NEWS & TRENDS

Welcome to the AMHIGLEY BUILDERS BLOG, where our experts share their insights and technical expertise in the construction industry.

 This month, Joe Kapitan, AIA, NCARB,CHC, explores the key considerations driving healthcare construction, from patient-centered design principles to trends shaping the future of these vital spaces. As someone who has been on both the client and construction manager side of healthcare construction, Joe offers unique insights on what makes a company experts in shaping the future of healthcare construction.

  Joe Kapitan, AIA, NCARB, CHC | Senior Director of Operations & Healthcare, OH | 2 Years with AMHigley

CRITICAL COMPONENTS FOR SHAPING HEALTHCARE CONSTRUCTION

Modern healthcare construction goes beyond just building structures; it’s about creating spaces that blend innovative design, a focus on patient care, and cutting-edge technology to create spaces that support healing and well-being. By prioritizing the key aspects of healthcare construction, construction managers can address the unique needs of each project and establish expertise in this specialized field. Every hospital or medical office operates differently, with its own mission and priorities.  As healthcare builders it is important to understand these complexities and ensure that patient care remains at the heart of every project.

Healthcare construction requires many approaches to building that differ from other industries. It often takes a larger-than-normal team to successfully pull off a significant healthcare construction project. There can be an extensive list of experts and consultants who all need to be engaged at various stages of the project. For example, medical equipment consultants work with the design team and the hospital user groups to identify the number and types of medical equipment necessary. They do the research on specific makes and models, and coordinates with the design team so that the correct electrical, data, plumbing and medical gases are supplied at each equipment location.

A medical equipment consultant’s scope of work can be extended to include order placement and shipping/receiving logistics. If the healthcare client decides to handle the procurement phase themselves, then the construction manager can expect to be much more involved in coordinating shipping and receiving with the owner to meet the completion and activation schedule. It is a particularly hectic time for a healthcare project, when the construction manager is completing punch list and building commissioning work at the same time the owner is bringing in medical equipment, furniture, signage, art, and IT equipment.

Southwest General Health Center 

Selecting the proper team is critical when a construction manager works in healthcare environments. Having a field superintendent experienced in healthcare construction is vital, and having detailed knowledge of mechanical, plumbing, and electrical systems brings added value. Most healthcare construction is happening within operational buildings or campuses. Multiple departments support the daily work of the hospital, which means that a certain rooms and utilities must remain open and active at any given time. Field superintendents can adapt, and design phased schedules to coordinate all work that needs to be done. A tremendous amount of pre-planning is required to successfully deliver a complicated project like the phased renovation of a central sterile department while it continues to function.

Since having experienced team members is a large part of the successful completion of a healthcare project, there are certifications that can help signal understanding and experience. The ICRA (Infection Control Risk Assessment) certification is certainly important for the tradespeople who are erecting and maintaining ICRA barriers—it ensures that they have a solid understanding of infection control and prevention requirements, and the reasoning behind them. The gold standard for identifying construction professionals who understand healthcare’s unique needs is ASHE’s Certified Healthcare Constructor (CHC) designation. Every CHC-certified construction professional has passed a rigorous test that ensures basic knowledge of ICRA and Interim Life Safety Measures (ILSM), healthcare codes and regulations, medical gas systems, HVAC room pressurization requirements of various spaces, radiology requirements, normal/critical/life safety electrical loads, and more.

Construction managers must understand the differences in types of healthcare construction—the needs of a new hospital will be different than those of a medical office building. An MOB is considered “healthcare lite,” in that it usually doesn’t contain medical gases or surgical spaces and may only have simple lab spaces and basic radiology equipment (typically X-ray or mammography machines). MOB construction is often free-standing, so ICRA is rarely a concern. Working inside an active hospital is much more intense, and the restrictions are numerous. Navigating the extensive list of restrictions is the daily work of the construction field staff performing construction activities in the middle of an active healthcare environment.

Western Reserve Medical Office Building

Within the walls of a hospital, surprises can be disastrous. To prevent any unforeseen challenges, due diligence and communication are key. Utility shutdowns are a prime example. The typical hospital construction project will have multiple utility tie-ins that will each require a planned shutdown. The water, power, HVAC, or electrical shutdowns almost always affect critical hospital systems including patient rooms and procedural areas, so great care is put into planning the shutdown weeks in advance. Shutdowns usually happen after midnight on weekends when hospital usage is lessened. Workers from other trades are sometimes brought in to stand at the ready, in case of unforeseen circumstances. To have a major utility shutdown completed without surprises is a major win for a project team.

Constant communication is necessary throughout the life of a project. Experts in healthcare construction should focus on educating the client about the construction process to achieve project success. Surgeons and nurse managers are experts in their medical specialties, but they cannot be expected to understand what the construction manager working nearby is doing, or how it could affect them. A seemingly simple task like briefly closing off a portion of corridor for renovation work can have profound effects on the daily operations of the hospital, especially if it was not properly communicated ahead of time. It is not just the adjacent care staff that needs to know—such a closure may affect patient transport, security, materials management, and pharmacy deliveries as well. Maintenance will need to know about it in case they need emergency access to valves and dampers, and EVS (janitorial) workers will be affected. There is no such thing as overcommunication in the realm of hospital construction.

When it comes to construction managers fulfilling the mission of a project, most healthcare clients have a mission statement that includes some version of “patients first,” – Healthcare construction managers must adopt the same mindset. The worst thing a healthcare constructor can do is to impede the quality of caregiving, so everything the construction manager does must be thoroughly pre-planned to minimize dust, noise, material and worker traffic, and utility outages. For example, procedural spaces needing renovation should not be started until the necessary materials are on hand, locally stored, or ship dates have been verified, to minimize the down time of the caregiving space. The ideal statement we want to hear from our clients at the end of a healthcare project is “the new space is fantastic, and you didn’t affect us at all.”

Rock Health Collective - Health Hub

Like an industry within construction, the healthcare field is constantly changing and adapting to modern technologies. Over the last decade there has been a greater use of prefabrication and modular building products for projects. There is more use of modular wall systems such as DIRTT and Falkbuilt. Furniture manufacturers are factory-building and shipping entire exam room casework modules that are quickly hung on wall cleats and simply need the hook up of the sink. Some vendors are making integrated, prefabricated operating room ceiling modules that contain all the necessary air diffusers, lights, and boom supports. On a larger scale, some major healthcare projects are prefabricating entire patient bathroom pods, as well as exam room and lab pods.

Healthcare codes and regulations continue to change, as well, which adds another layer of continuously learning and updating construction practices. When members of the construction team understand the key aspects of healthcare codes and regulations, they can better communicate with the design team and avoid potential pitfalls. For example, operating rooms are almost always required to be under positive pressure, so that outside air cannot enter the room, possibly bringing particulate contaminants and bacteria with it. Knowing this, the construction team can plan to pressure-test the “white box” of the operating room for air leakage right after completion of drywall finishing, but prior to continuing with the interior build-out of the room.

Healthcare construction is a multifaceted endeavor that requires a balance of planning, coordination, and ingenuity. From designing a “patient first” building to addressing operational concerns and ensuring the safety of both the professionals and patients, every aspect of healthcare construction presents its own set of challenges and complexities. Effective healthcare construction managers must communicate clearly, collaborate extensively, and comprehend all aspects of the project to ensure that hospitals or medical buildings function as vital centers for healing and well-being.