Positive Prognosis

Health Care Sector Enjoys a Positive Prognosis

Health care sector surges thanks to the ever-evolving treatment techniques and technologies.

by Jim Parsons

An aging population, new patient care techniques and constant advancements in treatment technology have become potent medicines for health-care construction in the tri-state region.

While figures for specific states are not available, published reports estimate that the activity nationwide will reach $45.4 billion in 2009, a 34% increase from 2005.

But there is another important influence that is as fundamental to the sector’s surge as diet and exercise are to personal wellness the bottom line. Hospitals, clinics and other facilities are also businesses competing with each other for patients with high expectations about the quality of care they receive.

John Schwarz, vice president of facilities for Cooper University Hospital in Camden, N.J., says most existing hospitals in the market offer only semi private rooms, a feature that does not appeal to today’s patients.

“There’s a lot of competition in the industry to say that you’re the first to have a tower with private rooms and all the comforts of home,” Schwarz says. “But the clinical quality improvements from these arrangementsreduced infection rates and patient/family satisfaction are also significant.”

advertisement

Cary Colton, senior vice president for Bovis Lend Lease, New York City, adds that the emergence of allied hospitals and care facilities has led to a shuffling of services and personnel among locations, creating the need for new and renovated facilities.

“Reorganization eliminates duplication and improves efficiency, making them better able to compete,” Colton adds.

New approaches, new facilities

Although renovations and retrofits remain part of the region’s project mix, the trend is significantly toward new construction.

Dan Fenyn, associate principal and health- care sector leader for the Glastonbury, Conn.-based S/L/A/M Collaborative, an architectural and engineering firm, says a big reason for this is that hospitals and specialized-care facilities are no longer designed merely as buildings where treatment services are delivered. They are, in fact, integral to the healing process itself.

“The goal is to create an environment that addresses each patient’s spiritual and emotional well-being, as well as his or her physical needs,” Fenyn says. “This is particularly important for cancer care because of the anxiety that can accompany the diagnosis of even a mild form of the disease.”

Fenyn points to a 48,000-sq-ft ambulatory services building and cancer center under way at Griffin Hospital in Darby, Conn., as an example. The patient-centered experience starts at the curb and continues inside where ample natural light and outward views complement the building’s gardens and other landscaping features.

“Research shows that helping patients gain a sense of calm and reassurance can empower them to help heal themselves,” Fenyn says. He adds that quality facilities also make health-care organizations more attractive to the limited talent pool of trained physicians and staff workers.

“There have been predictions that Connecticut will have one of the nation’s greatest nursing shortage in the next 10 years,” Fenyn says. “The best facilities will attract the best people.”

The New York City Health and Hospital Corporation (NYCHHC) is also applyting these theme to several projects in its five-year, $1.3 billion capital improvement program. For example, the $160 million retrofit and expansion of its Gouveneur Healthcare Services in Manhattan will provide long-term care patients with “neighborhoods” of private and semi-private rooms oriented around shared living space.

“We’re trying to provide each bed with 600 to 700 square feet of space that includes a family-style kitchen and dining areas,” explains Philip Cook, HHC’s senior vice president for facilities development. “We’re getting away from the large institutional spaces of the past in favor of environments that are more pleasant and home-like.”

Another lure for both patients and caregivers is the availability of the latest medical technology, which isn’t always compatible with existing buildings.

“We can’t provide the best treatment for patients with chronic diseases without facilities that have the space and flexibility to accommodate machines of increasing technology, and the IT systems to support it,” Cook says.

Schwarz says that one of Cooper’s incentives for constructing a new 10-story, 312,000-sq-ft patient pavilion is the need to eventually phase out an existing tower constructed in the 1940s.

“We’ve done as much as we can in the way of renovation to the old tower,” he says. Schwartz adds that problems in the old building include the prohibitive cost of meeting updated seismic standards, the structure’s small bay sizes and HVAC systems that are no longer sufficient to support clinical needs and high-tech equipment such as imaging machines.

