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Healthcare Design Targeting Comfortable Amenities To Retain Staff And Keep Patients Happy

Healthcare leaders are bracing for a potential nationwide staffing shortage after more than 19 months of a massive, tiring pandemic response.

Wellforce's David Storto, Newmark's Michael Greeley, Clark Construction's Jamie Gilman, HGA's Candice Barter and Celera Properties' Brian Carlisle

Real estate executives at Boston’s biggest healthcare entities are turning their attention to the well-being of the doctors and nurses they employ to keep their workforce as comfortable as their patients.

“People are fried, the healthcare community is just really tired,” Wellforce Chief Strategy Officer and Executive Vice President David Storto said last week at Bisnow’s New England Healthcare Innovation and Transformation event. “The issue that’s looming, there are a lot of people that have decided to check out, no longer being interested in being in healthcare.”

The renewed focus on staff comes amid concerns of mass departures of healthcare workers, partly due to recent deadlines by states for staff to receive their required Covid-19 vaccinations. Approximately 16% of hospitals had critical staffing shortages as of Oct. 1, according to the U.S. Department of Health and Human Services statistics reported by Bloomberg. The lack of available staff has forced hospitals to stop accepting patients and close portions of their emergency departments. 

At least 78% of Massachusetts residents have received at least one dose of any of the three available coronavirus vaccines, the second-highest percentage among states in the country. Gov. Charlie Baker’s administration has issued its own vaccination deadline of Oct. 31 for healthcare workers, although the mandate doesn’t apply to hospital workers and allows for medical and religious exemptions.

Wise Construction's Eric Libby, Ross & Baruzzini's Scott Vinson, Dana-Farber Cancer Institute's Wendy Gettleman, Phase Zero Design's Ron Goodin and Beth Israel Deaconess Medical Center's Peter Healy speak at a Bisnow event Sept. 28, 2021.

The deadly delta variant surge earlier this summer is waning, but Bay State healthcare leaders are bracing for a potential staff purge. UMass Memorial Health, Central Massachusetts' largest hospital system, last month said its 144 ICU beds were at capacity with Covid patients and others who deferred care during the pandemic. 

“There are still a significant number of people working in healthcare who have chosen not to be vaccinated,” Storto said. ”It’s entirely possible we’ll see services delayed. We’ll see beds closed. It’s happening already in other parts of the country.”

Healthcare facility designers are introducing small changes such as creating new sightlines with patient-facing doorways and patient-facing desks, or creating alcoves in hallways where workers can escape for quick breaks, experts said. Builders are incorporating more natural light and views when possible, taking cues from the evolution of office space meant to attract post-pandemic workers.

“One of the patients in our planning meeting stood up,” said Wendy Gettleman, Dana-Farber Cancer Institute's vice president of facilities management and real estate. “She said, ‘Everyone’s been focused on the patient for the last three hours. If you don’t focus on the staff and make sure they’re comfy, we won’t be happy either as patients.’”

S2N Technology Group's Matt Odell, AKF Group's Frank Thalakotur, Atrius Health's Chris Andreoli and East Boston Neighborhood Health Center's Greg Wilmont

Healing gardens have become a popular amenity for patients and staff, panelists said. Beth Israel Deaconess Medical Center’s new, 10-story, 345K SF healthcare facility broke ground in 2019 in the Longwood neighborhood and will include an 11K SF sixth-floor healing garden for staff, patients and families when it is expected to open in 2022.

Boston Children’s Hospital debuted an 8K SF garden in 2018 on top of its 11-story main building in Longwood, a replacement for a popular half-acre ground-floor garden demolished for the newer $1.5B facility. The Dana-Farber Cancer Institute has had a two-story indoor garden since 2011 at its Yawkey Center for Cancer Care, a 275K SF treatment center in the Longwood Medical Area. The 1,790 SF space has proven popular with patients and visitors during the hundreds of tours Gettleman has taken them on in the past decade, she said.

“They can get away from the overhead speakers, the questions, the reality, to give that breath to reinvigorate,” Phase Zero Design Healthcare Principal Ron Goodin said. “Creating those spaces is really important.”

Amenities like healing gardens can serve all hospital occupants, but developers are still doubling down on the patient experience; Ross & Baruzzini President Scott Vinson likened the current hospital check-in experience to being in a different type of institution.

“It’s similar to prison,” he said. "They take away your clothes, you’re told when you’re going to eat, you don’t really know when you’re going to get out. It’s controlled who can visit you, how long they can visit you. We’re really as an industry trying to separate that and enhance the patient experience."

Tsoi Kobus Design's Rick Kobus, Massachusetts Eye & Ear's John Fernandez, Redgate's Kristi Dowd, DPR Construction's Josh DiGloria, Thornton Tomasetti's Lisa Davey and Brigham & Women's Hospital's Doug Carney speak at a Bisnow event Sept. 28, 2021.

Healthcare developers said they believe construction costs, which have risen in the past year, will normalize early next year but remain above pre-pandemic levels. Currently, ambulatory care construction in the New England market costs between $900 and $1,200 per SF, Clark Construction Vice President Jamie Gilman said. For outpatient facilities deeper into the community, construction costs can range from $500 to $640 per SF. 

Walmart has partnered with modular construction firm BLOX to speed up production of its own growing health clinic network. The mega-retailer in a recent presentation claimed it can deliver a 12-room clinic in 12 weeks, Massachusetts Eye & Ear President John Fernandez said. 

“It’s happening all over the world already. New England is a laggard,” DPR Construction Project Executive Josh DiGloria said of prefabrication. “We’re prefabbing 20 ORs now, and the carpenter's union and the plumbers union are part of that solution.”