The healthcare sector has experienced tremendous challenges in the COVID-19 pandemic years and continues to see issues despite improved control over the issue today, according to panelists at a May 10 event hosted by the Society for Marketing Professional Services (SMPS)- St. Louis at Maggiano’s restaurant.
Putting technology and use analysis to work early — sometimes many years before the current crisis — has been a key in continuing to serve communities and manage real estate aspects of such efforts.
“Staffing has been a huge problem and is our number one priority,” said Gerry Kaiser, system vice president – facilities and real estate for SSM Health. “”We aren’t seeing as much of this in facilities, but it’s big in construction. Inflation — it’s almost impossible to cost projects. We stopped construction of a downtown supply center facility and are waiting for September to open another facility because of HVAC materials.”
Healthcare institutions often can’t compete on pay rates with contractors on the construction and design side, panelists agreed. “There’s a tremendous amount of pressure when big box and fast food outlets are paying $18 an hour,” said Kaiser. “We don’t even get applicants for some positions.”
In response, “we’re trying a new gig system where people who used to be [assigned] shifts can pick when they want to work,” said Charis Trost, director of strategic planning and design at Mercy Health. “We’re also leveraging technology with small robots and using efficiency monitors and a sensor system in clinics to track the use of exam rooms, equipment and staffing.”
Smart use of technology of any type requires understanding criteria, said Greg Mohler, vice president – construction and real estate at BJC HealthCare.
Supply chain hassles are continuing, and even getting vendors and suppliers to commit to projects can be a challenge these days. “We’re used to sending out seven bids and getting seven responses; now we’re lucky to get one or two,” Trost said.
Creativity becomes essential in such times. For instance, Mercy recently learned that it would take 10 months to receive bricks for a project. “We started thinking about whether we can use alternative materials,” said Trost.
Another concern is that some small or remote rural communications can’t sustain their own hospitals. “We’re in acquisition mode, which should be beneficial,” Kaiser said — larger systems will be able to keep those smaller institutions going. He expects to see more acuity-adaptable room and HVAC system adjustments, and continuing use of masks and Plexiglas enclosures where patients and staff interact.
“A lot of critical access hospitals are nearing the end of life for their facilities, but have the population for a large facility,” said Trost. “We’re looking at how we can leverage service in rural areas, make inpatient beds flexible and use virtual services. The pandemic has taught us a lot. We began modifying clinics to be accessible for patients. We have to balance between what is wanted and required with operational aspects. That can mean making simple modifications.”
BJC HealthCare has three rural facilities, started an integrated group approach about 12 years ago, and invests from a total system perspective, which includes being able to monitor all ICUs from one center. “We have to understand strategically and holistically what we can and should do,” Mohler said.
Thanks to a planning process that began in December 2019, BJC’s real estate team “hasn’t missed a heartbeat, so to speak, or a deadline (in building or adaptation projects). We have the flexibility and capability to turn any patient room into a negative-pressure space.” Other changes include patient room doors that are half-glass instead of solid and portals to move items in and out of rooms, so patients can be seen and served without constantly opening doors and going into their rooms.
Telehealth is here to stay, panelists agreed, and is an area that was ahead of the curve when the pandemic began. “We've been incorporating telehealth for the past 10 years. We use it to create as many barriers against a security breach as possible,” said Trost. That includes reducing the number of software programs being used throughout the hospital system.
“We’re trying to be flexible with patients having to use technology, with rovers (staff floating in various hospital areas, such as registration) to help them,” Trost added.
At SSM Health, “telehealth use spiked during the pandemic and we don’t expect it to go back,” Kaiser said. “It will be part of ever project, especially in rural areas. It will only get bigger — it’s part of everything.”
As hospitals consider design and construction now, it’s important to weigh initial costs with what they want to achieve, according to Trost. “We’re always looking at modularization and prefabrication offsite.”
Those techniques can often save both time and money. “We have the advantage of standard design, so we can stay fairly consistent on budget. We keep a stash of materials.”
This works for BJC as well. “Modularization is a huge opportunity for our industry. We’re doing racks of equipment offsite,” Mohler said. “We have to get better at this — we all want to get faster to market.”
“We do a lot of modularization,” Kaiser agreed. “You have to consider scale.”
Controlling costs is an ongoing issue in healthcare. “You have to do risk analysis. The challenge is how to make sure your costs are right. Identify lead times early on and get orders (for supplies and materials) in advance,” Mohler advised. Some upgrades are currently hold because of the price of materials — but clients can still succeed. “We were told something we had ordered was going to be more expensive and we’d be charged a ‘premium price,’ so we changed vendors!”
Managing expectations can be the biggest part of planning for design and construction jobs these days, Kaiser noted. “Expect projects to go up in costs 1 percent every month.”
The constantly rising costs of construction, materials and supplies, and labor mean that “past policies of monetizing buildings are coming back to haunt some healthcare facilities,” he said. “We are moving back to owning our buildings.”
Overall, panelists said, the healthcare sector is looking at ways to make medical care more accessible and equitable for more people by reaching out to communities and adding clinics and other facilities that people can walk to or that are on major bus routes. These moves are in line with the founding principles of service that are core to many hospital systems.
Tom Finan, co-founder and executive director of Construction Forum STL, moderated the session.
Feature photo credit: Sarah Sandvoss | CD Companies