“Operating rooms are also larger in the 700- to 900-sq-ft range than they were 20 to 30 years ago,” Schwarz adds.

Planning ahead

The Cooper project illustrates another growing hospital construction trend shelled floors set aside for future use. Originally planned as a six-story structure, the project grew by four floors in the schematic design stage, but only about half of the pavilion will be activated when the project is completed in 2008.

“Our board recognized that investing in additional space now would be a wise move, given the impending need to transfer capacity from the old tower within the next 10 years and the escalating cost of construction,” Schwarz says.

Whether they’re installing the latest medical technology today or in 10 years, Colton says hospitals typically delay major equipment purchases for as long as possible to avoid missing out on the latest advancements.

“We work with hospitals to accommodate their need for flexibility,” Colton says. “But at some point, you have to make an educated guess as to what’s required for the spaces and trades that are affected. These are complex buildings with complex equipment. It’s been a challenge for as long as we’ve been building hospitals.”

There’s also the issue of sustainability in the health-care sector. Projects such as the S/L/A/M-designed Pfizer Clinical Research Unit, a 62,000 sq ft facility in New Haven, Conn., are seeking green design features to lower energy costs and carbon footprints and to limit the spread of infection. The Pfizer building, which opened in April 2005, was certified LEED Silver.

“We’ve found that many health-care clients prefer to implement sustainability practices without going on a point hunt,” Fenyn says. “Certification is secondary to ensuring quality care.”

Fenyn adds that the key is to look at the whole delivery of the building, not simply a specific system or element.

“We’ll evaluate materials by their type, manufacturing process and whether they were made locally or have to be shipped long distances,” he says. “Some of the most fundamental elements of green design, such as daylighting, are also essential to patient-centered design.”

Cook agrees, noting that several HHC facilities achieved LEED certification before it became mandatory for new public buildings in January 2007.

“We do look forward to the long-term savings, but there remains the issue of the additional up-front investment,” he says. “We have to determine the options that are best for each facility, then try to get the additional funding for them.”

Revving up research

Also looking fit from a construction standpoint are research facilities associated with hospitals and commercial enterprises. For example, New Jersey’s $26.5 billion pharmaceutical and medical technology industry has emerged as the state’s biggest construction sector, according to the HealthCare Institute of New Jersey, the industry’s trade association.

Among the recent projects under way is Schering-Plough’s new 200,000-sf Global Clinical Supply facility in Summit, N.J., which broke ground in July. Part of the Schering-Plough research institute, the facility will contain a pilot plant for conducting clinical trials on new medicines, warehousing operations, and offices.

“HINJ member companies spent $1.9 billion on capital projects in 2006, nearly half of which accounted for new construction,” says Bill Healey, the association’s executive vice president. He adds that HINJ members’ $7.5 million investment in research and development will continue to accelerate, given the trend toward specific drugs for smaller populations.

Once again, much of this activity is being driven by competition. “We’re dealing not only with other states but with other countries,” Healey says. “As countries such as India and China graduate more scientists, they will gain a significantly higher profile in this industry.”

While there may be no magic pill for restoring or sustaining good health, experience is the key ingredient for designers and contractors.

“Health care facilities are complicated buildings with high technical requirements,” Fenyn says. “A seasoned planning and design team, plus a contractor who knows how to build it, are important not only to the institution but also the patients who will be using it.”

“We want the designers to have an understanding of not only what the current standards are but also where they are going,” Schwarz adds. “It wouldn’t be an enviable situation to work with someone and be learning along with them.”

Contractors must also bring a problem-solving ability to the table, particularly since much of the work is taking place in close proximity to active health-care services.

“This is especially true in New York, where you typically add to the top of a building or adjacent to it,” Colton says. “You need a specially trained contractor to figure out how to do it safely, keep the hospital running and stay out of everyone’s way while still getting the job done.”