Healthcare’s rapidly evolving realities include caring for an aging population, workforce shortages and burnout, increased uninsured, and lower reimbursement contracts. These realities challenge healthcare providers to deliver care more efficiently at a lower cost, within an environment where capital investments are competing with other immediate priorities. According to a 2021 American Hospital Association survey, hospitals paid $24 billion more per year for clinical labor than they did before the COVID-19 pandemic. Healthcare organizations seek greater speed in project delivery, increased connectivity, and coordination of services focused on one goal: demonstrated value.

As we transition from a pandemic to an endemic phase of COVID-19, DPR Construction’s healthcare core market team is launching a series of Healthcare Insights to consider how new pressures on the market will transform the delivery of care.

Healthcare organizations continue to face unprecedented demands stemming from the COVID-19 pandemic. Over the past two years, many healthcare employees have found themselves in positions that no longer give them a sense of purpose and meaning. This has contributed to an unprecedented exodus from the healthcare sector, resulting in significant job vacancies and exacerbating an already overburdened workforce.

A 2021 survey from Mental Health America noted that the pandemic led to 93% of healthcare workers experiencing stress and 76% reporting feelings of exhaustion and burnout. The mental health of frontline staff can alter interaction with patients negatively, resulting in a direct correlation to rankings such as HCAHPS scores. A Kaiser Family Foundation study reported similar findings.

A health system’s investment in a significant capital project can serve as a change agent to address historic stressors in the environment of care, operational workflows, and technology. However, deploying these capital projects in ways that support an over-extended workforce is key.

Strategies for consideration:

• Restoring commitment to the organization’s core values, demonstrated by investment priorities
• Investing in workforce education on the purpose of strategic capital projects that address operational and care delivery improvements
• Meaningful engagement of the healthcare workforce in capital project critical sequencing or phasing decisions
• Utilizing thoughtful communications regarding impacts on ongoing operations during construction through daily construction briefings or clinical operation huddles
• Prioritizing respite areas and re-examining space needs for the workforce to incorporate collaboration and staff-centric amenities

Engagement needs to start well before a shovel hits the ground. New capital projects often address legacy issues. In dated care settings, the staff is accustomed to workarounds, longer travel distances, and a lack of modern support mechanisms and technology. An upgraded facility can inspire a team and excite them about an increased ability to deliver care. Investing time to clearly articulate the “why” or purpose for a project is essential to end-user engagement.

Deb Sheehan, DPR Construction’s healthcare market strategy leader, finds meaningful engagement of the entire project team as essential to solving today’s challenges.

“Today, many healthcare organizations struggle to fund their capital projects due to escalation issues given the premiums resultant from supply chain and labor pressures. Clients are seeking solutions to recalibrate their program and key room needs,” Sheehan said. “We reset the table, ensuring team members are aligned and understand the drivers of the clinical needs, enabling decisions based on best value calibrated to available capital investments. Without this reset, the approach to solve the funding gap results in the traditional 'death by 1,000 cuts,’ whittling away at the quantity and quality of project-based changes solely on cost.”

Sheehan believes aligning with a core purpose causes fewer sacrifices to mission-critical elements with shared goals that every stakeholder can rally around.

“Ideally, the design and construction team collaborate with an organization’s senior leadership, working in support of a provider’s chief strategy and operations officers to model program adjustments with associated costs in real-time,” she said. “If they wanted to shell or defer investments in program elements, we could immediately represent the savings and surface-associated program adjustments that might not be intuitive.”

Phased renovations or expansions on active campuses are disruptive by their nature. The first step to alleviating disruptions is understanding the clinical operations necessary to be a good partner.

“To successfully plan for construction sequencing and phasing, a construction team needs to truly understand the clinical pathways: the clinician workflows and how that affects patients,” Sheehan said. “Teams must work together to sequence construction in ways that minimize disruptions, travel distances and effects on clinical support areas.”

For example, if a hospital has a high admission rate from the Emergency Department (ED) and construction work on the campus disrupts traffic flow, the result may cause Emergency Medical Services (EMS) diversion, causing a reduction in patient volume and admission. Construction sequencing needs to be cognizant of the financial impacts on facility operations and create work plans that minimize disruptions that affect patient volume.

While not all disruptions during construction can be avoided, creatively compensating with enhancements can ease frustration. In the case of an ED renovation, ideas such as converting a storage room into an EMS lounge can allow crews to restock supplies or grab a bite to eat between transports. Proactively planning communication in a manner sensitive to the needs of frontline care teams builds good faith and empathy. Routinely engaging broader facilities teams for longer-term planning supplemented by clinical huddles for daily briefings on construction impacts effectively keeps frontline care teams engaged in authoring plans to minimize disruption.

“Successful planning comes from a lens of what the clinical providers need to know, including arming them with the information they need to communicate with patients and families,” Sheehan said. “Keeping staff informed about noise and vibrations means they can advise the people they are caring for about ways to ease sleep cycles. If we can’t stop something from occurring, we can help the provider compensate for it to diminish the impact.”

Design and construction teams can begin by considering the perspective of how added pressures of executing a renovation or expansion project may affect everyone in the chain of care delivery with careful focus on the frontline clinical team and the patient. Limiting disruptions during construction, at its foundation, requires careful planning to avoid activities that can negatively impact the patient and care teams, focusing on ensuring construction activity does not deter any patient from accessing and receiving care.

Starting a project execution plan with thoughtful consideration of the impact on clinical operations is critical.

“Valet parking, enhanced wayfinding, clear pathways for patient access, and enhanced amenities can ease the impact of disruption on healthcare campuses,” said Sheehan. “We work hard to minimize impact to ongoing operations and pay attention to details that affect how patients define value.”

This includes ensuring a clean work area and minimizing noise disturbances and smells that can result from construction activity. Beyond required ICRA barriers, builders can use construction zone separations to aid the organization in promoting its mission and vision, supporting a healing environment with art or graphics applied to barriers along the patient journey through the campus. Considering how construction activities affect the entire chain-of-care delivery can alleviate anxiety and resultant stress on the clinical team members and patients.

“When you think about what patients value—and the level of care staff strives to provide—we must acknowledge our role in supporting them during a construction project,” Sheehan said.

A transparent, outcomes-focused vision minimizes stress in every facet of the project.

"We advise clients when endeavoring on a project that it is critical to get stakeholder alignment from the start,” Sheehan said. “Build and clearly communicate the ‘why’ statement behind a project. If a clinical team must deal with disruptions; It is a lot easier when they understand the purpose and benefit.”

Too often, this discussion stays in the C-suite. Bringing clinical providers into the conversation diminishes the unknowns and helps them understand how the organization will support their functions and patient care.

“During a recent visioning session with a provider in the Northwest, we ended up expanding the group to 40 people, including the frontline care leadership because those people are the change agents and the partners to our construction crews engaging with on the ground,” Sheehan said. “Having them in the discussion brings up functional details that can get missed or misunderstood and helps make everyone stewards of the objective and outcome goals of the project.” Broadening communications to larger "town hall" settings ensures that everyone—from front line providers to service teams—understands a project's mission and outcomes.

Healthcare clients need an excellent technical builder, but just as important, builders need to understand the needs of the impacted care service line to be truly empathetic partners throughout the process.

Photos: Robert Kneschke, Takasu/Shutterstock.com