Health Care Done Right

As more and more developers bring their expertise in finance and construction to the process of building medical environments, they are finding that health care facilities present a range of new challenges not present in more traditionally developer-driven building types. Successful practitioners in this new arena are putting themselves in the current mindset of health care providers in order to create consumer-driven products not unlike what users might produce on their own.

Hospitals and clinics in the 21st century are a far cry from the stripped-down facilities of the 1970s. They use what is being called evidence-based design to create buildings that become tools for health care delivery and healing. Design becomes an effective mechanism in preventing the spread of infection and improving provider performance, especially in emergency situations. Natural light, views to the outside, and acoustic qualities contribute to patient comfort and even shorten recovery times.

As developers have immersed themselves in the great leaps forward in health care design over the past decades, four distinct design issues have stood out between this emerging market and building types that have more traditionally been their bailiwick.

All hospitals and all clinics are not created equal. Operations at hospitals and clinics vary enormously based on markets, specialties, and even specific personnel. The training, philosophies, and methodologies of health care providers are far from uniform, and the passion and commitment they often bring to their work makes them uncompromising in their standards. Unlike most office workers, these users have very strong perspectives about the way the spaces they occupy can assist or detract from the success of their work.

It is no accident that health care tenants have seldom been candidates for inhabiting general tenant finish-out or adaptive use projects. Dimensions of specific spaces, efficient arrangements of rooms, and relationships of various personnel and equipment require particular building configurations and characteristics. One size does not fit all, and prototype design, more and more, is rejected in favor of customization and specificity. Doctors and nurses have to be in the loop when it comes to making design decisions. Their expertise, their knowledge of their own specializations and preferred procedures, and their buy-in are essential in creating a successful project.

In the current situation where demand for the best doctors and nurses exceeds supply, competitive advantage in health care environments can have a significant impact on personnel recruitment and retention. Top professionals are fleeing old, inefficient quarters in favor of places that not only facilitate high standards of medical practice, but also feel like an environment where high quality is a top priority. The operational and financial success of a hospital or clinic often can be traced to the success of the facility in helping attract and retain the best professionals.

Hospitals, in particular, have to be far more durable than most other building types. Hospitals are 24/7 environments that receive extraordinary wear and tear. Beds and equipment are moved around constantly, putting pressure on floors, walls, and door frames that takes a toll on buildings of normal construction quality. Constant cleaning, often with harsh chemicals, requires that tough materials and finishes be used.

Renovation and replacement are also more difficult in health care environments that undergo constant use. Construction noise, dust, and disruption that might be tolerable in an office building are unacceptable if they interfere with patient health and recovery. Hospital and many clinic spaces must be built to last. They need to be workhorse facilities that can function well and keep looking fresh and new for years.

For these reasons, tenant finish-out and core and shell construction standards are not suitable for most health care environments. Construction materials and assemblies for predictable renovation and renewal at the end of periodic lease cycles often prove inadequate and inappropriate in these more demanding environments.

Compared with the construction costs of other building types, those for many health care facilities are a relatively small fraction of total operational costs. Because the cost of health care equipment and personnel is so high, optimization of their time and efficiency must be a primary design concern. As a result, it is often more cost-effective to design first for operational efficiency and second for building efficiency.

It may be worthwhile to add an extra corridor and thereby inflate the building’s gross square feet if it will reduce travel distances for nurses dozens of times a day. Likewise, it may be more cost-effective to add an extra supply storage area on each floor if it will mean less personnel time spent on distribution. Because health care operations are so expensive, their optimization must drive building configurations.

Design of health care environments is a value-driven enterprise. Long-term economic benefit must be balanced against initial building costs. Shortsighted decisions during planning and construction phases can result in inflation of already high operational costs that multiply year after year over the life of the building.

Many sustainability issues are also health issues that are particularly applicable in medical contexts. Patients in hospitals and clinics are vulnerable and sensitive to the presence of toxins and particulate matter, and to other environmental conditions in a way the general building user is not.

Indoor air quality must be a substantial design concern, and building materials and finishes must be selected to minimize use of volatile organic compounds and other deleterious chemicals. Even cleaning agents required to maintain selected building materials must be taken into consideration. Mold prevention is a priority that cannot be compromised. Not only are respiratory illnesses severely aggravated by poor indoor air quality, but atmospheric toxins can cause complications for patients with other maladies.

Daylighting is another sustainability issue that can have a powerful impact on health. Abundant use of natural light not only can create energy savings, but also can have a positive effect on patient attitude and well-being. Greater exposure to sunlight increases the body’s production of the chemical serotonin, which is a natural antidepressant. Window sizes, shapes, and orientation to light and views have been demonstrated to be factors in patients’ need for pain medication and their recovery time.

Two recent projects demonstrate similarities between successful developer-driven health care projects and those built by institutions for their own use. Although the Chickasaw Nation Medical Center in Ada, Oklahoma, was user driven and the Lakeway Regional Medical Center in Lakeway, Texas, near Austin, was developer driven, their design processes and results have much in common.

Both projects employed extensive programming efforts at the beginning of the design process to ensure that the facilities would meet the specific medical needs of their communities. In the case of the Chickasaw project, tribal elders and cultural leaders were consulted throughout the design process, along with doctors, nurses, and administrative personnel. In the Lakeway project, a core group of physicians committed a substantial amount of time to conceptualizing and implementing the design, including creating a full-scale mock-up of a patient room to illicit user input for modifications.

Developers who are doing health care facilities the right way are responding to the specific needs of an industry that is ambitious and sophisticated. They are combining their ex­­pertise with a healthy respect for a building type that is both demanding and complex, and they are delivering projects that live up to high standards of building performance.

The article was originally published in Urban Land Magazine.

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