Designing a healthcare space can be quite complex, involving many stakeholders. It’s also an ever-evolving process that constantly seeks the most efficient, safe and research-based methods of delivering care. A new source of data, the COVID-19 pandemic, is sure to have an impact on how these facilities are built in the future.
By their nature, hospitals are different beasts from other property types. Elevators are large enough to accommodate patient beds, for example, and conspicuous signage and wayfinding are a must in what is usually a large, labyrinthine structure. Everything in a hospital is fine-tuned, even down to the doorknobs.
All of the attention to detail is no match, however, for a global pandemic like COVID-19. As we face a shortage of ICU beds and construct temporary hospitals, it’s clear that our healthcare system is going to have to react—not just to face this current crisis, but those that may occur down the line.
To be sure, many of the weaknesses in the U.S. healthcare system that the outbreak has laid bare are systemic. But we will see changes in the built environment too.
“I think that we’re already applying some lessons learned now,” said Jenny Han, director of healthcare design at Skender. “After the dust settles, people are going to take these lessons and apply them to future plans.”
Some of the changes we’ve already seen are drive-through testing that prevents potentially infected individuals from coming into close contact with other patients or staff. Faced with an influx of cases, hospitals are expanding their emergency departments into every nook and cranny, setting up exam chairs and partitions in their gleaming lobbies.
During this past cycle, there was an emphasis on making services more accessible out in the neighborhoods. As hospital systems looked for ways to deliver healthcare in a less expensive environment, this has resulted in a move away from the main campus. Hospitals have a higher proportion of space set aside for acute care, but this has also meant an overall declining number of beds.
“I know of some projects in the pipeline where there are replacement hospitals with less beds than the original facility. I wonder if they will reassess moving forward,” said Han. “After this pandemic, we are for sure going to see a difference in the way our codes are written and the way that we approach the built environment.”
The ways in which hospitals adjusted to past crises can inform how they will change after COVID-19. Rush University Medical Center is topped with a six-story, 800,000-square-foot, starburst-shaped tower that opened in 2012. The facility was designed in the wake of 9/11, and thus was intended to respond to a terrorism event.
One of those features—something that is also helpful during a pandemic—is built-in flexibility. The facility has planned ways to expand bed count beyond the standard model by 30 percent. Rush has been in surge mode for the past few weeks in response to COVID-19, so they currently have a larger capacity to deliver care.
Rush also built flexibility into the use of different units—a feature that came in handy during this current crisis as they were able to convert ICU units into COVID-19 units. This means stepping everything up in terms of infection control, safety and even housekeeping.
Just as we saw post-9/11, future hospitals will be designed to better respond to pandemic events. This includes attributes such as being able to isolate different areas of the hospital with separate air handler units and air filtration systems to mitigate cross-contamination. Though this may seem like a simple enough solution, if these infrastructural components aren’t in the initial design or they are lacking in financial commitment, it’s nearly impossible to accomplish as air will simply follow the path of least resistance.
Skender has emphasized modular construction in recent years, as evidenced by the firm’s building manufacturing facility in Chicago’s Little Village. Modular construction can offer cheaper build costs—a major concern in healthcare design. It’s also an approach that can serve the needs of this current crisis.
It’s best to think of modular construction as more of a manufacturing process than an off-site construction project. Regulating air flow with precise seals, for example, is much easier to accomplish in a precisely controlled environment like a modular factory.
The greatest benefit to modular is that it compresses the schedule. While that’s great for an owner or developer’s bottom line in that it brings a facility to occupancy quicker, it can be indispensable in an emergent crisis like this one where any delay can mean lives lost.
The ultimate modular solution is being constructed right now at McCormick Place. The Army Corps of Engineers is coordinating with The Metropolitan Pier and Exposition Authority (MPEA) to oversee the conversion of a portion of the McCormick Place Convention Center into an Alternate Care Facility (ACF) for COVID-19 patients.
When completed by the end of April, the ACF will effectively be the largest healthcare facility in Illinois, with the capacity to treat up to 3,000 low-to-moderate acuity patients across three of the convention center’s halls. In Hall C, 500 makeshift hospital rooms were erected in just over two days; another 1,750 rooms were later completed in Hall A.
“We mobilized and began work immediately,” said Thomas Caplis, vice president of healthcare at Walsh Construction, the contractor leading the conversion. “Walsh Construction is proud to support these extraordinary efforts of MPEA and Army Corps of Engineers that will offer essential care to our Chicago neighbors and much needed assistance to our vital healthcare system.”
The McCormick Place ACF will take pressure off of hospitals when, as experts predict, the Chicago area sees a peak in COVID-19 cases around mid-April. Paid for in part by $15 million in federal funding from the Federal Emergency Management Agency, the 10-feet by 10-feet makeshift hospital rooms will be separated by level of acuity.
It’s difficult to believe that any level of preparation could have foreseen the current pandemic and the healthcare system is having to respond in real time to the crisis. Once it is over, we can take any lessons learned and institute changes that might diminish a future catastrophe. Those changes can take many forms.
“It’s so multi layered. Just the fact that people don’t have access to healthcare, or they don’t have paid time off,” Han said. “All those things have to become questions for policy makers later.”
No one had a playbook for this crisis, and no one can see the shape that the next one will take. But that doesn’t mean we can’t learn from this event and try to make our healthcare facilities more agile. Lives depend on it.