Health Care Construction and Design Rife With Fresh Challenges Post-COVID

Health care is a rapidly evolving industry that requires adaptability on the part of everyone working in the field, be it medical providers, technicians, administrators and the real estate professionals responsible for the development of the facilities where people receive care. 

That was one of the main takeaways from Commercial Observer’s National Healthcare Construction Forum at 360 Madison Avenue in Midtown Manhattan on March 18. The event brought together industry leaders for discussions on improving health care through design, talent recruitment and infrastructure improvements. 

The day kicked off with a Q&A session between Joseph Mizzi, chief operating officer for Sciame Construction, and Joe Ienuso, group senior vice president of facilities and real estate at New York Presbyterian. The pair took questions from the audience and discussed New York City’s COVID-19 recovery, the impact of tariffs will have on construction costs, and more. 

“Let me start with sort of an ounce of optimism,” Ienuso told the crowd. “The reality of COVID for all of us in 2020, I think it’s fair to say nobody had a playbook for that. We may have all been exercising emergency preparedness and running tabletop drills since the reality of 9/11, but not one of those drills allowed us to exercise a global pandemic that shut us down effectively for over a year, and, quite frankly, we’re still recovering.”

The rapidly fluctuating nature of the current economic and political environment means there isn’t a playbook for what’s happening now either, Ienuso continued. He noted that collaboration  between owners, construction managers, architects and design teams is needed to navigate those uncertain waters when undertaking a project, particularly in the health care space. 

Costs were a major topic of discussion at the event, and one audience member asked if New York Presbyterian had to slow down or even pause some of the hospital’s projects as a result of cost issues. 

“We’re always going to be confronted with challenges,” Ienuso responded. “But I would say, if I have to put one of the projects that myself and my team are responsible for on hold, then my team and I have failed.” 

The first session of the day focused on the emotional and financial value of health care design. On the panel were Suzen Heeley, executive director of design and construction at Memorial Sloan Kettering; Andrea Hsu, principal with NK Architects; Juhyun Lee, senior associate design director for Gensler; Tina Macicia, associate vice president of design and construction with Montefiore Einstein; Andrew Weinberg, director of business development at LF Driscoll Healthcare; and Doug Carney, former system senior vice president and chief facilities officer at Mount Sinai Health System.  

The panelists discussed the importance of emotional and aesthetic value in health care design and the impact this can have on patients, hospital financials and staff retention. 

“We want to attract everybody — our patients, we want the family members to feel comfortable, the staff members to feel comfortable, and we want timeless design,” Macicia said. “Because it’s very, very, very expensive, and there has to be an emotional connection. If you don’t feel comfortable in a health care environment, are you going to go back to that particular location?”

The panelists all agreed that the right aesthetics can profoundly impact patients as they deal with some of the most stressful situations in their lives. And, not only are patients dealing with that stress, but so is the staff. There is a significant shortage of health care workers in the U.S., and hospitals and medical facilities will need to do all they can to attract and retain these workers, including providing a comforting work environment.  

“We’re talking about the emotional value of design, and historically — 30 years ago — it was all white and beige,” Hsu said. “We’re now seeing that there is a profound impact of aesthetics on patient outcomes and staff retention.” 

Attracting and retaining staff was the theme of the day’s next panel, particularly when it comes to facilities workers. The session included Steven Kim, director of engineering at The Brooklyn Hospital Center; Yvonne Wojcicki, executive director of campus life safety and regulatory compliance at Columbia University Irving Medical Center; John Hession, plant superintendent at Irving Medical Center; and Peter Pappas, president and CEO of PJ Mechanical. 

The speakers discussed the labor shortage in health care facilities management and how it should be addressed. Solutions can include mentorship of newer workers by veteran workers, marketing the career to younger students who haven’t yet decided on a path, and partnering with trade schools to align their curriculums with what the industry actually needs. 

“One of the things we’ve been experiencing is that boomers are leaving, and Gen Xers are thinking about slowing down,” Wojcicki said. “This is an exciting period post-COVID. We’re coming back to life as a city and organizations are coming back to life. But one of the things I think we’ve been focusing on now that the dust has settled after the pandemic is succession planning.”

The biggest theme of this discussion was finding solutions to recruit the next generation of facilities workers, because, as Kim pointed out, there are no facilities influencers hyping up the job on social media. 

