Health Care Infrastructure Post-Pandemic: What Works Best Now

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The pandemic’s lessons for the health care industry have reverberated throughout both treatment and related infrastructure, and will continue to drive the field’s built environment well into the future. 

Hospitals and offices alike have adapted to the necessities spurred by COVID-19. During Commercial Observer’s annual health care construction forum on June 16 in New York, industry experts assessed the topic of public health as it relates to physical space. They cited the pandemic, along with recent mass shootings, as catalysts for changes in design, technology and overall patient experience.  

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Yet, while changes begin at design and construction, owners and developers must be invested and deliberate from the get-go.

“We as owners cannot look to the design community and the built community to tell us what we need,” said Joe Ienuso, senior vice president of facilities and real estate for health care facility NewYork-Presbyterian. A panelist in the opening keynote “The Health Care Climate,” Ienuso kicked off the event alongside moderator Richard Meilan, senior executive director at the K&L Group division of MG Engineering

Both Ienuso and Meilan agreed that collaboration yields flexible spaces and requires a united vision for the health care facility in question. Over-designing without first assessing what the space should accomplish poses a risk to health care real estate — and may be entirely unnecessary.

For proof, look at field hospitals, which quickly became the norm during the pandemic. NewYork-Presbyterian built a 280-bed facility at Columbia University’s Baker Athletics Complex, Ienuso said, proving that sophisticated design isn’t the end-all, be-all to health care’s longevity and success. Rather, as long as a space maintains flexibility and accessibility, it is likely to accommodate purposes beyond its built intention.

The theme of flexibility rippled throughout the first panel, which addressed the importance of adaptability in light of recent mass shootings. Concerns over violence have infiltrated all facets of real estate, from the return to office to the safety of subway commutes. Such fears raise questions about how best to protect a built space — and, if worse comes to worst, how best to accommodate and address patients who haven’t been protected. 

Andrew Weinberg, director of business development at health care construction manager LF Driscoll, moderated the discussion titled “Long-Term Planning & Emergency Preparedness.” Weinberg spoke with Dino DeFeo, managing partner at engineering firm AKF; Tina Macica, associate vice president of design and construction at Montefiore Health System; Laura Morris, associate principal of health at architecture firm Perkins & Will; and Michael Rawlings, senior vice president of construction and support services for the Hospital for Special Surgery.

To prepare for mass casualties, health care centers have opted for a multipronged approach. Increasing both emergency room and intensive-care capacity will allow medical providers to immediately accommodate those who need help, Macica said, while installing weapons-detection systems will help protect people who enter the facility.

These changes can aid hospitals in ensuring the safety of their facilities, staff and patients, but require an approach to amenities that deviates from the rest of commercial real estate; in prioritizing safety, hospitals remain focused on basic utilities over intricate and eye-catching design. 

Such a strategy differs from offices, which now rely on glitzy, high-tech and wow-factor amenities to lure back employees. Hospitals certainly don’t need to evaluate whether patients will come; they simply need to function, so multi-use spaces are rapidly becoming a valuable asset. 

“A lobby is not going to be used as a lobby in a pandemic or a mass casualty event,” Morris said. “It could be used as an extra place to treat patients.”

An aesthetically pleasing and welcoming lobby is surely a plus, but it is useful only if it has concealed gas in the wall and access to power, among other treatment-related tools, Morris said. Converting spaces will help hospitals react to any situation that may arise. 

To achieve this flexibility, health care is turning to technology. The second panel — “Technology and the Patient Care Continuum” — looked at technology’s impact on building systems, as well as on the patient experience. Moderator Richard Benini, vice president and project executive at developer Lendlease, spoke with NewYork-Presbyterian’s Ienuso, as well as Peter Mulcahey, vice president of healthcare and life sciences at JRM Construction; Elizabeth Sullivan, associate project manager at Northwell Health; and Beth Muller, a director of information technology at engineering company Jaros, Baum & Bolles.

“Technology in health care is like turning the lights on or making sure that we have good air exchange,” said Ienuso. “It has to be present in everything that we do.”

