The construction industry as a whole is growing, and the health care sector continues to be a big part of that growth. There is tremendous pressure for hospitals and health systems to reduce costs and increase efficiencies while improving patient care as well as financial stability. While this may be daunting, streamlining processes and putting in place a few key best practices can save both time and money over the course of these construction projects, allowing for greater focus on patient welfare.

Health care construction spending in 2016 exceeded $40 billion and is expected to increase 5 percent annually through 2020, according to the U.S. Census Bureau. More than 50 percent of construction projects completed between 2012 and the first quarter of 2016 were construction renovations (including alterations and additions), according to information provided by the Healthcare Facilities Symposium. So, how can facilities keep up with these challenging demands and plan properly for the future?

During a recent webinar presented by Gordian, a construction data and software company, David Clark, associate vice president of facilities, construction and design at Jackson Health System in Miami, provided insight into how the health system plans for the future with facility master planning. While many projects are currently ongoing, the actual Jackson Health facility master plan was developed in 2012 around three critical questions:

1. How are we operating today?
2. Are we meeting the needs of the community?
3. How do we develop a strategy to improve and expand operations?

Jackson Health has six hospitals and 12 satellite facilities that together span more than 7.6 million square feet of occupied building space managed by the health system’s respective construction and facilities departments. These departments manage an average of 40 to 50 active projects a year.

With the development of an initial facility master plan, Jackson Health cultivated a new capital program, from which it defined signature projects. These signature projects included expansions and renovations of both the Jackson North Community Hospital and the Jackson South Community Hospital, building a new rehabilitation hospital, patient tower for transplant services and 100-bed hospital in West Miami Dade County.

Interestingly enough, project priorities have been evenly split between renovation projects and replacement projects. Perhaps one of the most difficult decisions included deciding whether a building was worth renovating or if it would it be better to demolish and build from the ground up. This is not an easy decision to make and requires careful consideration.

During the webinar, Clark was asked what matrix Jackson Health uses in determining whether to renovate by adding structures versus building new from the ground up. The organization uses a Phase I, Phase II, Phase III, due diligence process when reviewing renovation project requests.

• Phase I: Look at the project initiative request, look at historical data and estimate cost per square foot to determine ROI on proposed project
• Phase II: Bring on professionals, including architects and engineers, to look more in depth at aging facilities to see if infrastructure can support new project initiative and revisit ROI
• Phase III: Bring the engineering department and architects together with non-clinical departments such as IT to ensure departments can perform non-clinical services to match project initiatives in the structure; continue with cost benefit analysis, and if it is determined that it will work, proceed to renovate; if not, look at other options such as a new build or minor expansion

In making such a crucial decision, accurate construction cost data is key. Often project estimates are compiled from individual pieces of data pulled from different sources. This can lead to less than satisfactory estimates, which will inevitably lead to losses of time and money. They may even lead to erroneous conclusions on whether to move forward with a renovation or a rebuild. Therefore, compiling current, accurate and localized construction cost data is a key best practice during the planning stage of a project.

Square foot models further offer a solution to this crucial element. Instead of piecing individual pieces of data, this tool offers customizable estimations based on factors such as building type and location. During the planning process, comparing the numbers for a renovation square foot model versus a new construction square foot model provides a clear vantage over which option best suits the project at hand.

While the above methods on their own can lead to notable improvements within health care facilities, it is when they are strategically put into action together that major time and cost savings become a reality. This will lead to both better bottom lines and better patient care.

Scott Creekmore is the director of account management, healthcare for Gordian. Creekmore has managed job order contracting programs for Harris County, Harris County Hospital District, University of North Texas, University of Texas Health Science Center at San Antonio, USPS and City of New Orleans.  

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Today’s health care facilities have to be adaptable and efficient to remain competitive in the face of change, and also note the importance that the physical bricks-and-mortar building plays in the overall delivery of modern health care. In Part I of this article, we discussed how modern buildings play a critical role in addressing the unique challenges in today’s health care facilities. Meeting objectives like coordinated and integrated care requires facilities that are cutting edge, which means new approaches to planning, architecture and construction as well as operations and service delivery. With an emphasis on preventive medicine and cost-saving measures, facilities must incorporate design features that allow them to adapt to the rapidly changing landscape of the industry.

The Introduction of Modern Technology

The introduction of modern technology – from diagnostic and treatment technology to electronic health records (EHRs) and HIPAA Compliant Phone Services (Read More here) – all drive new protocols and methods, requiring continual innovation in building environments. Robotic surgery systems and MRIs are perhaps the most obvious examples of technology developments that impact buildings in terms of size, power, configuration, orientation, structure, infrastructure and the need for flexibility.

