The health care construction field is influenced by several forces, including financial pressures driven by the Affordable Care Act (ACA), more patient care being provided in community settings, the need to configure spaces that can adapt to rapid advances in technology and an overlapping regulatory environment. By understanding these drivers, construction professionals can gain insight into the challenges and opportunities in the health care sector.

Affordable Care Act
The ACA has had a profound effect on the way hospitals are reimbursed for services. Previously, they were reimbursed for care provided; now, they are moving toward a value-based system where they are rewarded for keeping patients healthy. With this focus on population health, providers are moving care delivery to outpatient facilities that are less costly and more convenient than traditional hospital facilities.

Because of these shifts and other forces—including more consolidation among health care organizations—construction is increasing for outpatient facilities and community medical offices. Annual construction surveys conducted by the American Society for Healthcare Engineering (ASHE) and Health Facilities Management magazine have reflected this trend. In 2014, 22
percent of respondents said health care legislation caused them to consider medical office building expansions, 22 percent considered more outpatient facilities in neighborhood settings, and 21 percent considered primary care clinics in neighborhoods. In 2015, 55 percent of respondents expect a greater shift to outpatient facilities.

Repurposing Facilities and Flexible Design
With the shift to community and population health, medical groups are working to repurpose acute hospital facilities to cater to patients requiring the most intensive care. Many hospitals are planning on repurposing and renovating existing facilities to meet future needs. Repurposing can be challenging because acute patients require more complex equipment, which can be difficult to house in space originally designed for less acute care.

At the same time, medical technology is rapidly advancing, leading to changes that affect health care construction. For example, the remarkable advancements in home health monitoring are helping support a move to outpatient care and other facilities—shifts that would not have been possible just a few years ago.

In response, many organizations are looking for flexible designs that will help them adapt to future needs. Many hospitals are including generic space, building out infrastructure to support future development and focusing on standardization to provide options down the road.

Regulatory Challenges
Hospitals are among the most regulated sectors in the country and have to comply with requirements from dozens of federal, state and local authorities. While these codes and standards keep patients, staff and visitors safe, they also can lead to frustration and delays in health care construction when conflicts arise.

Outdated codes pose another challenge. For example, the Centers for Medicare & Medicaid Services currently requires hospitals to comply with the 2000 edition of NFPA 101: Life Safety Code, which was written before the Sept. 11 terror attacks, Hurricane Katrina and Hurricane Sandy. Updated editions of these codes incorporate lessons learned from these incidents, and they reflect the latest technological and safety advancements. Conflicts may occur when the local or state construction codes reference more recent editions while the federal requirements remain at the 2000 edition.

To get involved with the push for current codes or to learn more about regulatory issues, visit the ASHE website ( to read the group’s latest advocacy report.

Become a Trusted Team Member
Hospitals are sensitive environments that house vulnerable patients, and renovation often occurs in areas directly adjacent to patient care areas. Inadvertent shutdowns of power or medical gas are construction mistakes that can truly be a matter of life or death. Even routine construction activity can negatively affect patient care.  

Many hospital owners and facility professionals look for credentials such as the Certified Healthcare Constructor certification offered by the American Hospital Association. This program distinguishes elite construction professionals who understand the unique nature of health care facilities and the approach needed when undertaking health care construction. In addition, ASHE offers the Health Care Construction certificate program, which shows that recipients have undergone training to work safely in the health care construction environment. Subcontractors and specialty contractors can take advantage of ASHE’s online Health Care Construction Subcontractor Program.

By understanding the driving forces behind health care construction trends—and proving their commitment to health care through certification and certificate programs—construction professionals can help health care organizations reach their goals and ultimately provide safe, healing environments for patients.

Dale Woodin is senior executive director at the American Society for Healthcare Engineering, a personal membership group of the American Hospital Association. For more information, call (312) 422-3812 or email