Prescription for hospital, health care facility success

Hospital and health care facility projects are especially important due to their sensitive nature. Engineers charged with designing these buildings must take special care when working in these mission critical facilities.

By Consulting-Specifying Engineer November 26, 2013


Michael Chow, PE, CxA, LEED AP BD+C, Member/Owner, Metro CD Engineering LLC, Powell, Ohio

George Isherwood, PE, Vice President, Peter Basso Associates, Troy, Mich.

Michael Lentz, Associate, RMF Engineering, Baltimore 

CSE: What sorts of challenges do hospitals and health care facilities pose that you don’t encounter on other projects? 

Michael Chow: Remodeling existing health care facilities and hospitals can be challenging due to the existing conditions and keeping the facility running 24/7 during construction. There may be a lack of record engineering drawings, labeling of HVAC systems, or electrical panelboard schedules. Also, there may be tight above-suspended ceiling space for new engineering systems (e.g., ductwork).

George Isherwood: The people who go to health care facilities are under stress. Whether they are the patient or a family member, they are often overcome by worry and concern. I believe this is important to keep in mind when designing systems in health care facilities. Making things easy and comfortable should be our highest priority.

Michael Lentz: The biggest challenges that I see in health care facilities are energy savings, maintenance, pressurization, and operational redundancy. With the current economic situation, health care, just like any other industry, has had to cut corners. New projects are demanding tighter budgets, and health care facilities are reducing their maintenance staff. This is a more serious concern in health care due to the nature of the facilities to care for patients. It is very difficult to meet the energy savings that are required by U.S. Green Building Council LEED, or even requested by the owner, and sometimes still meet the need of the patients and the facility. Tighter budgets also restrict what types of energy-saving measures the project can support. Budgets have also pushed for more maintenance-friendly equipment while trying not to lose quality or redundancy capabilities.

CSE: Looking into the future 2 to 5 years, how will the needs and characteristics of hospitals and health care facilities change?

Lentz: More and more health care facilities are outsourcing maintenance, which then requires a more maintenance-friendly design. This can greatly increase the cost of the project. Mechanical equipment needs to be more advanced in order to reduce maintenance. The mechanical equipment needs to communicate with the building management system (BMS) more so fewer staff members can monitor a larger number of pieces of equipment. The equipment needs more alarm points in order to troubleshoot problems quicker and easier. Also, more and more of the mechanical equipment is either being required to be or requested to be on emergency power. All of this affects the project budget and contributes to the rising cost of health care.

Isherwood: In my experience, I believe the health care industry is making great strides at changing the public’s perception on what to expect when visiting medical and health care facilities. Health care facilities have always been a place you go when you’re sick or injured. In the near future, that will continue to change. I first noticed this when we went to visit my mother-in-law at our local hospital. She commented that her room was like a nice hotel. My oldest daughter attended a healthy cooking class, and my younger children wanted to go back for dinner after my mother-in-law was discharged. Looking at the design of hospitals, sometimes we become immune to the effects they have on the general public. My children’s experience going to the hospital was one of excitement and learning, which is day and night to my memory in visiting hospitals as a child and a young adult.

Chow: We anticipate there will be more renovations to existing hospitals and health care facilities. The challenge will be to meet the future codes such as the number of receptacles in critical patient rooms increasing due to changes in NFPA 70: National Electrical Code (NEC). The existing electrical infrastructure may not be able to accommodate these changes without significant additions that many times are not accounted for in the initial construction budget by the owner of the facility. 

CSE: How often are you called on to retro-commission hospitals and health care facilities, as opposed to new construction of a building? What are some key differences between the two?

Isherwood: In our experience, commissioning services are being purchased for new construction in hospitals, but the demand for retro-commissioning services is not as high. We believe this is because of the high monitoring of existing systems from outside review agencies. Even though these reviews are being completed, we believe most health care systems do not fully realize the benefits of retro-commissioning. 

CSE: Since the Affordable Care Act passed, what shift in the types of hospitals and health care facilities work have you experienced? For example, a bigger workload, more retro work on existing facilities vs. new construction, etc.

Isherwood: I think health care networks are still figuring out how the Affordable Care Act is going to benefit them and they are holding back resources until the government uncertainty is clarified. We have experienced a shift toward smaller renovations and infrastructure projects. 

CSE: How has the economy impacted your work in this area? Have you seen the number of projects decline with the recession, and improve now that the economy is on the uptick?

Isherwood: I believe the economy has not had a significant impact on the largely privatized health care design industry. I believe the implementation and shifting of resources from the adoption of the Affordable Care Act has overpowered any positive effects from the rising economy.