Retrofitting in Hospital Construction: Meeting Demand by Optimizing Facilities

When it comes to providing more hospital beds for lifesaving care, America faces a big problem: Many hospitals serve communities inside city limits, where space can be scarce and building brand-new facilities might be impossible. For hospital leaders — and the contractors they work with — retrofitting existing hospital facilities to accommodate energy-efficient upgrades, install new equipment or additional beds is often the most practical solution. 

Yet even retrofitting has its challenges — especially since many of these worksites are also active hospitals, which must continue to operate alongside the construction crews. This can make scheduling and aligning on budget tough. This article dives into how retrofitting existing healthcare facilities happens, including challenges to overcome for the executive and project teams, and best practices for navigating these precarious jobs with both caution and care. 

Overcoming Retrofitting’s Biggest Challenges

Renovations to healthcare facilities are often undertaken to increase the amount of patient rooms, upgrade technology and equipment, expand departments, and improve accessibility. Expansion projects might include constructing additional wings or floors or adding new specialty centers. 

Additionally, with medical equipment always evolving and advancements being made in research for fighting disease, implementing clinic modernization strategies with MRI machines, CT scanners, or other imaging equipment might be necessary. 

While retrofitting may be useful for saving costs compared to constructing a new hospital, costs can add up quickly with the price of new technology, and dealing with unforeseen conditions—such as managing supply chain disruptions, compliance missteps or hospital emergencies that take precedence over the construction project.

These delays have the risk of not only impacting the construction schedule, but also shutting down hospital operations — which can create operational strain for staff and impact patients in the hospital or healthcare facility.

Preconstruction

When planning a healthcare retrofit project — or any healthcare construction project — it’s important to recognize that preconstruction can be an extensive process, sometimes spanning several years. During this time, senior stakeholders must align on project goals, regulatory requirements, and operational needs. 

Owners and their representatives should be prepared for the time and budget demands of this phase, as early decisions can significantly impact the project's success.

Building During Operations

One of the greatest challenges of retrofitting is managing an active construction site alongside an active worksite for doctors, nurses and medical staff. Since non-medical professionals are working within a medical setting, hospitals must balance the urgency of the construction schedule with the need to maintain a safe environment for patients and staff.

Infection control is a major priority when it comes to retrofits, since pathogens or dust can escape construction areas and impact patient health. Bringing on a skilled and diligent infection prevention team is as necessary as vetting a general contractor (GC) for these projects, and robust training for facilities managers is a must.

Selecting an experienced general contractor is a pivotal factor for this type of work, because scheduling the build is not the only challenging aspect of the job. Hospitals must also coordinate department closures and patient relocations while working closely with charge nurses and staff to keep patients safe. 

The priority when working in a hospital or clinic is the operations of the active facility. The schedule must align with the needs of staff, and be flexible enough to handle emergencies that may come up in a healthcare setting. The construction work must interfere only minimally with healthcare work — or else patient safety is at risk. 

As the build begins, another common pain point of retrofitting is noise and vibration. Sound output must be monitored regularly in any retrofit. Noise is one of the main reasons a site might get shut down. There are certain hours that noise-producing work is allowable, and sometimes even during those hours, staff and recovering patients complain. Noise can be a hazard too: For example, there are safety risks with noise when it comes to premature babies in NICU.

Best Practices for Hospital Retrofitting

Part of what makes working in an active hospital environment so complex is that the capital projects team and GC are dealing with stakeholders whose priority is not construction—and whose expertise does not lie in the industry. In general, working with medical staff can be confusing because there is a wide gap in the institutional knowledge between the construction teams and the medical teams.

Following a few best practices, however, can keep the project moving smoothly and provide valuable insights to an owner developing in the healthcare space. 

Use visual tools to get buy-in.

A vast amount of stakeholders need to align on goals and expectations of the project—making buy-in an important part of the process. Visual tools like 3D renderings and architectural drawings help stakeholders and end-users understand the proposed changes. 

Starting early in their owner-architect-contractor (OAC) meetings, hospital leadership and project teams must develop a plan to communicate clearly about what the project will achieve to the teams and departments that will use the facility.