Similarly, the portability of and access to EHRs requires fundamental shifts in building technology, information systems and building infrastructure to support communication flow. As health systems introduce EHRs, the ability to manage pre- and post-visit data more effectively, as well as the “medical encounter-protocol data,” becomes evident. This data needs to be managed such that it is securely available, portable and accessible by authorized providers and medical staff.

Few organizations can match The Vancouver Clinic, a privately held multispecialty medical group in Southwest Washington, in terms of explosive growth. The clinic network has grown from 65 to 270 physicians or providers in fewer than 11 years. That growth has been driven by effective integration of services supported by robust information, diagnostic and treatment technology.

Replacing Facilities

Replacing older facilities has become necessary and urgent in many communities. The 1946 Hill-Burton Act funded hospital and clinic projects in 4,000 U.S. communities – especially underserved rural communities – and these facilities have reached the limits of functionality and use. Meanwhile, the development of comprehensive medical centers within cities shifted services and concentrated care in urban areas. Megahospitals in virtually every city in the U.S. define the institutional hospital campus, which is not effective or conducive for outpatient modalities and services.

The construction effort associated with replacing aging plants can be extremely complex, especially when a facility is in use and housing critical patients. In the hospital setting, services are expensive, and shutting down an operating room may cost hundreds of thousands of dollars a week. Challenges include prescriptive, complex regulations and the need to upgrade multiple systems’ support infrastructure.

Coquille Valley Hospital, a Critical Access Hospital (CAH) in Coquille, Ore., exemplifies the new commitment to addressing customer needs with a transformational experience for the patient/customer, family and community. The three-story facility serves some 12,500 patients, including three retirement communities. The replacement hospital introduced single-occupancy patient rooms supported by state-of-the-art interventional programs and public spaces derived from those found in modern hotels. The transformational experience ensures compliance with HIPAA and accessibility while optimizing flow.

Transforming the National Imperative
There is no question that there is a national imperative to modernize, repurpose or replace aging health care facilities. However, this process is no longer solely about the edifice. Indeed, it is about the ways in which a bricks and mortar building can enable the transformation of the health care enterprise and the experience of all users, including patients as customers.

Miguel Burbano de Lara is an architect at Fort Collins, Colo.-based Neenan Archistruction. He can be reached at miguel.burbano@neenan.com.

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Today’s health care buildings must enable and support a sustainable health care enterprise’s response to the Affordable Care Act (ACA), which mandates for safety, superior quality, and lower costs in the treatment of patients. This article written by florida health insurance exchanges has more information on ACA. Understanding how the act works from a patient’s perspective is critical if we are to create modern buildings and methodologies that play a critical role in addressing the ACA emphasis on population health.

ACA is grounded in coordinated and integrated care. In order to support these objectives, the nation’s aging plant requires accelerated intervention for modernization, repurposing, or replacement using a radically different approach to planning, architecture and construction.

In addition to the physical building response, health care organizations are also transforming services delivery. They are shifting from episodic treatment to preventive protocols, and from high-cost inpatient programs to lower-cost, more accessible outpatient delivery. To support these shifts, today’s health care organizations seek facilities that are designed to support higher efficiency, lower costs, integration of players, consolidation and accountability, which produce different demands for facility development.

The ACA Imperative Shift

The ACA introduced an imperative shift from inpatient to outpatient care, as well as a move toward population and community-based health care creating significant facility challenges for health care leaders. Space must be allocated in ambulatory care facilities to support the population wellness and behavioral health programs, which are driven by primary care and outpatient services.

Electronic Health Records

Electronic Health Record (EHR)-enabled care is a significant driver for coordinated, integrated care in the new patient-centered medical home (PCMH) delivery model. For example, the Sutter Gould Medical Foundation’s Turlock Care Center in Turlock, Calif., which opened in August 2014, consolidated several clinics in order to provide better services distribution and better access, as well as new services and new technology. Operating on the principles of a PCMH, the ambulatory center offers urgent care, primary care and specialty care, supplemented by behavioral health, nutritional and social services. The center optimizes EHR technology, Lean workflow processes and architectural solutions that nurture the care team philosophy.

Cost Containment & Speed to Market

Architectural solutions that are driven by EHR technology and sustain Lean workflow processes have proven cost-effective. Specifically, effective results can be achieved through careful allocation and arrangement of space to sustain care team delivery models. For example, when a facility is designed to increase the number of universal examining rooms by decreasing non-productive space, the organization is able to increase productivity, often without increasing the number of staff. At the same time, the care team’s model eliminates redundant positions, as when medical assistants who are also capable of scheduling appointments eliminate the need for redundant scheduling staff.

