertiary and quaternary care, and thus not very flexible around capacity. The COVID-19 pandemic should cause us to rethink investments in many areas to better serve patients, while balancing the need for preparedness for the inevitable next time.”

Healthcare providers are considering a range of options to minimize risk, including redirecting patients and providers through their facilities to maintain social distancing and installing forehead temperature scanners in waiting room entrances, said Catherine Gow, principal of health facilities planning for Francis Cauffman Architects. Widening hallways to 16 feet to improve access and add capacity is also under consideration at some facilities.

Rather than just designing a regular med-surg unit, providers are weighing whether to make it convertible to an intensive-care unit without having to worry about portable air filtration systems, medical gas lines and emergency outlets.

“One nurse manager I was talking to at Penn (Medicine) said that healthcare was never going to be the same again—I agree,” Gow said.

That nurse said some of Penn Medicine’s units didn’t have windows, so they had to buy more than 100 baby monitors so they could keep an eye on patients, Gow said.

Even smaller things like curtains pose infection-control issues, and shades will likely be integrated into the windows themselves, she said.

“Acuity-adaptable rooms, ultraviolet lights—all these things will change in the design of the future,” Gow said.

In addition to flexibility, providers aim to become more self-sustaining. Victoria, Texas-based Citizens Medical Center is building a natural gas micro- grid—a local energy grid that can operate autonomously—with the help of backup energy supplier Enchanted Rock.

While many healthcare providers have diesel backup generators, those can typically only power a fraction of their facilities.

After Hurricane Harvey hit in 2017, Citizens Medical Center wanted a more robust solution, said Allan Schurr, chief commercial officer at Enchanted Rock. “There’s a trend for hospitals looking for full facility backup power,” said Schurr, adding natural gas is cleaner and less expensive than the diesel alternatives. “It’s becoming apparent that hospitals have to become more flexible than they are today. They are concerned about the compounding effect of a health crisis plus significant power outages.”

But capital budgets will likely be constrained as hospitals have lost a major revenue source amid rising expenses. More than a third of the survey respondents said their healthcare construction and design business is either flat or declining. That share has likely increased since most respondents filled out the survey in mid-April.

Many healthcare providers are postponing or canceling construction projects as their revenue plummets, largely due to the delay of non-urgent procedures. Margins have also sunk.

“It has significantly impacted our revenue,” construction management firm LF Driscoll wrote in the survey. “Many projects have been shut down or slowed down. We have had outright cancellations of projects that have been awarded but not yet started. We have incurred significant costs that cannot be passed on for protection of our staff, workers and job sites.”

Small, rural hospitals that don’t have the infrastructure to accommodate critically ill patients are taking the biggest hits, Huey said. “Some hospitals will close,” he said.

Rural hospitals have been removing or repurposing inpatient beds given that on an average day, fewer than half were occupied. Overall, hospitals shed around 150,000 inpatient beds from 1975 to 2018, according to the American Hospital Association.

Experts don’t expect the current crisis to measurably shift that trend. Still, while the overall number of beds will likely continue to wane given the advance of outpatient care, home health and telemedicine, there will be a renewed focus on intensive care, they said.

“While we believe that healthcare work will continue to grow, every project currently planned or in construction will or should be reexamined to see if adjustments can be made to better serve the ‘new normal,’ ” Pepper Construction Group wrote in the survey.

With hospitals working toward more flexible, inpatient accommodations, the national dialogue surrounding the need for specialized healthcare spaces will undoubtedly change, Savage said.

“The design of new facilities and the renovation of existing ones will likely heavily reflect the lasting effects of the pandemic,” he said.

SURVEY: Construction & Design: 2020