As cliche as it may sound, a picture is often worth a thousand words when it comes to communicating a physical vision — and project teams have a wealth of up-and-coming tools at their disposal to do so, which can help bridge the divide in institutional knowledge between the clinical staff and construction teams.

Scheduling regular meetings to go over architectural drawings, 3D renderings and even virtual reality (VR) tools can help stakeholders visualize proposed changes to their facility and even virtually “walk” through the facilities before they’re built, helping them better understand the spatial configuration and functionality of new designs. 

When these teams are more informed and invested in the design process, they can provide more useful feedback — making the process collaborative, and making sure the final design meets both operational and patient care needs. 

As the build goes on, using construction software to share design changes and updates can be a useful way to keep approvals efficient and on schedule. Advanced cloud-based platforms offer the ability to share designs in real-time, keep documentation organized in a single place, and allow stakeholders to comment when necessary. Establishing a single place for all stakeholders to align on project needs and goals while minimizing the risk of confusion. 

Pick experienced teams.

The vetting process for selecting team members should be stringent, focusing on proven track records in healthcare construction. 

An expensive, lengthy and critical project like a healthcare retrofit should not rely on any construction company’s “B-team,” so to speak. Hospitals require precise coordination and specific knowledge; experienced professionals bring a wealth of knowledge and skills to navigate these challenges effectively.

To evaluate contractors successfully, facilities teams and capital project managers should carefully consider the portfolio of past projects looking for experience with similar projects and proven success managing schedules and resources. Contractors and their teams must keep safety the top priority, so meeting with project teams can help assess whether a company has a proper culture of safety and risk management. 

Working with seasoned architects, project managers (PMs) and contractors is absolutely necessary for healthcare retrofits, as the insights they’ve gained across projects can guide their tasks more smoothly. In addition, healthcare construction work tends to be a tight-knit community of the same stakeholders — and having teams with established relationships can ease tensions that might arise. 

Understand the challenges of healthcare compliance.

Because safety and providing care are the most important priorities of any healthcare facility, compliance standards strengthen the organization’s professional health and well-being. But navigating these bodies can be tricky, and time-consuming. 

Hospitals and project stakeholders should familiarize themselves with local, state, and federal regulations that apply to healthcare construction, including specific regulations from authorities having jurisdiction (AHJs) like the Joint Commission or Centers for Medicare & Medicaid Services (CMS). 

Additionally, third-party compliance experts can be hired to advise on projects. While this may add to the budget, it may ultimately pay off in the long run if these experts prevent scheduling mishap and keep project momentum moving forward. 

Finally, using advanced construction software can create a single source of truth for projects — as well as an archive of past projects — which can help reduce the risk of error when it comes to getting signoff from inspectors. 

Value input from end-users.

Collaboration and teamwork are key to any successful construction job, and this is never more true than in healthcare, where stakeholders abound, regulations can be strict, and navigating compliance can be immensely time-consuming.

When dealing with clinical staff, anyone involved on the construction side must present a strong front, avoiding airing grievances or pointing out minor mistakes that could bog down both morale and timelines. Project teams should focus on clearly articulating their needs, and respecting the valuable time of medical workers. 

When it comes to collaborating, healthcare executives and project leaders can play an important role in bridging the gap between medical staff and project team members. Creating a culture of communication and respect early on, as well as establishing a schedule of regular meetings to discuss progress, can help ensure alignment and smooth collaboration. 

Senior medical team members may not understand the process of construction as well as industry professionals, but ultimately they will be operating the facility once construction is complete—so actively listening to and valuing their ideas is an important step in fostering a successful relationship. 

When it comes to moving patients or departments, project managers should work closely with administrators and department heads to identify an optimal schedule, usually performing these moves during off-peak hours to minimize impact on hospital services.

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The Big Picture of Hospital Retrofitting

While retrofit projects can be complex and long, they are also driven by a profound sense of purpose, as the collaborative efforts of all stakeholders all result in a finished product that provides care and dignity to patients.

Ultimately, this commitment to a greater cause can inspire teams to overcome obstacles and deliver results that truly matter — and improve patient lives for years to come.

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