St. Charles Prineville is a case in point. The hospital selected a dramatically different, innovative medical care team module for its new campus in Prineville, Ore., which opened in fall of 2015. St. Charles Prineville offers comprehensive patient, family and visitor services, including primary care and specialty care clinics, emergency department, lab, radiology and rehab. The health system has an ambitious goal of co-locating the functions of the nurse’s station to serve and support surgery, the emergency department and the walk-in clinic, thus leveraging nursing staff with a broad skill set to perform multiple tasks.

As the ACA directives make their way into the market, facilities must evolve. Key drivers include EHR technology, Lean workflow processes and architectural forms that foster the care team approach. As budgets tighten and operations must become more efficient, tactics that save time and money are valued more than ever.

Tune in for Part II on this topic.

Miguel Burbano de Lara, AIA, NCARB, architect at Fort Collins, Colo.-based Neenan Archistruction can be reached at miguel.burbano@neenan.com.

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It has been said that everything is bigger in Texas, and Dallas’ Parkland Hospital is no exception. Open to patients Aug. 20, 2015, the new hospital is intended to serve 30,000 people per day for the next 50 years. When construction started in 2008, it was the 10th largest medical construction project in the world, and the largest public health care project in the country built in a single phase. Today it is ranks as the 31^st largest hospital in the United States. While working with this facility, Kenosha, Wis.-based Kenall LED Lighting and Controls was asked to provide a streamlined, ultra reliable lighting solution.

Parkland was designed by a joint venture of architectural firms HDR, based in Omaha, Neb., and Corgan, based in Dallas. Because of the facility’s size and design parameters, sourcing consistent, reliable, energy-efficient lighting products that could be delivered on time and on budget was a very important piece of the Parkland puzzle.

“Our biggest challenge was the sheer scale of the project, so we wanted to keep the [lighting] design as simple as possible and be consistent throughout,” said Jeffrey Hargens, an electrical engineer and lighting designer at HDR.

To keep maintenance and relamping simple, specifiers selected sealed MedMaster T5 luminaires for the 862 patient rooms. In addition, Kenall provided a combination of LED and fluorescent lighting fixtures for the corridors, surgical suites, MRI and imaging suites, bathrooms and workstations, including:

• MedMaster Behavioral Health luminaires
• Mighty Mac patient room luminaires
• SimpleSeal corridor lighting
• MedMaster exam lighting
• MedMaster surgical suite lighting
• Stratalume task lighting
• CleanScene graphic panel luminaires for MRI and imaging suites
• Auracyl wall sconces
• MedMaster sealed downlights
• MedMaster vanity lights
• SoftStep Contour and MightyMac step lights

• Lighted wayfinding and informational signage

The Parkland Hospital project was Kenall’s largest single project to date — one awarded based on a reputation for consistency, quality and on-time delivery.

“This is a job that you can’t have a manufacturer back out of or be late on: other suppliers had issues, but we never had any complaints with Kenall,” Hargens said.

Despite its size, the Parkland Hospital project was delivered on budget and only four months behind schedule. The building was originally projected to be 1.68 million square feet in size, but eventually reached 2.8 million square feet and 17 stories tall.

As a result of innovations in many areas, including lighting, it is also environmentally friendly. The hospital was expected to achieve LEED Silver certification, but in June 2015 it was awarded LEED Gold certification by the USGBC.

Frank Gonzales is the director of product management at Kenall. He can be contacted at 262- 891-9700.

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There’s no doubt health care facilities face real challenges when dealing with construction and design. One way to combat these challenges is by staying up-to-date on industry-related trends.

One trend that will continue to expand is outpatient construction as it uses surgical technology to accelerate inpatient procedures into outpatient settings, as well as the continuing trend of patients being funneled by health care systems into outpatient settings. Additionally, as hospitals and health care systems focus on population health, determining what infrastructure will meet the needs of the communities they serve while still supporting current operational efficiency will become increasingly important.

Serious strategy questions will have to be asked. Do entirely new facilities need to be built? Would it be more cost-effective to renovate or repurpose facilities? Perhaps maximizing space through consolidating facilities would be the most advantageous avenue. Or maybe, depending on the circumstances, leasing facilities may offer the best value.

Each situation is unique and it’s critical that health care facilities accommodate necessary changes in finding alternative avenues to provide care in the communities they serve. That includes: ambulatory care facilities, long-term care facilities, imaging centers, medical office buildings and assisted living.

With so many options of potential health care service models available, health care facilities continually face the need to increase their capabilities within those models. Whether it’s keeping up with the latest in technology, adhering compliance to new code requirements, increasing efficiency or upgrading facilities to meet patient needs, the ongoing endgame is improving patient satisfaction.

