February 18, 2015

It’s no secret that healthcare facility dollars are at an all-time premium. Changes to federal Medicare and Medicaid funding to hospitals, combined with uncertainty about impacts of the Affordable Care Act, mean that now—more so than ever—owners must make every dollar invested in their facilities count.

As capital program budgets have tightened, renovation and adaptive reuse projects have surged. That trend stands in sharp contrast to the early- to mid-2000s, when mega-sized replacement hospital and expansion projects were booming.

Today, healthcare owners with limited dollars are taking smaller “bites at the apple” with targeted, strategically planned, smaller volume renovation and reuse projects.

The focus is on maximizing vital inpatient services by moving them into spaces previously occupied by less urgent ambulatory services and administrative spaces. Those, in turn, are being moved to lower-cost medical office building (MOB) facilities.Valuable hospital space is being reclaimed for high-demand critical patient services like cardiac cath labs, neonatal intensive care beds and more.

‘Domino’ Projects

The strategy behind shifting and reusing space in fully operational facilities may be likened to setting up a game of dominoes. The order in which an owner undertakes each needed renovation project—or domino —impacts the projects immediately before and after it. Place them in the most effective order (or with dominoes, at the correct angle), and they will fall in smooth succession achieving the desired result. Put one out of order or at the wrong angle, however, and the domino trail—the owner’s capital facility budget, that is—may lose momentum and deliver a less satisfying outcome.

So how are successful healthcare owners prioritizing and expending their limited capital dollars to most effectively meet the needs of an ever-growing patient base? And how do they decide which project should take precedence (i.e., how should the dominoes be stacked) to meet both patient demand and their own business objectives?

Savvy owners understand the value of a “big-picture” outlook. Sometimes it can be difficult to see beyond the demands of day-to-day operations, however, to develop a comprehensive, long-term strategy.

Early Involvement Adds Value

That is where bringing a highly knowledgeable, experienced team on board early can reap the greatest benefits. The right team can help find efficiencies and preserve capital by setting up the most effective “domino plan” for a series of healthcare remodel and reuse projects in a given facility.

A prime example is the series of successive reuse projects DPR Hardin is performing for a confidential client in Greenville, SC. Commonly referred to as the “domino projects,” DPR Hardin’s work there has included an adaptive reuse of third floor hospital space to create a gastrointestinal (GI) unit for inpatient use. That project was enabled by first moving all outpatient GI functions to an MOB outside the hospital. Another project entailed moving doctors’ office space that previously occupied a wing of the hospital to the nearby MOB, making way for a project to add six more neonatal intensive care unit (NICU) beds.

DPR Hardin similarly is helping Piedmont Hospital in Atlanta strategize and construct the most effective reuse of some of its space. One project is moving administrative and executive offices out of the hospital to an MOB, freeing up hospital space that will be converted into additional neonatal ICU units.

Pinpointing Constructability Issues, Schedule Impacts, Conflicts

At Piedmont Hospital and on other projects, DPR Hardin’s early involvement in the strategic planning and development of healthcare remodel and adaptive reuse projects is delivering clear benefits. By coming on board from the beginning and working collaboratively with the owner and design team, DPR Hardin helped uncover constructability factors related to existing conditions of previously occupied space. The team also helped the owner leverage efficiencies in moving or adding building systems or relocating medical gas lines—elements typically associated with healthcare reuse projects.

An experienced contractor also offers capability to survey or laser scan existing space to uncover unknown impacts of a proposed project. That was the case on another project for the confidential client in Greenville, SC—the vertical expansion and relocation of a portion of the MRI department.

Designed to relocate two MRIs from the basement level to three floors above to better serve inpatient needs, the project was planned to go directly above the hospital’s kitchen. Existing conditions of the ceiling space above the kitchen were unknown, however. Brought on board early, DPR Hardin laser scanned the space and discovered that extensive structural work would be needed. The project team was able to devise a seamless solution well in advance of start of construction to avoid disrupting the vital 24/7 kitchen operations.

The bottom line? Having the right domino strategy in place can make a big impact in the successful completion of renovation and adaptive reuse projects.