“The challenges are there,” Kim said. “I think the younger generation tends to appeal to the things that are in front of them. So one of the things that we try and do is get in front of them in the trade schools, and really nurture the youth as we get them on board and advise them that there are growth potentials outside of what you may have been told are the traditional pathways.”

The panelists also discussed working with unions to help meet employee needs, establishing apprenticeship programs, and connecting senior staff with the newer staff so each can benefit from the other’s experience and way of thinking. 

The speakers during the next panel were Jeffrey Berman, principal at Jeffrey Berman Architect; Antonio Cabrera, vice president and director of health care at Hunter Roberts Construction Group; Melissa Kiefer, vice president of project development,planning, design and construction at the Hospital for Special Surgery; and Brandon Reiner, a partner with the law firm Tannenbaum Helpern Syracuse & Hirschtritt. 

The group discussed the strategies that go along with building and maintaining health care infrastructure. The panel covered the frequency in which ambulatory care facilities are being built, including the challenges of converting spaces that were once offices or stores into medical centers.

Deciding on which locations will work best for a medical facility “starts fundamentally with what market we want to be in,” Kiefer said, noting how much her organization relies on publicly available data on health care in New York to make those decisions. She also noted that understanding the different health care dynamics of the populations in each market can help the Hospital for Special Surgery determine if it will lease or buy a property and if that property is  the right facility to meet the medical needs of a population. 

“Ultimately, all of us want to get back to where patients are closer to home,” Kiefer added.

 The final two panels of the day covered energy innovations in health care construction and navigating construction costs. 

On the energy panel, Rahul Tikekar, senior vice president with Loring Consulting Engineers, was joined by Dan Mastin, energy and program manager for New York Presbyterian; Colin Barrett, energy and program manager at Mount Sinai Health System; and Edward Borman, project executive with Allan Briteway Electrical Contractors.

Barrett highlighted projects at Mount Sinai focusing on heat recovery and electrification that aim to reduce carbon emissions and operational costs. 

Barrett said Mount Sinai is focusing time, energy and money on capturing what he called “waste heat” from processes in the hospital and utilizing that heat for other purposes throughout the facility. 

“The reason why that’s important is that, conventionally, we would take our heat from our data centers or heat from our MRIs, and we’ll send that up to our cooling towers, and it just goes off in the atmosphere,” he said. “At the same time, we’ll have a boiler down in the central plant that will be burning natural gas or using electricity to generate heat. So we’re trying to find projects where we can capture that heat, instead of sending it off to the atmosphere, and use that heat. That helps us both with our bottom line in terms of our operational costs, and helps us reduce our carbon emissions.”

New York Presbyterian is also using heat recovery methods to improve the hospital’s environmental impact as well as its bottom line, Mastin noted. 

There are challenges that come with making buildings more sustainable, particularly older buildings where the electrical materials might present an issue. The group also discussed designing systems for future heat recovery and LED lighting upgrades as well as the impact of tariffs on material costs. Panelists also fundamentally agreed that timelines and adaptability need to be realistic if hospitals and health systems are to meet sustainability goals. 

Of course, meeting goals of any kind in the health care space requires conversations around costs and budgets, which is where the final panel of the day set its focus. Ryan Lean, associate partner at JB&B, was joined on stage by Alex Kaplan, president of design and construction firm Cost Concepts; Madeline Julian, assistant vice president of capital project management at Columbia University Irving Medical Center; Daniel Ahn, vice president of planning and design at Catholic Health; and Vincent Fiorillo, project executive at Consigli Construction. 

The panel discussed how labor shortages, increased HR expenses, higher lending costs, tariffs, and steeper interest rates, as well as changes to Medicare and Medicaid, all impact health care cost management. 

“We’re still dealing with the stresses that COVID left behind to the health care system,” Julian said. “In addition to the federal policies and the regulations, the instability of not knowing what’s going to happen makes it really difficult for academic medical centers to plan for long-term projects.”

But, at the end of the day, it’s about every aspect of a project’s development coming together to make sure the medical needs of a community are met, and managing the cost of a project in the most efficient way, the panelists agreed. 

“It’s hard to look at everything in a vacuum and it’s hard to look at everything just individually,” Lean said. “So you may be focusing on one particular area which has jumped up in price. But if you zoom out and look at the whole project and what the offerings are, maybe there’s some other savings you could have in different areas that will offset some of the increased pricing. So it’s a tradeoff.”

Amanda Schiavo can be reached at aschiavo@commercialobserver.com.