The decreasing availability of qualified staff can dictate construction activity in healthcare facilities.

As the baby boomer generation crosses over into retirement and advances in medicine make cures more affordable and available, hospitals and the services they provide are in high demand. But in most urban areas, and even in some suburban areas, hospitals need to continually expand and upgrade to fulfill the needs of the population, and competition between medical facilities for these patients is tough.

Essentially, it boils down to an “arms race” to be the most technologically advanced or most well-known hospital in the local area or state. Whether it’s a new state-of-the art MRI wing, new patient beds or redesigned amenities for their doctors and staff, hospitals are putting a lot of money and thought into their facilities.   

While most hospital owners and administrators would rather avoid a new construction or renovation project, at most facilities, it is essential to keep up with the competition. Whether it's a minor patient suite renovation, an operating room technology upgrade, or a campus-wide building project, construction projects can be expensive, inconvenient and invasive to their daily operations.   

So, why would hospitals go through this? Even in today’s economy, healthcare is expected to be one of the top-five growth segments in construction in the coming years, with no signs of slowing down, according to AGC Chief Economist Ken Simonson.

Construction Drivers
Many factors drive the rapid changes and construction in healthcare facilities, with the most obvious being the need to stay in business. Obviously, hospitals need to make money and attract patients to do so. The best way to attract this revenue is to make the hospital the premier hospital of choice to cure specific ailments or diseases. The goal is to be known as the best hospital offering the latest advances in medical technology, which, in turn will attract the most people.    

Today's patient is more educated and technologically savvy, and will shop around to get the most advanced procedures with the best equipment. Healthcare facility decision-makers realize that while high-tech devices and expensive renovations may require a large investment of capital, the return on investment is worth the monetary risk. The rewards will go to those who can figure out how to create the most cost-effective solution to improving their facility while offering a space or technology a nearby facility does not have, and ultimately increase the level of healthcare service they can provide their patients.   

In most cases, the only way to accommodate these technology upgrades is through additions or renovations. New equipment needs to be housed in special rooms, often with vibratory or acoustical mitigation controls, while hospital floors carrying heavy equipment needs to be structurally reinforced. In addition, increasing ORs and patient rooms can also bring in more money, as increases in both alleviate schedules, allow more processes and can increase hospital stays.    

Rhode Island Hospital in Providence, R.I., recently increased its patient beds by 110 in a $48 million building addition, and is still looking to increase that number to keep up with patient demand. These patient rooms are not only beautifully designed with rich millwork and furnishings, but are also loaded with the finest amenities,  such as wireless Internet and cable television. It is this extra level of patient client service that encourages the word-of-mouth advertising that drives business.   

It is not just the technology and doctors that attract business – people want to go to a hospital that is attractive, comfortable, and offers them and their families amenities they cannot get in other facilities. For obvious reasons, out-of-date lobbies and waiting areas do not support the image of a state-of-the-art medical facility.    

Several years ago, New England Baptist Hospital in Boston, wanted to increase its stature among the medical facility competition in eastern Massachusetts. One of the first projects it undertook was the renovation of its entire lobby as it was completely out of date, and did not reflect the world-class institution it was.    

They expanded into the existing gift shop, open atrium and other adjacent areas to provide a larger and more patient- and visitor-friendly space.    

Other amenities, such as resource centers, cafes and healing gardens, are also very important in driving construction. In particular, access to outdoor spaces provides some patients a change of scenery during long treatments and hospital stays.   

The increasing costs and decreasing availability of qualified staff also dictates construction activity in healthcare facilities. Owners must always remember that the hospital is only as good as the doctors in it and some of the practices have considerable influence. To retain talent and teams that augment the hospital’s reputation, they must not only upgrade the obvious medical rooms, but also remember to upgrade the back-of-the-house areas for the doctors.

By the Code
Healthcare buildings are 24/7 environments, and when a healthcare facility's age, condition or ability to function begins to compromise quality or safety, changes or upgrades are required. New regulations and code requirements are passed every year, which require healthcare facilities to make frequent upgrades to stay within the bounds of the law. When hospital construction and renovation projects hit a certain price point, these code upgrades must be addressed.   

Also, because hospital facilities are expected to run continuously, the building and its systems are in high demand all the time. In addition, high-performance HVAC and electrical systems with emergency back-up systems are necessary because of the care required and the types of procedures performed. Because of this, equipment and lifecycle costs can impact the healthcare provider’s financial success. 

Healthcare facilities are also attempting to become green by implementing these new energy efficient systems, better lighting and more proficient water delivery systems in new construction and renovation. An owner might also choose to upgrade to newer mechanical equipment, not only to save money and be more sustainable, but also be more efficient.    

Because none of the drivers for renovating and building healthcare facilities have diminished with increasing economic pressures, the demand for healthcare facility construction continues. There are many forces specific to healthcare that makes construction necessary for it to prosper.   

But, there are also many opposing factors that make construction and renovation difficult and costly. Experienced healthcare facility owners and construction companies need project team assistance to overcome the challenges involved with a healthcare construction program. With the partnership of a construction manager who understands the drivers and goals of healthcare providers, lead the hospital to spend their capital wisely.

Tony Miliote is the managing director of Shawmut Design and Construction’s healthcare and science projects. He has overseen projects at New England Baptist Hospital, Tufts University and Rhode Island Hospital. He can be reached at 617-622-7000 or This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .