7 steps to save money and improve care in hospital expansion and renovation

It’s project time, and you have to get it right. You need to identify and resolve the real challenges within your facilities. And the hospital expansion or renovation needs to address the practical problems of delivering care. Your strategy is to identify and achieve those sometimes elusive and often oddly competing objectives. Your focus is on the final building as a solution to the functional problems, concentrating primarily on purchase value and construction schedule. Here’s how to approach your project to get the best value from construction with the best solutions for your facility, staff and patients.

1. Start with Design-Build

The Design-Build delivery system serves the healthcare industry well. Since a Design-Build company delivers both architectural designa and construction, hospital owners engage in decision-making with the same leadership from the very inception of the process through its completion. All participants of the process work for the same goal, and the project is positioned for long-term success. With robust, multi-disciplined expertise present from project onset, the best-value solutions are identified. And owners can be confident and decisive in selecting designs, materials and building options, leading to a fast-track project with minimal unforeseen costs and delays.

2. Identify the real challenges

The first step in any hospital expansion is identifying the facility’s real challenges. Board members and C-suite administrators meet with designers as they ascertain the right project goals. Competent project team leadership ferrets out and accurately labels the organization’s “pain points:” the places where hospital staff members feel “pain” due to poor operational structure or inefficiencies in the hospital building design. Project designers interview salient staff members (chief of nursing, facilities manager, etc.), as well as front-line floor staff members, who will be valuably candid in one-on-one settings. Designers spend extensive time directly observing patient and staff flows to gain a thorough understanding of the existing facility and identify optimal hospital layout planning.

Engineers should evaluate the existing equipment, both medical (e.g., headwalls, radiological setup, Pyxis SupplyStation® Systems) and non-medical (e.g., HVAC, electrical system, generators, boilers). And they should quantify all of their operational efficiencies.

A robust evaluation enables designers to help owners determine their true needs over their wants and prioritize the major facility problems, because a hospital’s desires always outweigh its available resources. Of course, a want in some facilities is a need in others. Code compliance, licensure and patient safety always stand out as needs. Staff efficiency is more of a need in rural small hospitals, but it should always be high priority; after all, a more efficient staff costs less (time is money), provides better patient care and has higher morale.

For example, a Texas community hospital realized it needed to get creative with funding for capital upgrades. The current hospital was old, and the infrastructure hadn’t been well maintained. Funds were limited, and even though the community wouldn’t pass a bond referendum, it didn’t want the hospital to abandon its central location and move to the outskirts.

In response, designers proposed a substantial construction project overhauling the areas that directly impact patient satisfaction: the ER, radiology, and surgery. The project also corrected relationships — spatial movement between the existing ER and radiology — that were the culmination of years of important additions, which had the unintentional effect of compromising a coherent patient experience.

The hospital renovation process optimized patient satisfaction and created sufficient space on the main campus to bring back services that had been operating in leased, off-campus spaces. The savings from those terminated leases provided additional income to offset some of the upgrade costs of the central hospital at its existing location.

3. Evaluate with insight

During the pre-design evaluation, the owners and project team leaders closely review financial records to determine the highest and most profitable sources of revenue: where is the hospital thriving and where is it merely surviving? The team will determine if and how a hospital expansion project can lead to capitalizing on existing profit centers, and if it can fix, minimize, or even possibly eliminate the services that are a drain on hospital resources. Though financials are a sensitive topic, transparency of both the areas to celebrate and areas to address is essential in order for the project designers to objectively analyze past services, formulate sound future projections and make insightful recommendations.

For example, one hospital wanted to increase from two ORs to four. Its surgeons felt there were too few preferred times available for them to work, and they asked administration to add space. Wanting to satisfy their surgeons as well as gain the prestige of having more ORs, administrators were favorable to the idea. And they reasoned more ORs would surely generate more revenue to cover the cost. Yet, to their discovery, when the design team reviewed the financials, the metrics simply couldn’t justify doubling the OR capability. Even an unlikely, best-case scenario was that an increase of a single OR might generate sufficient revenue to cover its cost, but two were unrealistic. As a result, the surgeons worked through strategies involving scheduling operations to optimize available time.