With the breadth to ease a variety of hospital functions, technology surely impacts everything from operating room systems to patient experience to telemedicine, which became widely popular during the pandemic. Even now, telemedicine continues to allow for remote appointments without sacrificing face-to-face interactions, and is a useful tool already well-integrated into the fabric of health care systems. 

Yet implementing additional forms of technology are often easier said than done, as the latest upgrades tend to be expensive and not particularly user-friendly.

Muller noted that seamless integration is therefore a prerequisite for successfully converging technology and health care. Older people, who widely comprise hospital demographics, may express hesitation toward the digital, so getting them to utilize upgrades is where an all-hands-on-deck approach comes in handy. Prior to designing a space with modern technology, an organization must first have a vision and an understanding of what that technology should do — and how patients will realistically use it. 

“We really want to put the money facing toward the patients,” Mulcahey said. “But we also have obligations to set up buildings in a way that they’re minimizing the amount of effort and cost to maintain — and continue the performance of those buildings throughout the life cycle of the space.”

In “The Impact of Technology and Innovation in Health Care Construction,” moderator Mogens Smed, CEO of construction company Falkbuilt Ltd., continued the conversation about technological trends. He chatted with Patrick Burke III, assistant vice president of capital project management at Columbia University; Mitchell Clayton, senior vice president of real estate and facilities at Thomas Jefferson University & Jefferson Health; and Steve Polyakov, partner and chair of the health care and pharmacy law practice at Tartar Krinsky & Drogin.

The conversation began with the acknowledgement that leveraging technology is no easy feat, as there’s no one-size-fits-all patient or provider. As such, companies must unite in putting their best foot forward, Clayton said — coordination that begins, yet again, on the front end of a building’s design.

To get everyone on the same page from the start, Jefferson Hospital incorporates WELL building guidelines via a design guide specification. The guidelines call for LEED standards, among other specifications. By helping the hospital merge purpose with design, Jefferson’s guide ideally mitigates later setbacks and aims to create a harmonious, tech-savvy space. 

Spatial harmony resounded throughout the next discussion, a fireside chat called “Creating a State-of-the-Art Health Care Institution for the Region.” Rahul Tikekar, principal and senior vice president at Loring Consulting Engineers, and David Kontra, senior director of real estate at the Children’s Hospital of Philadelphia (CHOP), assessed the evolution of health care as it related to changes at CHOP.

Both panelists agreed that health care’s future hinges on user experience — not only for patients but also for their families and hospital employees. Experiential change begins by making facilities accessible to all three; CHOP recently opened a second hospital in King of Prussia, Pa., which has provided increased access to residents in Philadelphia’s western suburbs. 

Moving deeper into the patient community is a burgeoning trend for hospitals, as health care ultimately comes down to providing patients with treatment access. Perhaps the forum’s last panel put it best, when panelist Cathy Dolan-Schweitzer, a senior project manager at Columbia University Irving Medical Center, said, “A healthy citizen is our most important asset.”

That panel, entitled “Design and Construction Trends Within the Health Care Industry,” also included Jacobie Ricard, director of construction at Mount Sinai St. Luke’s; Suzen Heeley, executive director of design & construction for Memorial Sloan Kettering Cancer Center; Arthur Metzler, president and CEO of design firm AMA Group; and Constantine Zachariadis, managing partner at technology consultant TM Technology Partners. David Pfeffer, partner and chair of the construction practice group at Tarter Krinsky & Drogin, moderated the discussion.

Capping off the day was a closing keynote between Tom Ahn, vice president of real estate at Mount Sinai Health System, and Richard Lanzarone, construction executive at Turner Construction.

“Health care is the fastest-growing sector in the real estate industry in the nation today,” Ahn concluded. 

He noted that the pandemic has widely raised awareness of health care. It is through this awareness that corresponding infrastructure has had the opportunity to expand its capacity and purpose — and ultimately deliver what patients need. 

Anna Staropoli can be reached at astaropoli@commercialobserver.com