Dealing With the Special Risk in Healthcare Construction

The COVID-19 pandemic delayed or cancelled many hospital construction projects as providers’ financial resources were directed to pandemic-related issues.

But healthcare construction is rebounding. Notably, the U.S. Health Resources and Services Administration has earmarked nearly $1 billion in American Rescue Plan funding for construction projects at 1,300 health centers that help medically underserved populations.¹

However, it’s not just government projects driving growth: Overall, healthcare construction is expected to increase 1.4% in 2021 over 2020, making it the only industry sector with growth in construction. Healthcare construction is expected to grow another 4.4% in 2022.²

Pandemic informs construction

Providers have learned how the physical environment affects a pandemic’s spread, changing how facilities are built, particularly hospitals in need of renovation due to COVID-19. Improving hospitals’ physical structures to meet pandemic-driven patient care and safety is similar to changes undertaken at airports to improve security following the 9/11 terrorist attacks.

Due to the pandemic, many hospitals are focusing on renovation, not new construction; their goals are resiliency, flexibility, adaptability and potential for future use. High on the list are projects that reflect pandemic safety needs, such as ventilation projects, given the need to control airflow to prevent the spread of infectious diseases.³

Other projects aim to remove bottlenecks at entrances, especially to guard against lines at automated doors in which contagious and uninfected patients might mingle. Hospitals are also converting administrative offices into spaces for patient care since remote work has resulted in vacant offices.

Balancing clinical and construction risk

Any type of healthcare renovation entails clinical and construction risk. The additional risk — when renovation in a functioning hospital disturbs dust and mold, causing them to go airborne — makes it essential for the healthcare and construction entities alike to work with extra precautions.

The construction and renovation process significantly increases the risk of hospital acquired infections, which can be mitigated with prudent practices.

The Joint Commission (TJC), which sets standards for care, provides guidelines about conducting an Infection Control Risk Assessment (ICRA) when there are significant changes in the environment, community or patient population. While not mandated before construction, it’s unlikely that an insurance carrier will look kindly on projects that ignore an ICRA.

TJC requires an evaluation of six risk elements prior to construction or renovation activities, including air quality, infection control, utility systems, noise, vibration, and other hazards.

Air quality key

Outside of hand washing, the most important aspect in minimizing the transmission of infectious organisms is proper air quality and flow. The risk of a change in the airflow design, or the necessity for increased or specialized ventilation is greatest during construction, renovation, and demolition activities.

As such, conducting an ICRA requires cooperation between outside contractors and the hospital’s infection prevention, engineering and nursing faculty.

Choosing a contractor that is familiar with patient safety precautions and hospital policies is critical to ensure on time completion, patient safety and the overall success of construction and renovation projects.

Occupational Safety and Health Administration (OSHA) standards state that any worker, whether in construction or a hospital employee, may be vulnerable to traditional and environmental risks during a construction project.

As a result, finding contractors for healthcare construction projects requires particular attention. A history of successfully completed projects and special certifications, like ICRA certified, Health Care Physical Environment Worker and Certified Healthcare Construction, can help identify contractors equipped to handle healthcare construction.

Given that patient lives and millions of dollars are at risk, underwriters are checking that these safeguards are in place. When appropriate risk controls cannot be confirmed, insurance companies may not even quote the coverage, much less place it.

HUB International’s experts in healthcare and construction can help get going the complicated process of hospital construction projects — and get coverage.

¹ Healthcare Finance, “Nearly $1 billion in American Rescue Plan Funds will renovate health centers,” September 28, 2021.
² Archinect, “AIA expects construction to surge, but not until 2022,” July 21, 2021.
³ Health Facilities Management, “2021 Hospital Construction Survey,” April 22, 2021.