4. Study the strategy

Designers intimately review with administrators their facility’s 5 to 10-year strategic plan, which inevitably reveals gaps and may even necessitate adding focus and detail before making immediate construction decisions. However, that process, coupled with a realistic analysis of the financials, helps both designers and owners recognize and veer off from pursuing projects that involve excessive and unwise debt.

The preliminary evaluation enables designers to credibly advise owners if it’s at all possible to save an existing facility rather than build a new one, or to at least retain and renovate the old building for a reconfigured mission.

Demonstrating this decision-making approach, a community hospital on a robust campus wished to convert its inventory of semi-private rooms to private patient rooms without reducing the total number of beds. In order to accommodate the additional 100 beds needed, owners and designers unsuccessfully looked for space where they could put a new patient tower to accommodate new beds without creating sprawl. The final solution was to convert the physicians’ office building immediately adjacent to the hospital that was already connected to the patient floor.

5. Simplify — solve multiple problems with single solutions

While the initial broad evaluation of the owners’ perceived problem is necessarily involved and tedious, it can still be expeditious, requiring a definitive period of time from analysis to proposal. In response to the designers’ evaluation and proposal, owners address a manageable amount of the highest priority needs, fully embracing solutions that have the greatest return on investment. And the best solutions are the ones that find correlations between existing problems and then bundle tasks for multiple fixes in a single solution.

For example, consider that a hospital typically needs three labor, delivery, recovery and postpartum (LDRP) rooms, but at times it must simultaneously service up to two times (or more) new mothers than capacity. With that in mind, designers can place obstetrics next to medical-surgery. At high-demand times in obstetrics, the adjacent med-surg private patient rooms can be pressed into service for the new mothers who are displaced from OB by the next wave of laboring moms. By planning for that long-term solution, the hospital builds for the most efficient use of space, not the worst-case scenario, while still genuinely meeting the needs of the community with excellent patient care.

One community hospital was not interested in the overall planning process at first, when its decision makers had wanted to move the undersized lab from the basement to the first floor near the front entrance. However, as the design team reviewed this plan, it became clear that the first floor replacement was basically going to duplicate the undersized basement original, resulting in spending money to duplicate something that didn’t work in the first place. So together, the owners and designers performed overall planning to find a better way. The team concluded that a larger project would correct both the lab size problem as well as other lingering, latent issues that would have only gotten worse had they not been teased out and solved in that renovation.

6. Value 360-degree input

A team approach produces the best options. Designers assemble teams from all elements of the hospital community to explore issues and brainstorm solutions. They openly share the outcomes of the conversations and solicit feedback. There’s not necessarily one right answer and often, no obvious or easy solution. But it’s a benefit when decisionmakers can assess and select from multiple, competing desirable options.

7. Execute with care

Once the hospital expansion or renovation moves from design to construction, building site personnel must be ever cognizant that they’re working in and around a hospital, whose moment-by-moment function is to solve immediate needs — and whose staff performs critical tasks of delivering potentially lifesaving care. There can be no tolerance for compromising that mission. The Design-Build team must have protections in place so that, like the doctors who take the Latin oath “primum non nocere,” they “first, do no harm.”

The Design-Build company must also be continually aware that it’s spending valuable resources and be good stewards of that trust. Team members must be committed to and capable of quality and safety. And they need to get things right the first time, even if the solution is neither obvious nor easy.

Healthcare in America isn’t getting less expensive, less complicated, or in any less demand. So when hospitals need to expand, they need healthcare construction services that are focused, competent and experienced in the medical field. The right partner will likely be essential in getting a hospital construction project to solve the real problems with the right solutions.

A successful hospital building program

Anderson Hospital in Maryville, Illinois has enjoyed an efficient, effective building program since the 1970s. To see the results of long-term planning, best-value solutions and collaborative Design-Build delivery over time, read about the construction program of Anderson Hospital.

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