Another ongoing trend is moving toward more green alternatives, such as LED lighting, low-flow plumbing fixtures and more efficient HVAC systems. Also, as rapid technology advancements involve more sophisticated techniques and equipment, facilities will need to address network data needs, security system enhancement and more up-to-date patient monitoring systems.

The health care industry needs to implement smart growth solutions to capitalize on their existing footprints. There is much to take into consideration. From planning, design and procurement, through construction and operations, each phase of the construction lifecycle offers its own unique set of challenges.

While navigating the complexities of health care construction can be a daunting challenge, opportunities for easing the load are real. Whether through capitalizing on current industry trends or taking on the different stages of the construction lifecycle using the above best practices, meeting deadlines and staying on budget do not necessarily have to be either/or propositions. This will ultimately allow for better overall experiences for health care staffs as well patients and their families.

Douglas Gayden is the director of health care for Greenville, S.C.-based Gordian. He can be reached at 678.920.3672.

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SEATTLE – SoilFreeze, based in Seattle, provides a unique technology that can reduce time and costs during construction projects. As the only U.S. construction company specializing in ground-freezing technology, SoilFreeze provides services like structural shoring, groundwater cutoff and soil contamination remediation for health care facilities and other commercial buildings.

To get the job done, SoilFreeze relies on commercial refrigeration systems manufactured and produced by Technical Systems Inc. (TSI), a division of Pryor, Okla.-based RAE Corporation. Through the partnership, SoilFreeze has access to innovative and sustainable forms of technology that can complete projects seamlessly and in short amounts of time.

Commercial Chilling

Commercial refrigeration systems work by using a liquid refrigerant to cool evaporator tubes and absorb heat from the chilled water circulating through the machine. The chilled vapor is then drawn out of the evaporator by the compressor. From there, the compressor pumps the refrigerant vapor to the condenser, raising its pressure and temperature. The refrigerant condenses on or in the condenser tubes, giving up its heat to the cooling water (or air). The high-pressure liquid refrigerant from the condenser then passes through the expansion device that reduces the refrigerant pressure and temperature as it enters the evaporator. The refrigerant again flows over the chilled-water coils absorbing more heat and completing the cycle. There has also been an evolution of ac drives or variable frequency drive technology (used to boost the energy efficiency of AC electric motors) and reset control features that give the chiller duty ratings.

Commercial refrigeration systems allow builders to develop a waterproof barrier by freezing the ground. This eliminates the need to pump groundwater out of an excavation site and to treat and store it somewhere else. It also eliminates the risk of spreading contaminated groundwater into previously uncontaminated areas. If you’re in warmer climates and could do with the perspective of national hvac companies checking out parent companies similar to CoolSys can provide some insight if you’re interested.

The process of freezing the ground before an excavation is time-consuming, but with the right technology and tools, it saves time as the excavation does not need to be stopped repeatedly in order to shore up and waterproof newly excavated areas. This makes the productivity of professional excavation companies like Rickabaugh Construction increase as less focus needs to be made on freezing the ground.

Construction Sites

When working on construction sites, the first step SoilFreeze takes is installing piping vertically in the ground to form a freezing system around the perimeter of the excavation site. From there, a flow system is hooked up to these pipes in order to circulate refrigerant through a chilling system; this fluid pulls heat out of the ground and is re-cooled by the chillers continuously until the ground reaches -20 degrees Fahrenheit. This process takes between four and eight weeks, depending on soil conditions and ambient temperatures.

Once the ground reaches -20 degrees Fahrenheit, the refrigerant solution continues to circulate to maintain this temperature and keep the ground structurally sound throughout the excavation process. Excavation work ranges in duration based on the construction project, but can last up to two years or more. Accordingly, if you would like to learn more about the role of excavation technology in the construction industry as well as in home improvement projects, you can find further information by reaching out to an excavation contractor who can talk you through the process.

“Long-term, extensive ground freezing requires extremely reliable chilling equipment and technology,” said Larry Applegate, president of SoilFreeze, in a statement. “We contacted RAE Corporation many years ago to purchase our very first chiller. Over time, we’ve continued to purchase their equipment, because they have proven to meet our needs.”

TSI has modified their commercial chillers to better meet the needs of SoilFreeze. According to a statement from Jeremy Colvard, vice president at RAE Corporation, the chillers built for SoilFreeze are designed to be loaded and unloaded with forklifts or cranes, and to be controlled remotely.

“We designed a microprocessor control system so that Larry [Applegate] and his team can remotely connect to and communicate with the refrigeration units,” said Colvard in a statement.

This article was provided by Pryor, Okla.-based Technical Systems Chilling Equipment. The company creates technologically advanced equipment used in health care facilities and other commercial buildings to improve building performance. They can be contacted at 918-825-7222.

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