Issues, Considerations Moving Post-COVID
Slowly but surely, the nation is beginning to emerge from strict COVID protocols and return to some semblance of normalcy. While it's a bit too soon to craft 'best pandemic design practices,' Nashville Medical News recently spoke with two experts to get their take on design considerations and the reemergence of some pre-pandemic trends.
Matthew Griffith, AIA
Matthew Griffith, AIA, vice president and senior architect with the Gould Turner Group, a subsidiary of Barge Design Solutions, said a number of healthcare design 'trends' have actually become core philosophies. Chief among that list is evidence-based design. In fact, EDAC - Evidence-Based Design Accreditation and Certification - is an internationally recognized program of the Center for Health Design.
"Biophilic design in definitely a hot-button topic these days," Griffith said of one example of an evidence-based design concept. Biophilic design seeks to connect the built space more closely to nature by incorporating natural lighting, greenery and other outdoor elements.
Budget and the bottom line remain an important consideration, but Griffith said value is increasingly measured in ways other than direct billables. "Healing gardens are a non-revenue-generating space, but I think there's been evidence over the years of the benefits for patients and staff."
Features leading to improved staff retention and patient satisfaction ultimately do impact the bottom line. "I think more and more owners are seeing benefits in spaces they wouldn't have 15 or 20 years ago," he added.
Time, Budget & Contingency
While willing to include amenities and evidence-based design options, money, of course, remains a major consideration.
"Everyone is operating on razor thin margins," Griffith said, adding speed-to-market considerations loom large for budgeting. "Faster done, faster to use, faster to generate revenue," he pointed out. That reasoning has led to a growing interest in prefabrication modules, which can shave weeks off a construction schedule compared to being stick built on site.
Nathan Hines, project manager at Turner Construction, said time and money are taking a hit when it comes to construction supplies. "Right now, I would say the biggest issue we're having is raw metals," he explained. "We're seeing price increases. We're also seeing lead times growing exponentially."
Hines said it's never a fun conversation to sit down with a client six months after coming up with a plan only to tell them pricing and timing have changed. Budgeting a reasonable amount for contingencies helps mitigate some of that risk and keeps a project on track monetarily.
Since time is money, Hines said it's important to have plans in place to address scheduling contingencies, too. "If we foresee there may be a potential risk with securing materials, we try to get that bought out as quickly as possible," he said. "Sometimes that may be an early release package or paying a premium on the front end to secure the materials on a certain deliverable date."
One of the best mitigating factors, he continued, is for the construction and design teams to work well together. While construction typically receives plans once they have been finalized, Hines said communicating supply shortages or shipping delays with design can help construction get a jump start. With the current issues with metals, he continued, the architectural team might release the steel package before the overall design is completed so that construction can lock in a price and have a longer lead time to secure delivery.
"Cleanability is huge ... that's always been the case, but it's even more so with COVID," said Griffith. "Don't be surprised if you see rounded drywall corners come back," he said of reviving the once-popular style. "A curved corner is more easily cleaned."
Happily, Griffith noted, many products that are durable and cleanable are now also beautiful. "In healthcare, in general, hard surface flooring is a code requirement in a lot of spaces," he said, noting vinyl flooring makes sense. "It looks good and is very low maintenance. And from a longevity standpoint, it's beneficial to a hospital."
However, Griffith continued, people hear 'vinyl' and immediately think of old hospital design or school cafeterias, but that's not what today's vinyl looks like. LVTs - or luxury vinyl tiles - come in a range of appearances from stone to wood while still being easily maintained. Griffith added pricing has come down to put high-end looks within reach.
Flexibility & Adaptability
Already a pre-pandemic consideration, both our experts agreed one of COVID's lasting impacts will be an increased emphasis on building for flexibility.
"How do we think through the potential of the next pandemic?" Hines questioned. Part of the answer, he continued, is to design and build in a way to maximize spaces, but rethinking processes also has to be part of the equation. From considering triage to ED workflows to looking at mechanical systems that control air flow exchanges, Hines said there are opportunities to build in flexibility and adaptability in numerous ways.
Griffith agreed, saying he thinks hospitals will look at HVAC systems in terms of being able to section off parts of the building and figuring out how to quickly move from negative to positive pressure as needed.
While a hospital provider wouldn't build a 500-bed critical care facility on the chance that another pandemic might ramp up ICU needs, Griffith said hospitals are building rooms that are acuity adaptable by roughing in mechanical and engineering capabilities at a higher level for easier access if the need arises.
"Universal care room was a big buzz word 10 to 12 years ago," said Griffith. "It lost traction, and now with COVID, it's become more attractive again." He noted there is increasing interest in designing spaces to be flexible that traditionally wouldn't be. "It's being more proactive on the front end to be more prepared for the next wave."
Hines said there has been an uptick in universal spaces, particularly around emergency departments, to accommodate both overflow and safety. "We want the flexibility of universal spaces, but it's also a safety consideration," he noted. "If there are 20 access points, when a pandemic happens, you can completely lock down certain doors so that maybe you only have one or two entry points for screening and to control flow."
Technology is another point of emphasis. Griffith said COVID illustrated the vital need to have the right infrastructure in place. From telehealth and virtual monitoring to ordering meals on iPads to limit contact, hospitals quickly became very aware of their bandwidth and cabling capabilities.
Hines said technology could also play an important role in patient throughput. For example, he said some areas are using telehealth with EMS to better assess patients in an ambulance to determine if the patient needs to come to the ED or might be better served in another setting.
Approachable design extends well past patient rooms, said Griffith. As healthcare trends toward a community wellness concept, he said hospitals are adding more amenities open to all. Especially in rural areas, he said it isn't uncommon for hospitals to team up with private fitness providers to create a workout site on campus or to tie a hospital walking trail into a city greenway.
"Any time we can reduce the institutional feel and take the apprehension out, that's a big driver of our design," concluded Griffith.