Before the COVID-19 pandemic unfolded, occupied hospital renovations were already a complicated task. From maintaining sterile areas and negative pressure spaces to avoiding disruption to patient services—managing these projects has always been a complex task that requires expert oversight. And these challenges have only been amplified by the current pandemic.

Below are several healthcare construction best practices to consider when navigating COVID-19’s challenges, what trends we can expect to arise as a result, and how these learnings can be applied to our post-pandemic world.

Building for COVID-19 While COVID-19 Was Building

The key to maintaining long-term relationships with premier healthcare institutions is trust and flexibility. COVID-19 necessitated quick action, requiring the reallocation of construction staff from other ongoing projects on campus to address the immediate and rapidly evolving needs the hospitals had for addressing the pandemic. Management needed to quickly assess best fit roles for staff to pivot into. Staff, in turn, had to rapidly switch their focus from one project to the next. Additionally, they had to be flexible in their roles and be prepared to do whatever it takes to keep the project moving: project managers became supers. Moreover, subcontractors needed to modify their plans on all projects, COVID-19 specific and other, to incorporate COVID-19 measures.

Social Distancing Complicates Construction Operations

Hospital renovation teams were already tasked with separating construction activities from the ongoing activities of the hospitals. Typically operating with limited space — COVID-19 has only made this more difficult due to social distancing mandates.

Take for instance the fact that very often teams share bathrooms with hospital staff and visitors. When feasible, it’s important to rotate staff and minimize the number of construction personnel on-site at any given time. This requires maintaining robust PPE protocols – proper gloves, masks, and eyewear at all times — in addition to a significant increase in the frequency of sanitizing common areas including offices, shanties, bathrooms, etc.

The Role of Technology

To perform in this environment, you have to be technically sound. New technology for temperature scanning and screening of workers is essential for all projects, not just healthcare construction. What’s more, the need for laser scanning and reality capture of existing conditions is necessary — now more than ever — as we limit the amount of time needed to survey in and around occupied buildings.

Design Changes

We are already beginning to see changes in the way facilities are designed. Design changes related to addressing the admittance of virus patients will now begin at the front door. There will likely be separate entrances for elective patients, adults, pediatrics, etc., with robust prescreening. The logic being that separation and isolation as soon as patients walk through the front door can mitigate any potential infection spread. Moving into the depths of the hospital, waiting areas will all become negatively pressurized. Rooms will be larger to accommodate surge beds.

The HVAC controls system will include greater flexibility in isolating a bed unit, an entire floor, and/or units on multiple floors. HEPA filtration and UV systems will be standard and commissioned as such to ensure that healthcare facility systems are operating properly to limit the spread of the virus and other airborne pathogens. Access to these floors will be restricted and may include separate elevators for further isolation. More treatment will be taking place just outside the patient rooms, allowing for less frequent caregiver visits to infected patients, without any sacrifice to patient care.

Looking Ahead

Prefabricated and modular construction continues to innovate year after year, and as we look to reduce the amounts of hours and workers on site, this type of construction allows the majority of work to take place off-site within a controlled and clean environment. We are also seeing modular solutions being implemented to offer COVID-19 screening at building entry points and hospital emergency rooms. Going forward, we anticipate that these screening measures will be designed into the lobbies and entry points to help tackle the challenges of future pandemics and increase security for healthcare facilities.

Worker welfare and wellness are also a top priority for the future of healthcare construction. We must ensure workers are safe and healthy above and beyond current best practices. Additional protocols are required for cleaning, on-site medics can assess the health of workers displaying symptoms and provide treatment, and designated areas for hand washing will be much more abundant in and around the construction sites of the future. Better and more available cleaning equipment like “foggers” will help projects be cleaned more efficiently as well as recover from a positive case faster, and the live, electronic tracking of PPE supplies will be mandatory. 

Without exception, the needs that our industry had resulting from the virus were immediate.  Being responsive, nimble, and flexible were mandatory skills that will transcend the pandemic. COVID-19 also highlighted the importance of being willing to work in a team environment, as every aspect of project delivery was expedited through clear and continuous communication.  Only the construction organizations that can adapt to COVID-19’s hurdles and uncertainty will survive. Because if this summer’s prolonged challenges have shown us anything, it’s that this virus isn’t going away anytime soon. 

Rich Steimel serves as principal in charge, Lendlease Healthcare. For nearly 30 years, Lendlease has worked with some of the nation’s leading healthcare organizations—including New York City’sMount Sinai Medical Center, New York University Langone Medical Center, Northwell Health andNew York-Presbyterian Hospital—on expanding, renovating and modernizing occupied facilities, as well as building new ones.

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