Clinical Trials: What Works in Healthcare Construction Now

New York City healthcare executives at a recent Commercial Observer forum debate the costs and benefits of building and converting space

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Four years after the coronavirus pandemic swept the country, the people who design and maintain New York City’s health care facilities reflected on several lessons they learned about managing a crisis.

When the city’s hospitals became the global epicenter of COVID-19 treatment for several months in 2020, facilities executives converted operating rooms and other spaces into intensive care units on the fly. They quickly upgraded their HVAC systems to ensure that clean air was circulating constantly, and updated their telecom networks to accommodate the need for patient telehealth visits.

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Even though the country’s official public health emergency concerning COVID-19 has wound down, the challenges facing the region’s medical centers are far from settled. 

“Here in New York we’ve had to deal with so many different issues over the last few years, whether it was COVID-19 or superstorms, and we learned how we can make hospitals more resilient,” said Michael Rawlings, senior vice president at Hospital for Special Surgery. “You hear about health care burnout from doctors and nurses, but resilience is about springing back.”

Rawlings was among the scores of health care and real estate experts gathered at Commercial Observer’s Healthcare Construction forum on March 5 to share insights about how to integrate smart technology into their buildings and networks, minimize risk, and plan for a future that includes crises they haven’t even begun to think about.

“We just came out of the pandemic, we’re facing big labor shortages with nurses, high interest rates, and competition from CVS and Amazon getting into the health care space. How do you manage your capital budget?” Rahul Tikekar, senior vice president at Loring Consulting Engineers, asked one panel guest at the forum, which was held at the City University of New York Graduate Center on Fifth Avenue.

The answers can vary. 

Hospital executives must plan for the present and the future simultaneously while ensuring that costs don’t run out of control. Luigi Tirro, Northwell Health’s director of facilities development, is a big fan of design build, in which designers and contractors work together on a project from the start, which he believes brings continuity and new ideas to the table. 

“The problem is the old ways of designing and building anywhere can lead to a lot of mistakes being made and bring out additional costs,” Tirro said. “It can be a hardship on the hospital, especially for Northwell. It can mean another project not starting, or we don’t complete another project.”

Nathan Howell, vice president and market sector leader at architecture and engineering firm STV, thinks the region should embrace modular prefabricated construction, which is used in other parts of the country.

“We should think about more modular and faster ways to construct these spaces and modify them as fast as possible,” Howell said. “We’re still challenged on code requirements to get there.”

In New York City, health care institutions are constrained by cost and space. Hospital executives said that they have been looking more closely at converting commercial office buildings for doctors’ offices or ambulatory care facilities, thanks to the glut of vacant office space on the market. But opening a full-fledged hospital in one of these buildings isn’t always practical because a building’s specifications don’t match a hospital’s needs.

“When we think about current real estate conditions in New York City, it’s inevitable we’ll have patient-facing space in a commercial office building or a former retail space,” New York Presbyterian Hospital Group Senior Vice President Joe Ienuso said. “We want large floor plates — 30,000 to 40,000 square feet — with very high bay space, 18- to 20-foot slab to slab, and as generous a column grid we can establish. Those three things give us flexibility going forward.”

Even if hospitals want to expand their footprints, the most cost-efficient option may often be renovating existing buildings thanks to the high price of city land. But renovations can be far more challenging than new construction projects, thanks to the difficulty of installing complex ductwork and wiring in hospital ceilings that must occur while a hospital remains open to treat patients.

“Everyone would love a new building but it’s not in the cards for a lot of health systems,” Jonathan Cogswell, vice president of Manhattan development at Northwell Health, said. “The decision to adapt to net new construction is more driven by infrastructure above the ceiling, but what’s below the ceiling drives decisions too. In some cases, you couldn’t drop that ceiling an inch and stay above code.” 

That’s why some hospital executives choose to tear down existing structures on their campuses. New York-Presbyterian, which has 12 million square feet of existing space, is currently planning to raze a century-old building it owns in order to provide a new hub for its cancer research and treatment

“One thing we don’t have on the ready is available land,” Ienuso said. “Sometimes buildings are old, not historic, and not everything that’s old is historic. It’s a difficult decision to take something down.”

