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Op-Ed: Designing for the future of health care – and pandemics

COVID-19 arrived in the U.S. in the beginning of 2020 and within a couple months the pandemic was virtually closing down the entire country. The COVID-19 pandemic caused disruptions, pain, suffering and negative consequences for a broad spectrum of our world population and economies.  

The health care industry and the construction of health care projects have been significantly impacted responding and fighting this unprecedented pandemic in modern history. The disruption to our health care systems caused lost revenue from non-emergency and elective surgery. Those systems subsequently started reevaluating, delaying or canceling large capital construction projects. 

Some essential and smaller scale projects did move forward with many challenges. And the short-term emergency construction projects that continued and will continue will not offset the long-term effect from the projects that have been canceled or postponed indefinitely. 

Moving forward, health care construction and related industries will be challenged to navigate the short term while health care systems and hospitals plan for the future. Certain infrastructure projects will proceed so hospitals can improve HVAC systems for infection prevention, add components to enable flexibility to change pressurization on a moment’s notice, separate patients in the emergency department, increase ICU and isolation capacity, expand storage capacity and control supply chain. 

The pandemic disrupted the entire health care industry and altered how almost every project is and will be designed and built in the future.  The challenges from the disruption have demanded that construction contractors across the United States think strategically and to become anticipatory organizations as they ponder the future of construction in general and of health care construction in particular. 

It is essential for designers and contractors to dedicate additional time to learn, adhere to, and adjust to the way people view daily habits, environments, interactions and overall personal safety. The required reassessments need to be in the forefront for the planning and preparation for the next health emergency or natural catastrophe.

Health care facilities planning in a post-COVID world must consider complex operational and infrastructure design and construction elements. Hospitals must set an important goal to continue elective and necessary non-life-threatening surgery cases while dealing with overflowing emergency departments and intensive care unit beds. 

Patients need to have access to and feel comfortable to have surgery during a pandemic. Therefore, medical centers must implement design and staff reconfiguration plans to create segregated areas within certain units or adjacent to the main hospital to ensure connectivity, a smooth flow of processes and procedures and increase patient satisfaction.

Hospitals must take a hard long-term look at prioritizing infrastructure upgrade projects. Installing new HVAC (heating, ventilation, and air conditioning) systems and improving the medical gas infrastructure may not have a significant return on investment initially, but will be major factors relating to patient decisions when determining where to have treatments done.  Patients actually may ask about building wellness in addition to who is the surgeon doing their procedure.

The presence of correctly scaled systems within a health care facility is vital to allow for adaptability and agility. Designers and contractors must increasingly focus on taking an intense look behind the walls of health care facilities for future renovations and new construction. IT and communication systems must be in place and flexible enough to monitor, treat and communicate outside the room of the highly contagious patients. 

Health care systems are planning to expand and deploy services to more rural areas. Micro hospital development is being considered with urgent care and inpatient capabilities on a smaller scale. This strategy will provide treatment options closer to patients and alleviate some overflow at the main acute care hospitals. More services that must continue regardless of a pandemic (e.g., childbirth) will be moved out of the hospital to an ambulatory or free-standing satellite facility.  

Discussions are needed regarding alternative development, such as increased use of modular construction solutions, which the medical sector has not fully embraced. Adoption of this type of prefabrication will be important due to the potential decline in skilled construction workers and also to gain the significant value of benefits such as controlled construction environments, waste reduction, and quality control. 

The construction industry greatly increased its knowledge about health care facility needs during the pandemic. The lessons learned will significantly benefit projects that are in planning or early in construction stages. Design and construction teams will have the strategic advantage of being able to quickly respond by modifying infrastructure, evaluating new workflows and patient flows, incorporating technology, and even changing to adaptable or universal rooms. Existing facilities will present many innovative opportunities and options for retrofits. 

Innovations, such as the “Internet of Medical Things,” have enhanced a doctor’s capabilities to monitor patients remotely in real time. Such innovation results in a reduction in number of patient rooms needed in some medical facilities. The innovation also increases the complexity of the construction due to constantly evolving designs to accommodate modern technologies.   The increase in surgeons’ need for virtual reality and robotics has created the need for more VR training spaces and smart operating rooms.  

Key stakeholders, designers and construction teams are re-thinking master plans. For example, waiting rooms are being reconfigured to better accommodate patient needs, social distancing and general safety and wellbeing, while also allowing for the expansion of critical spaces. One major trend related to the pandemic is semi-private rooms being converted to private rooms to encourage social distancing. And quarantine wings are being added or expanded. 

The pandemic has caused an exponential acceleration of technology and change in health care facilities because of the increased needs for innovation, agility and flexibility. There never has been a greater opportunity for innovation in health care. Design and construction innovations are facilitating the development and use of technology and techniques that once were thought to be impossible or not possible in the near future. And that means designers and contractors now are now able to plan and achieve what was once impossible.

Glenn Ebersole is a registered professional engineer and is the Executive Director, Strategic Business Development/Marketing for RCS Construction – a woman-owned general contractor firm – in Collegeville, PA. He can be reached at 610-415-1130 or gebersole@rcsconstruction.net

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