COVID-19 accelerated the trending move to bring high-quality healthcare from hospitals directly to underserved parts of the community and into patient homes. As such, it hurried the adaptation of emerging technology and interoperability initiatives like telehealth. The pandemic also solidified the necessity of trends like community based-outpatient models of value healthcare and exposed opportunities to upgrade existing inpatient critical care centers into more flexible intensive care sites.

The current challenge for many healthcare systems is to create master planning strategies that allow for both “healthy” patient and critical care services to function simultaneously and without interruption, should another outbreak occur. Keeping preventative appointments, elective procedures, and non-urgent surgeries operational is imperative in enabling steady streams of revenue to continue uninterrupted while ensuring resources be efficiently allocated to combat pandemic-sized emergencies. Yet, with minimal funding available for larger-scale changes to building plans, additions, and expansions, planning objectives must take a holistic look at logistics and balancing solutions.

Master Planning Strategy + Financial Capability

Financial realities are driving implementation of healthcare master planning. During the pandemic, many hospital systems intensified spending on staffing and supplies. Non-urgent procedures, testing, and elective surgeries were forced to pause, and money-making operating rooms were turned into intensive care units to make room for more COVID-19 patients. The number of non-COVID patients seeking services at emergency departments, physician offices, and radiology practices severely decreased. As a result, healthcare systems were left struggling with a financial crisis on top of an ever-evolving public health emergency.

One challenge post-COVID is to create a master plan that balances upfront cost-effective capital improvement expenses with pre-planned deployable “just-in-time” solutions that allow institutions to minimize upfront costs and defer to them when/if the need arises.  Conjointly, master plans that put a focus on better serving communities geographically create a win-win situation. These strategic facilities would better support the under-served neighborhoods during “normal” times and also serve a larger role in the institution’s logistics plan during times of emergency. This would enable the system to expand its capacity by leveraging all facilities.  Additionally, planning should take into account the need to create flexible critical care spaces and provide more efficient care for “healthy” patients. The expansion of ambulatory outpatient reach and the modification of inpatient critical care systems can be accomplished both quickly and economically.

Community-Based Outpatient Strategy

Healthcare systems are expanding their geographic footprint beyond the centralized acute care campus and into the neighborhoods they seek to serve. The need for outpatient strategies that provide integrated and convenient access for “healthy” patients across NYC has been solidified by the disproportionate toll of COVID-19 on City residents.

Prior to the 2020 pandemic, the NYC healthcare landscape had already been moving toward a community-based outpatient care model. Many hospital systems began adopting value-based healthcare initiatives to better serve patients by creating more geographic access to outpatient ambulatory care. The data surrounding COVID’s impact on NYC has strengthened the need for these model changes to move forward. Low-income neighborhoods with scant access to healthcare options suffered the highest death rates during the pandemic. Not only were the incidents of COVID-19 much higher in these areas, but the availability of testing was much lower in these neighborhoods with limited healthcare access.

To continue the push of creating accessible outpatient healthcare options in communities that need it most, a holistic healthcare system analysis can offer organization-specific solutions. General cost-saving outpatient options can include:

Fit-Out + Adaptive Re-Use

The creation of cost-effective community reach can be effectively accomplished with the fit-out or adaptive reuse of existing infrastructure. Ambulatory space typically operates in Class B Occupancy allowing for much more economical options in terms of both initial and overall life cycle costs. COVID has exacerbated the amount of underutilized commercial properties, opening the door to more opportunities to pick up Class B space affordably. In much of the City, unused retail centers, office space, and mixed-use developments are available in accessible locations. Additionally, ultra-low-cost trends to modify space within neighborhood churches, mosques, and synagogues into operational outpatient sites offer the potential for delivering better value-based services to some of the City’s most underserved areas.

Prefabricated + Modular Components

Prefabricated and modular fit-out solutions can create inexpensive designs that take into account flexibility and efficiency of space. Prefabricated elements can cut construction costs and save time, enabling the development of an outpatient facility to begin generating revenue quickly. Healthcare projects with repetitive design elements can also take advantage of the consistent design standards afforded with prefabricated components, in turn, reinforcing their brand quality in new geographic locations.

Inpatient – Critical Care Facilities

In addition to utilizing lower-cost spaces for “healthy” outpatient care, urban healthcare strategies also consider maintaining an institutional zone for inpatient critical care at centralized sites. The shift converts existing larger scale hospitals into complex care sites, dedicated to critical care and complex surgery. The additional space afforded through the expansion of geographically placed outpatient facilities and the movement of remote/telehealth staff affords the room for important critical care modifications.

Once again, to create timely and affordable changes to existing hospital systems, a holistic healthcare system analysis during the planning stage can offer organization-specific alternatives and possibilities. General cost-saving options for much-needed hospital upgrades include:

Engineered Design Flexibility

One of the lessons learned from the pandemic was the lack of pre-engineered flexibility in space. Current designs did not easily allow for quick conversion of spaces into ICU beds or triage facilities. Healthcare must now upgrade its layouts to put greater weight on flexibility to address unpredictability in care delivery and patient volume. Re-engineering space to be more flexible and efficient can allow for the growth and contraction of departments with the interchangeability of rooms and the unification of circulation systems. The use of prefabricated or modular design elements can aide in creating quick and inexpensive alterations with minimal structural changes.

Means + Methods

When structural changes are implemented in building upgrades, optimal means and methods that address unique challenges specific to the construction of healthcare sites, are critical. Careful consideration must be given to potential disruptions of existing operations, the anticipation of unforeseen conditions, safety, traffic control, protection of adjacent structures, and sequencing of critical milestones. A construction engineering consultant can provide strategic options and a detailed phasing and logistics plan to mitigate potentially costly disruptions to healthcare operations, air quality, and emergency procedures. Bringing in this service early in the design process (i.e. Design Development) can best serve the project to direct the design team in the optimal direction.

On-Call Emergency Temporary Structures

If structural changes or fit-out options cannot be afforded in master planning and development goals, securing on-call services for the deployment of temporary structures in case of an emergency can be an appealing option. Engineering temporary structures in collaboration with modular industry partners enables the placement of temporary pre-determined facilities quickly and without the capital expense. This essentially creates a “just-in-time” solution allowing for better financial management.

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