In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

David Surette is director of healthcare and life sciences at Shawmut Design and Construction (Boston). Here, he shares his thoughts on construction schedules, expanding behavioral health services, and the changing space of healthcare facilities.

1. Communication is critical in construction

As more and more work is being performed in the midst of fully functional critical-care areas, construction firms have less time to get in and do what they need to do. In sensitive healthcare settings, communication is critical. Life-saving hospital functions need to be undisturbed while construction schedules are adhered to. This requires working closely with the hospital staff, including nurses, and meeting with them daily to ensure that all the sounds, smells, and debris are completely contained and pose no disruption. Remaining flexible enough to adjust work at a moment’s notice and forming strong relationships with hospital staff are imperative.

2. Shifting care to community health centers

The Affordable Care Act is changing the face of healthcare and how primary care works. Services are shifting out to community healthcare centers because these facilities are positioned to bring critical services to the country’s most economically challenged areas. As a result, spaces at existing community healthcare centers need major upgrades, including equipment, expanded exam rooms, and new or renovated spaces dedicated to behavioral health.

3. Enhanced focus on behavioral health services

Behavioral health services are in high demand thanks in part to the capital reimbursement system. Doctors now have more options when it comes to behavioral healthcare, and new clinical spaces are being constructed in existing healthcare facilities to allow for a more balanced and coordinated approach between medical and behavioral treatment. These clinical spaces are separate from the ER, yet close enough that the facilities and equipment can be easily accessed, and include patient rooms and nurse stations that allow for around-the-clock patient observation.

4. Increased use of group treatment approach

Group treatment sessions that involve multiple patients at a time are becoming more prevalent. For example, obstetricians will engage a team composed of a nurse, nutritionist, and/or midwife to care for a group of expecting women. Understanding and planning for these types of “communal” spaces will be a key in facilitating the needs of the group.

5. Lean’s growing track record

While evidence shows that Lean construction can result in double-digit percentage savings on both schedule and cost, the healthcare industry is experiencing greater implementation of Lean practices on building projects and renovations of all sizes. Hospital and healthcare facility construction teams are ahead of the curve since they began implementing Lean several years ago as a way to not disturb the day-to-day processes for the delivery of patient care. Now, more knowledgeable capital program managers and facilities directors are opening up to undertaking Lean projects. As they do, designers and builders who are vying for selection will be asked to demonstrate their Lean construction track-record.

David Surette

David Surette is director of healthcare and life sciences at Shawmut Design and Construction and can be reached at


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