the newsletter of tbd consultants - edition 2, 2nd qtr 2006 - Healthcare Special

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In this Edition

Healthcare Facilities
SB1953-Painful Medicine
Hospital Costs

Construction Management Specialists
111 Pine Street, Suite 1315
San Francisco, CA 94111
(415) 981-9430


Healthcare Facilities

Healthcare facilities have been going through a transition with advances in medical techniques really accelerating starting in the 1980s. Amongst these changes has been the introduction of large diagnostic equipment, requiring specially shielded rooms, and also an increased use of electronic systems for record keeping and communication between different sections of a facility (e.g. the pharmacy may be notified electronically of a prescription when the doctor issues it, so it is waiting for the patient when they go to pick it up). With these technological innovations, coupled with a reduction in the number of hospital beds (resulting from the move to more outpatient treatment) hospital facilities are becoming as much a hi-tech center as a place for people.

On the other hand, with hospital groups competing with each other to attract customers, their facilities are now being planned as much, if not more, with the patient in mind than the practitioner, trying to provide a more homely, welcoming and caring atmosphere. For instance, final food preparation is often kept close to where patients are housed, in order to provide more flexibility and a more responsive service for patients/customers. While the final food preparation may be kept local, the initial preparation, as with other services, such as laundry, might be provided elsewhere in-house, or provided on a regional basis, or by a commercial contractor.

As mentioned above, there has been a move to more outpatient treatment, reducing the number of hospital beds, which are now, with some exceptions, almost exclusively acute-care beds. Major operations, which would previously have necessitated a hospital stay during recuperation, have now frequently been replaced by less invasive procedures, thanks to miniaturization of equipment and new techniques. These kinds of developments have led to increased use of outpatient facilities, which often include surgical rooms for such procedures. These outpatient facilities are also often being located out in the community as local clinics, taking the healthcare to the people, rather than the old way of people having to go to the large, more distant hospital. These clinics might also contain fitness facilities because preventive medicine or health promotion is receiving more emphasis, trying to keep the population healthy and reducing the need for treatment facilities.

The development of new medical technologies has meant that hospitals now have to be designed to facilitate the changes that are to come. Ideally, designs should try to anticipate where changes would occur, but technology breakthroughs seldom follow completely predictable patterns. Consequently, designs need to be responsive to changes as they happen. The use of interstitial space facilitates flexibility, but the cost of providing this space often rules out its incorporation in a design. Healthcare campus layout provides the capability for one area to be redeveloped while the rest of the complex continues as normal. A modular approach in the design helps provide flexibility, for instance using a common room size for offices and examination rooms, etc., allows for easy change of use. However, flexibility has a cost, and a life-cycle cost analysis might prove useful to check the value of providing the capability.

Labor can account for around three-quarters of hospital running costs, so a design that promotes efficiency provides a good return. For instance, units with patient beds are now normally arranged so that the nurse is more central in relation to the patients (not the long, narrow wards of years gone by).



Electronic storage and messaging is taking the world by storm, but how is it affecting the medical community. We look at how hospitals are introducing this technology, and how it is affecting the medical staff and the construction costs.

SB 1953-Painful Medicine

SB 1953 was put in place to ensure that hospital facilities would still be functional after a major earthquake, but a side effect has been to send a seismic tremor though the healthcare construction market. We look at what SB 1953 is, and how it is affecting the construction budgets for healthcare projects.

Hospital Costs

Hospital construction costs have been increasing at about twice the rate of general construction work. What are the issues driving hospital construction costs? We address these issues in this article.

Design consultant: Katie Levine of Vallance, Inc.