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.
Richard Simone is CEO and president of Central Consulting & Contracting, a New York and Florida-based full-service construction management and general contracting company specializing in healthcare facilities, and a certified healthcare constructor as recognized by the American Hospital Association. Here, he shares five ways that healthcare construction is affected by the COVID-19 pandemic.
- Changing construction safety requirements
Across the U.S., construction contractors have had to adjust to a variety of new safety requirements considering COVID-19 within short timeframes. These guidelines differ by state and city and are often updated or changed to keep in line with new and developing safety measures to fight against the spread of the virus. For example, contractors in New York City had to quickly adapt and implement protocols put forth by the state and the city’s Department of Buildings (NYC DOB), including temperature checks, contact tracing, cleaning logs, social distancing, and mask-wearing requirements. Following New York State Governor Andrew Cuomo’s announcement on May 15 regarding the first phase of reopening, NYC DOB inspectors spent two months visiting job sites in an advisory role, initially working with contractors to ensure interpretation and compliance were in line. In July, fines starting at $5,000 were put in place for each non-compliance item, with certain non-compliance offenses resulting in the issuance of immediate stop-work orders. Contractors have surviving by being nimble, swift, and resourceful, such as adding personnel to sites, expanding existing site personnel responsibilities to ensure compliance, or staggering work shifts to enforce social distancing.
- Scheduling and supply chain issues
While most projects deemed essential didn’t stop due to the pandemic, many experienced disruptions and, ultimately, slowdowns. Supply chain issues and the availability of proper personal protective equipment contributed to timeline extensions. Key manufacturing plants shut down in response to COVID-19, and their raw materials supply chains followed suit, causing additional delays. In other instances, where plants were still operating, inventories became backlogged in production due to lack of staff. Some completed materials simply remained in yards until transit delays were over.
Fortunately, our company has not experienced some of the issues such as delays regarding supply-chain backlogs that were predicted back in March, mainly because the supply chain came back on line and was able to quickly catch up on manufacturing items we required.
- Project delays and cancellations
As healthcare systems became overwhelmed with patient surges and the immediate need for additional inpatient beds, their focus shifted from project planning to temporary conversions. The result was that many projects in or near design phase were placed on hold during the spring. Now, systems nationwide are beginning to re-evaluate capital projects and reconsider the need for certain projects to move forward. In some cases, even projects that had been confirmed are now being canceled or resized. Other projects ready to start construction are being delayed, pending evaluation of the systems’ financial commitments and cash flow. For those systems that aren’t planning new buildings, we expect to see future projects to focus on improving HVAC infrastructure for infection prevention and flexibility to change pressurization on a moment’s notice; increasing ICU and isolation capacity; new bulk oxygen system designs; and controlling supply chain.
- Hospital financials
Based on July 2020 data from more than 800 hospitals, operating margins were down 28 percent in the first seven months of the year compared to the same period in 2019, according to the latest edition of Kaufman Hall’s National Hospital Flash Report. Many healthcare systems have spent millions of dollars expanding areas for additional ICU beds to manage the COVID-19 patient surge, in addition to the increase in staff, overtime, supplies, and equipment required to treat these patients. Because patient case numbers have decelerated in many areas, hospitals have experienced lower patient volumes than in 2019, as patients are not yet ready to go to an acute care hospital for non-essential services. To ensure patients feel safe to get the care they need, hospitals and private practices are implementing new processes, such as having patients wait in their car until a staff member comes to escort them in; requiring all staff and patients to wear face masks; not allowing patients to be accompanied by another person unless absolutely necessary; implementing a streamline virtual process for pre-operative readiness; remote patient monitoring; and virtual check-ups. Increasing surgery volumes will help the financial recovery of health systems.
- Shrinking workforce
The construction labor pool was at historic lows before the pandemic, with trade schools experiencing lower admissions and younger workers choosing alternative career paths. Thirty-two percent of construction laborers were 45-64 years old in 2018, according to the Bureau of Labor Statistics, and 80 percent of construction firms were having trouble hiring craft workers as of August of the same year, based on research from the Association of General Contractors, which advocates for federal, state, and local measures that support the industry.
The pandemic further diminished trade labor early on. Many workers chose to shelter in place for fear of becoming sick or spreading the virus to family members. With schools and childcare facilities closed, others had to stay home to care for their children. Also, some workers who were close to retirement decided to retire early. All of these factors affected field and manufacturing workforces, compounding COVID-19-related issues.
In order to start correcting the skilled trade shortage, I believe young people should be introduced to the trade early on through high school vocational programs, for example, or other mentorship, sponsorship, and apprenticeship opportunities. Like other professions, they should be presented with the choice and be able to decide for themselves whether or not to learn a skilled trade. As a result of the pandemic, it is more important now than ever for the industry to emphasize technology and diversity to attract younger people and the untapped labor pool.
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