Contractors specializing in health care construction were hit with a double whammy in 2009: the economic recession and the passage of the Patient Protection and Affordable Care Act (ACA). The 2016 Dodge Construction Outlook reports health care construction starts dropped 38 percent in square footage and 32 percent in dollar terms in 2009. After the initial plummet, construction began to increase only to fall again in 2012 during the Supreme Court’s hearing of the ACA. Such uncertainty eroded business owners’ already low confidence in industry forecasts, leading to challenges when making hiring decisions and investment plans.
Fast forward to 2016 and contractors are regaining confidence in the market. This year’s Dodge Construction Outlook forecasts 1 percent growth in square footage and a 4 percent increase in the dollar value of activity, while Associated Builders and Contractors predicts an 8 percent increase in spending compared to 2015. Health care construction may be picking back up, but—like many other markets—the industry operates a little bit differently than it did before.
“The number one reason the change is occurring is because it’s important that facilities are driven by strategy. We don’t have the luxury of building without being strategic about construction,” says Lora Schwartz, principal of the Healthcare Program Solutions team at CBRE Healthcare. “We weren’t really frivolous before, but we’re very pointed about what we spend money on today.”
According to CBRE Healthcare—a division of commercial real estate services and investment firm CBRE that focuses on capital programming with hospitals and health care systems—medical facilities are required to do more with less. They need construction teams to help them create more efficient buildings on tighter budgets, make better use of space on smaller buildings, provide better care with less funding and even get more work done with less staff. To accomplish these goals, owners, contractors and designers must carefully plan ways to optimize efficiency.
“It’s not like before the economic downturn at the end of the last decade when owners were just building,” says Curtis Skolnick, managing director of CBRE Healthcare’s Healthcare Program Solutions team. “Now, owners a have to scrutinize every square foot or dollar allocated.”
Improving the patient experience is a major factor affecting the changes in health care construction. “Hospitals are much more focused on the patient experience; they are rated on it through online surveys,” Schwartz says. “With the prevalence of the Internet, anyone can go on and look at rating sites and see how hospitals compare.”
Schwartz says the top factors that matter to patients when rating a hospital are cleanliness and the look and feel of the facility. Hospitals are struggling to upgrade facilities to provide excellent health care as well as top-notch patient experiences.
“We work with a lot of clients that deliver great care and have advanced technology, but their facilities need to match the care they’re delivering,’” Skolnick says.
In response, many hospitals are beginning to offer private patient rooms. “Privacy is a big deal for patients,” Skolnick says. “For instance, in our inpatient spaces, why do we expect patients to accept or want roommates during a very vulnerable time of their lives?
Hospitals also are adding amenities to make facilities feel more comfortable.
“There are not as many patient towers or new, large health care facilities being built these days. More often, we see things like 40- to 60-bed inpatient rehabilitation facilities. They are private rooms with higher finishes that feel less institutional,” says Ed Smith, vice president of health care for Doster Construction, Birmingham, Ala. “They are much more comfortable and aesthetically pleasing than what I was building earlier in my career.”
Hospitals also are offering amenities such as small flat-screen televisions, room service, Wi-Fi, art on the walls, and homier furnishings and fixtures. “If someone wants to spend the night, give them more than the standard chair. Perhaps provide a couch that converts to a laydown bed space,” Skolnick says. “Offer an environment that allows someone who is in the hospital for multiple days to stay connected to work and the world. Hospitals are reaching out from an amenity standpoint to make sure people have a home-like environment.”
These amenities mean homier building designs as well, such as including lots of windows and views of nature, better lighting levels and air flow exchanges in operating rooms. “We need to make sure the supply air in a patient’s room isn’t too loud and is diffused across the room so it maximizes patient comfort,” Skolnick says. Consider placing a window at the end of the hallway, instead of a door or hard wall, to connect people to the outside as they navigate a space.”