The construction industry appears to be on a health kick, and by all accounts it isn’t a fad. Trends identified in recent years in the health care sector are strengthening with a surge of new projects nationwide. 

“All parts of the country are experiencing significant health care design and construction activity,” observes Hank Adams, HDR’s global director of health. “We’re expecting continued growth into the near future and feel optimistic that the marketplace will continue to be strong.”

Modern urban planning strategies, engineering advancements and sophisticated design take center stage as oversized hospitals serving large patient populations within a 100-mile radius make way for more specialized centers that target the overall wellness of the local community. 

“Today’s health care market is not solely about building large hospitals,” explains Chris Brandt, executive vice president of the Virginia-based construction development firm Hourigan Group. “It’s focused on the ever-increasing aging workforce. There are more people retiring and in need of health care than any other time in the history of the United States.”

Brandt reports Hourigan Group’s current backlog of health care projects is roughly $350 million, and has experienced a very healthy increase in the last two years. Propelled by this mega-trend—the growing need for care of an aging baby boomer population—as well as further consolidation of providers through mergers and acquisitions, Hourigan and others throughout the country are working on a combination of remodels, additions and ground-up construction projects. 

Traditional hospitals will continue to serve patients, and many of the older facilities are getting much-needed makeovers, but the current emphasis has shifted to a variety of specialty areas and creating the right arena for each. In an effort to meet this demand, the newest facilities cater to outpatient services such as rehabilitation and specializations, including cancer treatment or neurological research, and ambulatory emergency and surgical services.

More recently, a wave of projects feature academic or translational research centers and previously dormant categories such as mental health, which experts agree is due for attention.  

“There hasn’t been a lot of investment in behavioral and mental health facilities in recent years,” Adams says. “However, there is a new trend starting with renewed interest and investment in these specialized facilities serving a broad range of treatment. This is very important. We need to provide better facilities for this underserved patient population.”

Lance Kramer, project manager for Grand Junction, Colo.-based FCI Constructors, concurs: “The last 10 years of media focus and the overall understanding of mental health care has created this need for the market that’s probably always been there, but that had not really been talked about,” he notes.

Whether the projects are medical office buildings and ambulatory services or academic medical centers and rehabilitation, today’s projects primarily are fueled by technology and time. 

CONSTANT LEARNING PROCESS

Technology continues to move at a rapid pace, and health care is working to keep up, which means the construction industry is right at its side. Advancements are impacting the sector in a variety of ways. In some cases, the technology is a new system or unit within the structure itself, which requires continual training as subcontractors, designers and manufacturers work together to learn and then best deliver the latest tools to serve the client’s needs.

“It’s a constant learning process of how we train and keep up with the technology,” Brandt says. “We need to keep up with the suppliers that provide specialty equipment like operating lamps and articulating arms, as well as the subcontractors actually doing the installation.” 

Such was the case for a project completed four years ago that called for the addition of an extremely large and rare (at the time) piece of cancer treatment equipment that unexpectedly altered the outcome of a center’s finished product. In a project designed by Birmingham, Ala.-based Williams Blackstock Architects, a comprehensive cancer center for the University of Alabama at Birmingham underwent a full renovation. The client decided to add a nuclear medicine department half way through the project, which called for the inclusion of a 27-ton, $25 million cyclotron that produces radioactive isotopes set into 8-foot thick concrete—a move that got the firm thinking outside of the box. 

“In the middle of the project, it was decided that we needed to install the cyclotron, and we had to figure out how to get it into the building. We looked at a lot of different options and finally decided the best solution was to lower it down through the recently completed lobby floor to get it into the basement,” recalls the firm’s principal, Joel Blackstock. “When we asked to see the unit installed elsewhere for reference, we were told there was only one other one, and it was in Russia. A lot of times universities bring in cutting-edge technologies and in order to figure it out, we have to work very closely with the researchers and physicians, the manufacturer and the regulating authorities.”

For another recent upgrade in Grand Junction, FCI Constructors installed a HUGS Infant Security System at St. Mary’s Hospital. Borrowing from the safety trend in the education sector, the system prevents a baby from being removed from the same floor as its mother, even shutting down elevator service should a newborn pass a certain alarm point in the hospital. 

On a much grander scale, technology has made it so that it is no longer necessary to go into a hospital for a surgery and stay for several days. Instead, ambulatory services and outpatient facilities are spreading like wildfire to cater to this shift. Although they have been around for the last 25 years, the amount being built and the level of sophistication is increasing exponentially due to new technologies, according to Brandt.

For example, for a 19-story, $260 million (construction cost) adult outpatient facility for Virginia Commonwealth University that’s currently in the design and construction phases, Hourigan was charged with the task of building a multitude of operating rooms, each of which addresses a specific service to be performed. 

“You have to have rooms for a colonoscopy and another for kidney or bladder stones,” Brandt explains. “Each room has specific equipment to handle those specific illnesses or needs, and that requires a lot of technology.”

THE RACE IS ON

Industry experts also are leveraging technology to improve processes that ultimately save money and time. This is critical as facilities race to compete for patients and construction executives are forced to accommodate the growing expectation of little-to-no disruption of services. 

“In western Colorado, people are calling three to five different hospitals to get a quote for an MRI. The public has that information more readily available, so service providers are competing for the best price and also upgrading the equipment to provide better marketing,” Kramer says. “Everyone is just more aware of it.”

For one project, FCI shaved off one quarter of the rough-in time to finish an improvement project to a floor in a 12-story hospital. Because the team would be using an existing elevator to move 95% of the material to the site, 127 headwalls were prefabricated in large sections, modeled and cut to length in a controlled environment offsite and then delivered to the job.

Sometimes a building code forces contractors to speed up the process. For example, by November 2018, hospitals featuring pharmacies that mix hazardous and non-hazardous medications will need to be in compliance with USP800, and companies are working through design challenges to comply with that requirement, Kramer says. 

Population-related health and wellness trends have created demand for more decentralized and accessible ambulatory care services beyond the walls of the health care facility, within the community and close to patients. New health care facilities are now leading a trend toward mixed-use facilities that support healthy lifestyles, Adams explains. For instance, the firm is currently working on a project in Denver called Peña Station NEXT, a transit hub on the light rail line where HDR is planning an ambulatory facility that will be an anchor for a development including retail, office, recreation and residential components. 

“This promotes a healthy lifestyle and healthy living and becomes an urban planning catalyst that creates community,” Adams adds.

Design firms are using technology, strategic planning and integrated project delivery methods to collaborate on design and construction of complex health care projects—an approach Adams sees gaining momentum in the sector.

For a recent new patient pavilion project in Philadelphia, HDR came up with a parametric design model in which a 3D model was populated with a cost model to test different planning scenarios and project phasing in real time with construction and projects costs included. 

“It was incredibly effective in terms of testing different ideas rapidly, and doing that in a way we could look at costs in real time and have immediate results,” Adams explains. “Rather than spending several months during the planning phase and studying only three ideas, we can study 15 to 20 ideas in the same amount of time because we can iterate so much faster. That’s the fun of it. It gives you more power in your design process.”

For the same project, the entire client, design and construction team co-located within a single office space and has been working together from the start of the design phase. The collacated design and construction team engaged key trade subcontractors early in the design process to allow for design assist on major systems within the hospital.

Design firms also are beginning to more effectively harness data to make and ultimately better inform clients in decision-making. As a result, HDR recently has expanded its design practice to include data scientists and data engineers. 

“It’s really become a model of collaboration,” Adams says.