Many of us who write for the real estate segment of D Healthcare Daily have often written on subjects of lean design, evidence-based design, lean construction, energy-sustainable LEED principles, and BIM. These topics are often useful, newsworthy and important to the design and construction of health related facilities, and I find them beneficial to my own business. Indeed anyone needing new facilities or renovation of existing facilities enjoy the comfort of knowing that there are professionals to rely on who understand the need for cost-effective delivery of well-designed projects. In the age of reform that is now much more imminent than just a theoretical concept, questions may well go deeper. Architects, engineers, construction managers, and real estate advisors are continuously seeking to deliver the right facility for pressing needs and to deliver it as well-designed for its intended use, within the cost and timeframes required as possible. These are the issues that challenge our professions in the best of situations.
In the past, we could all focus on building projects the right way, with all respect given to operational needs and environmental concerns. Given reforms’ constrained cost environments, increased workload demands, and uncertain shifts in the delivery of care models, the questions should include “Is this the right project?” If we build for this specific use now, will it have to be torn down and replaced in the future? Sustainability now becomes an issue going beyond the standard ecologically and energy focused efforts today. Will we build and retrofit facilities that are usable 70 to 90 years from now? Can they be designed for change-in-usage without breaking the bank on first costs?
It’s not a hidden fact that there is a lot of healthcare construction in the North Texas region right now. The needs for those projects have been well-studied, documented, and agreed to years ago. There is no doubt that on opening day they will better the meet the needs of patients and families in our region than ever before. But as planning and construction and property deals continue, can North Texans be assured that dollars are being properly spent in the right way for facilities where healthcare can be provided in the future, and in their children’s future?
The motivation for new projects has many drivers, from location for best market capture, to providing best access to healthcare in local communities; from creating nicer offices for physician recruiting, to capitalizing assets. Drivers often include increased demand for spaces for patients to keep up with our growing population. North Texas has certainly grown at the highest pace in the country for the longest period of time on record, so those drivers are very real. But we might ask, are we building too many beds? Is there adequate clinic space for 10 years out? Going forward, can more be gained from planning the kinds of buildings built for long-term flexibility? In other words, can a bed tower built today become a clinic or research lab in the future?
In terms of flexibility there are many concepts we can conjure, from modularity, design for renovation, and adaptive re-use to create options for the future. Whether they are driven by market changes, workload changes, or changes in technology, careful, adaptable design will earn the most points. By utilizing such methods wisely, evolving needs can be accommodated while achieving less energy usage to develop. Special consideration in the design stage for both facilities and their systems is the requirement in the event of potential change in occupancy usage. Whereas many outpatient settings can be accommodated inside business occupancies those for acute care require institutional occupancies—along with their higher requirements for life safety and inpatient care. The shift between these occupancy types can be tricky or impossible depending on how well the facility is. It is much easier to shift from an institutional to a business usage than the other way around. If planned properly, in the end, potential savings can be very beneficial over the many chapters of a building’s life.
The plan to achieve flexibility, or adaptive re-use, begins in the strategic business phase when a philosophical premise can be built for extending the life of structures built for the use of patient care. Commitment to its principle through careful master planning and project implementation can assure the concept remains intact. The payoff is less capital spent, less property developed, and greater life of facilities.
Dan Killebrew is a partner at Dallas-based FKP Architects.