**Photo taken prior to COVID-19.
History shows that disruptive times spark creativity, discovery, and innovation.
Sir Isaac Newton developed the Law of Gravity while at home, isolated, during the plague in 1665. World War I and II field hospitals gave rise to groundbreaking surgical methods and trauma care.
To assess the lessons and future opportunities emerging from the 2020 experience of building during a global pandemic, we talked to frontline experts involved in the construction and design process.
What is clear from multiple conversations is a central takeaway: Game-changing preconstruction practices are emerging to address today’s building challenges. While many of these practices were well underway before the pandemic hit, the strain on healthcare services amplified their potential impact.
Healthcare clients, facing big decisions, short on time, and needing to stretch conflicted budgets, rely more than ever on their design and construction partners. As they confront current and future adaptations to their facilities, health system leaders need the informed advice of experts who can quickly analyze a range of planning and strategy options.
Client needs driving the increased benefit of more diligent, team-based preconstruction actions include:
Our conversations revealed the urgency of managing the dual challenge of declining hospital revenue and construction cost volatility. Top-of-mind concerns include:
- The unpredictable cost escalation of some materials, including lumber, PVC, steel, and copper. Data reporting from RS Means shows that since January of 2020, 57% of construction material costs and 82% of labor costs increased. Other prices declined, but the volatility of the marketplace remains in early 2021.
- Supply chain disruptions due to COVID-19 impacts at the manufacturing level and throughout the material distribution chain.
- Availability of construction labor, particularly in specialty trades such as HVAC and low voltage, continues to impact cost estimating.
Healthcare system leaders are evaluating ways to integrate more resilient and adaptive readiness programs for potential patient surges. No one anticipated the capacity problems as pandemic hospitalizations surged, and continue to surge, as we head into what we hope will be a year of vaccine relief. Yet everyone realizes there could be a future pandemic, public health crisis or disaster that will test patient space capacity.
“Hospital executives are balancing the need to provide the excess bed space with their need to generate revenue and survive,” said Scott Bullock, Preconstruction Division Manager at Robins & Morton.
Accomplishing this combined objective requires team members with experience in planning and building adaptable, future-ready spaces. “This adaptability will be a fundamental characteristic of every future renovation or newly built project,” Bullock said. “We need to develop a pathway for every client to do this creatively, and to accomplish it without a high construction cost.
Broader, More Diverse Collaboration
Adopting virtual technology – and adapting to its pros and cons – surfaced as one of the most prolific topics in our conversations. Bernita Beikmann, Chief Process Officer and Executive Vice President of global architecture firm HKS, described the favorable opportunity for teams now collaborating virtually.
“I think it’s going to change the way we work ultimately, and I also think the changes will be positive in many ways,” Beikmann said. “It is forcing us to communicate a bit differently. For example, we have access to people we did not have access to before. You can easily bring in the lead designer or the HVAC engineer and problem-solve together with a construction [professional] with a particular niche expertise, all without adding a lot of hours and time to the job. If you are just talking about an hour [Microsoft] Teams call, as opposed to flying to a job site and spending a day or two there, that is a tremendous advantage to the client and the entire team.”
Beikmann also described subtle ways that the virtual tools aid communication and collaboration. She sometimes uses the chat function in [Microsoft] Teams to ask a question of a collaborator while the meeting is in progress. “Before, if you were lucky, you could catch them on their phone after the meeting. But chatting in real-time allows a welcome level of multitasking.”
Prefabrication, Modular, and Offsite Building
Achieving flexibility goals will require a multi-prong approach. One such solution, accelerating in 2020, is prefabrication and offsite manufacturing.
Kyle Davis, Senior Mechanical Preconstruction Manager for Robins & Morton, said more healthcare clients are gaining confidence in modular options as a beneficial building strategy. A self-described “modular evangelist,” Davis explained why interest is expanding within the client world.
“The main goal when the pandemic arrived was to reduce the density of people clustered together on the jobsite. Moving construction activity and people to offsite locations improved safety and density,” he said. “For our clients, they also have the opportunity now to see the quality improvements as well. This helps them gain confidence in using offsite fabrication on more projects in the future.”
A crucial factor in the success of these future initiatives, Davis points out, is how early in the planning and design process they should be introduced and examined. “If we can identify the most opportune elements for prefabrication during design development and have the right people at the table, everyone benefits,” he said.
Beyond providing project schedule and pricing advice, the depth of client advising today is dramatically expanding, said Randall “Buzz” Summerford, Senior Project Manager for Healthcare with Jacobs. “Owners are making quick decisions because of the urgency surrounding pandemic response. But sometimes their initial idea may not be best for the long-term. Sometimes, they simply do not have the resources to research and think through all the ‘what-ifs’ involved.”
Having another partner, “someone who understands the world they are working in, offers an essential perspective, and provides ideas that go beyond the conventional preconstruction template,” Summerford said.
This echoes a point communicated by several experts. Their view reflects how additional risk and uncertainty in future decision making will place more weight on trust, healthcare know-how, and partnership.
Patrick Duke, Managing Director for CBRE Healthcare, corroborates the value in trusted partnerships. “So much of the great work done during COVID-19 would never have happened without the increased collaboration we see today,” he said. “When you understand the impacts of construction in a COVID environment, you know how it’s all connected and can tell when questions come up whether the issue is a blip on the radar screen or whether it will continue to be a concern longer term.”
Each of the experts we spoke with forecast significant changes ahead in healthcare preconstruction and project delivery. Because COVID-19 gave new perspective on how a large-scale disruptive event can impact costs, Kyle Davis predicted changes to the prescriptive formulas long used by many in the industry. “The old cost-per-square-foot calculation is not a lock-in anymore,” Davis reported. Instead of following past familiar patterns, he predicted that “the lessons learned during this pandemic experience are going to be the new estimating and preconstruction frontier. How we navigate that in 2021 and beyond is the challenge and the opportunity.”