With changing care delivery models and an industry-wide push for single-bed patient rooms, building projects are inevitable for most healthcare systems and hospitals. But finding the best value in renovations or expansion versus greenfield construction isn’t always as cut and dry.

Kurt Rockstroh, AIA, ACHA, president & CEO, Steffian Bradley Architects; Kenneth Webb, AIA, LEED AP BD+C, vice president, HKS; and Jacob Knowles, LEED AP, associate director of sustainable design, Bard, Rao + Athanas Consulting Engineers LLC, weighed the pros and cons of each at the HEALTHCARE DESIGN Conference taking place in Phoenix Nov. 3-6 during their session “Greenfield vs. Renovation & Expansion—Redefining Campus Renewal in a Post-healthcare Reform Climate.”

While there are a number of factors that may influence what decision is best, the number one influence often is access to capital—and how much capital.

If the money is there, other drivers for new construction include an aging existing infrastructure that can’t support today’s systems and technology, a lack of land on the existing site, or the fact that exploring a renovation rather than new-build facility will bring a sub-optimal solution, Rockstroh says.

And features that may make a greenfield project more attractive for owners include the ability to build in one single phase, site flexibility, creating a new branding image, and avoiding disruptions to operations at the existing site.

However, not all hospitals and health systems will find new construction to be the best bet, with influences for renovations ranging from community attachment to a local site or historic value of the building to political benefits of maintaining it or the cost savings of renovating outweighing a relocation, Rockstroh explains.

To get started in figuring out what's best overall, Webb says project teams should assess space efficiencies from a lean perspective, creating a value stream map for operations under the options being weighed. He also suggests taking a page out of the books of other industries for how best to increase patient safety through a new project.

“We can look to industries like automobile or aerospace and how they’ve used standardization,” he says.

And when it comes to that push for private rooms, Webb adds that the infrastructure may not be in place at an existing facility to support the new model. Additionally, the technology expected from patients—including temperature and lighting controls, real-time conferencing with physicians, etc.—may also not be supported by the current building. “The issue here is all these things take up space,” Webb says.

Renovations also cause challenges in creating more space in the patient room for family, and to support modern components of the care environment, like patient lifts.

On the engineering front, Knowles says teams need to weigh the effectiveness of existing systems as well as existing electrical voltage.

And while the use of BIM on building projects is a standard on most projects these days, information on existing buildings is not always available to input into models. Another trend taking the construction sector by storm is the use of prefabrication to bring efficiencies to projects. While more common on new projects, Knowles says it can be used in renovations—for example, dropping a pre-built penthouse onto the top of an existing facility to transfer systems in one shot.

Another trend beginning to be explored in healthcare is the use of chilled beams for heating and cooling, and displacement ventilation. There are opportunities to use these systems in renovated space, but they will likely take up valuable square footage.