When patients go into the hospital, their foremost concern is the treatment they will receive. Few give a thought to the design, planning, construction and overall effort that goes into making the facility an environment for healing.
But the design and construction of the components that make up a medical facility are extremely important to the overall treatment patients receive during their stay.
"The concept of 'evidence-based design' is aimed at developing an environment that considers all sorts of factors, such as light and noise level, to support the healing process and help patients recover sooner," said Russ Burns, president of the largest medical construction group in the United States, Turner Universal. Universal is the medical division of Turner Construction Inc., which moved from St. Louis to Nashville three years ago.
The medical construction industry in Middle Tennessee has a major economic impact on the region and even the nation. Billions of dollars are spent every year in the United States on expanding existing facilities and building new ones.
Because the region is considered by many to be the major health care hub for the nation, many construction companies are headquartered or have their health care divisions based in the Nashville Metropolitan area.
Some of the companies here involved in health care construction are Turner, Skanska, Centex, Medical Construction, and BE & K.
In the past five years, Vanderbilt University Medical Center by itself has been involved with more than 325 projects valued at well over $750 million - including the $270 million Children's Hospital completed last year. During the same period, Middle Tennessee has seen considerably more than $1 billion in health care construction overall.
Nationally, the industry is involved in building about $20 billion in medical related facilities each year, and by the end of the decade it is projected to approach $30 billion, according to industry insiders.
"Since 2000, the industry has seen a significant increase in construction spending compared to the '90s," said Cris Bryant, vice president of BE & K Building Group Inc, a Birmingham construction company with its medical division headquartered in Nashville. "And it is going to continue to grow for a lot of reasons."
One of the main reasons is the aging American population, which is driving a growing demand for hospital beds and medical procedures.
At the same time, the continuing growth and change in technology has meant more space is needed to accommodate all of the equipment. Surgery suites are very technology-laden and need more space than in the past to accommodate everything, Bryant said.
Also, acute care hospitals have grown older and need to be refurbished or replaced. "Most of the existing hospitals were built 30 to 40 years ago," said Turner Universal's Burns.
In addition to acute care hospital construction, there has been an increased demand for diagnostic and outpatient centers in health care, according to Burns. Increasingly, medical centers are building outpatient centers as part of their complex. Williamson Medical Center has added one as part of its new addition.
Paradoxically, this doesn't decrease the space needed by hospitals. "Because of the growth of outpatient facilities, the patient in a hospital is sicker than in the past," said Dennis Miller, chief executive of Williamson Medical Center.
According to Miller, this means more surgical and equipment space is needed in an acute care hospital than in the past.
The right contractor
The building of a new hospital or the addition to an existing facility requires a unique working relationship between the hospital's management and staff and the designers and contractors.
"It is important to get a construction company that is interested in working closely with you," said Bill Jewell, director of facilities at Saint Thomas Hospital.
Building medical facilities is not the same as building an office building.
"If you can build a hospital, you can build anything," said Wade Putnam, president of Nashville-headquartered Medical Construction Group Inc. "Everything is much more complicated."
Putnam, whose company is building the $72 million expansion of Williamson Medical Center, said there are a lot of codes, regulations and special requirements that must be followed in constructing a medical building.
Federal, state, county and city agencies are involved in setting all types of standards. As an example, minimum standards require corridors to be at least eight feet wide, Putnam said.
Equipment areas must be able to accommodate various and complex machinery, such as MRIs or X-rays, in a relatively small area, he added.
Rooms must be built into self-contained compartments to stop the spread of smoke in case of a fire.
In addition to the required firewalls, some walls need special features. For instance, the radiology department requires lead in the walls to stop X-rays from penetrating to outside areas.
To prevent the spread of disease, some of the rooms must be under negative air pressure. This function works by causing air to rush into a room under negative pressure every time its door is opened, thus preventing contaminated air from seeping out and going into other areas of a medical facility.
Emergency rooms, already complex because of their multiple functions and equipment, often have special decontamination tanks and plumbing. These are used to allow patients contaminated with chemical or biological substances to be safely contained and washed without the materials going into the public sewer system or other areas of the hospital.
Maternity wards require alarm systems to alert staff in case a baby is removed without permission.
In addition, medical facilities need an emergency power system to back up the regular electrical system. In case of a power failure, the backup must come on within seconds and switch over to generators, keeping lights and equipment operating.
Putnam said a hospital must be built as a system that will work together.
In case of a fire, doors must automatically shut, the right sprinklers must come on, emergency lights must flash, alarms must sound, dampers have to shut in the ventilating system, the location of the fire needs to light up on a special panel to show emergency personnel the fire's location, and the fire department must be notified. All of this activity needs to happen in a moment.
"The complexity of building a hospital means staying on top of everything to keep things from getting out of control. One of the most crucial issues is project creep," said David Nicely, vice president of operations and former construction project manager for HCA's recently completed $100 million StoneCrest Medical Center in Smyrna.
He said this happens when more and more people become involved as the project progresses. To keep the process under control and within budget, weekly meetings of architects, owners and subcontractors are held, Nicely said.
The meetings of an acute care hospital such as StoneCrest, with 30 departments, will have between 30 and 40 people, he said.
And the cost for a modern hospital like StoneCrest?
It runs about $1 million per bed, Nicely said.