Even when a medical institution wants to build or renovate facilities on its own property, it must still get the surrounding neighborhood on board. That’s easier said than done. A Bronx community group sought to block New York City Health + Hospitals’ plan to build an affordable housing project for formerly incarcerated individuals on its Jacobi Medical Center in Morris Park. And thousands of Lenox Hill residents signed a petition to oppose Northwell Health’s $2.5 billion plan to build a new hospital tower for Lenox Hill Hospital at Lexington Avenue and 77th Street.

Doug Carney, who has led expansions at Children’s Hospital of Philadelphia and Brigham and Women’s Hospital in Boston before joining the Mount Sinai Health System as its senior vice president for real estate, planning, design, construction and engineering, said that integrating community groups into early planning stages and offering tangible benefits to the surrounding neighborhood makes everyone happier. 

In Boston, Carney was able to use a state energy grant to add rooftop solar panels to scores of nearby low-rise single-family homes that could charge hospital batteries and provide free electricity. In Philadelphia, Carney did an “elegant planning process” after buying land a decade ago for a 500-bed tower that ensured that a 50-mile running trail along the Schuylkill River wasn’t interrupted.

“This had the potential to wall off a really vibrant, emerging neighborhood from the Schuylkill River,” he said. “There were strategic interactions that we were able to do that didn’t ruffle feathers.”

But the biggest challenge hospital executives face may be ensuring that the patient experience doesn’t get worse once a new or renovated facility reopens. New technologies like smart cameras, artificial intelligence, and telehealth-driven check-in systems can sacrifice human interaction in exchange for efficiency, which hospital experts want to avoid.

“We’re in an age where technology is incredibly prevalent and it’s easy to put that at the forefront,” Howell said. “You check in on your phone and get directed to your exam room, and, in some cases, you see a physician over a screen, but at what point is it better than telehealth? Technology should not substitute human connection but should enhance and deliver that human component.”

Everyone is a hospital patient some day, and hospital executives must figure out how to ensure their buildings can handle the onslaught of patients efficiently as the needs for medical care in the 21st century only grow.

“When you have a crisis and you want to see the guidance of a specialist you don’t want to wait three months for an appointment,” Ienuso said. “Whether it’s getting an appointment for an exam room or having a procedure in the operating room, the facilities side of the house has to understand those elements so we can plan and improve the way we use those spaces going forward.”

Commercial Observer’s Healthcare Construction Forum also featured remarks from Commercial Observer Editor in Chief Max Gross and a panel on “Smart Healthcare Infrastructure: Integrating Technology for Enhanced Patient Care” moderated by Andrew Weinberg, director of business development at LF Driscoll Healthcare with Northwell Health’s Cogswell; STV’s  Howell; Melissa Kiefer, vice president of project development, planning, design and construction at Hospital for Special Surgery; and Beth Muller, technologies director at mechanical engineering firm JB&B.

That panel was followed by a fireside chat with NewYork-Presbyterian Hospital’s Ienuso and Joseph Mizzi, president of Sciame Construction.

Next came the panel “Transforming Legacy Campuses: A Master Plan for Transitioning Older Institutions Into Cutting-Edge Healthcare and Life Science Facilities” moderated by Patrick Shea, vice president of operations and safety at mechanical engineering firm F.W. Sims. The panel included Patrick Burke, vice president of facilities management, operations and planning at Columbia University Irving Medical Center; Mount Sinai’s Carney; Alexander Gutkin, principal at Legacy Engineers; and Walker Shanklin, director of architecture at architecture firm SGA.

In the late morning session, there were fireside chats on “Construction Safety in Healthcare: Best Practices for Risk Mitigation” with Tom Singh, corporate director of facilities environment of care compliance at New York-Presbyterian Hospital; Yvonne Wojcicki, executive director of campus life safety and regulatory compliance at Columbia University Irving Medical Center; and Thomas D’Ercole, Northeast regional director a Plaza Construction.

Then it was followed by a fireside chat on “Future-Planning Healthcare Spaces: Adaptable Designs for Changing Needs” with Mark Csontos, strategic project engineer at Gil-Bar Health & Life Science; and architect Jeffrey Berman; and Elizabeth Sullivan, assistant vice president at Northwell Health. There was another fireside chat on “Healthcare Design and Construction Trends: 2024 and Beyond” with Loring Consulting’s Tikekar; and Northwell’s Tirro. Finally, a fireside chat discussed “Resilient Design for Healthcare: Building for Preparedness” and featured Brian Marman, project executive at construction firm Lendlease, and Hospital for Special Surgery’s Rawlings.