Healthy Health Care Dominates 2011 Commercial Construction

We can debate the motivations for the latest wave of health care construction, but it's evident that health facility building is dominating the 2011 commercial construction landscape in Greater Madison. Every local care provider has something going up or in the planning stage, including the expanding Verona campus of Epic Systems, which is adding more space for its annual Users Conference.


Healthy construction

While health care construction hit a snag during the height of the Great Recession, it has regained momentum. "Some of it is just pent-up demand because the capital markets turned pretty negative pretty quickly with the whole mortgage debacle," stated Todd Burchill, vice president of strategy and business development for Dean Clinic. "I think a lot of projects were just delayed or put on the shelf."

They are no longer gathering dust. SSM Health Care, which includes St. Mary's Hospital, is completing a 10-year "2014" capital investment plan that included a 235,000-sq.-ft. east wing expansion at St. Mary's, and a 185,000-sq.-ft. Dean-St. Mary's outpatient building, a combined $182 million investment. Now, St. Mary's is focused on the construction of a new neonatal intensive care unit, part of a larger $36 million women's and children's capital improvement plan.

After centralizing its cardiac care facility, Meriter Health Services is building new clinics in Monona and DeForest. It should complete the reconstruction of its surgical services department in 2012 for an estimated cost of $44 million, and it is remodeling and expanding its birthing suite for a projected $22 million.

Dean Clinic is building a new 155,000-sq.-ft. clinic in Janesville, and is planning a larger Waunakee clinic to meet market demand.

This fall, UW Health will open its new 33,000-sq.-ft. Yahara Clinic, which will effectively consolidate existing clinics in Monona and McFarland in one location, and it recently announced plans for the $100 million University Crossing project.

Epic Systems soon will complete a 200,000-sq.-ft. addition to its learning campus to serve 7,000 visitors expected to attend its Users Conference, and a workforce that will reach 5,000 by year's end.

Kristin McManmon, vice president of operations for St. Mary's Hospital, said part of the building boom is linked to the new, evidence-based ways to deliver care. New in-patient features include additional private rooms and added space for technology, infrastructure, and support.

The trend toward more private rooms is connected with evidence that they improve outcomes through noise mitigation and infection control, and with the importance of more natural light for the overall patient experience. In Dane County, the in-patient experience is felt by a fast-growing population of aging baby boomers that, according to McManmon, creates "shifts in requirements and expectations from patients."

McManmon said new design concepts are not driven by the government's emerging reimbursement policies, which pay for quality (avoiding preventable incidents like falls and bedsores) rather than simply services rendered. "It's the better body of evidence about how to design space so that families have an area, patient care is provided in one location, and there is kind of a zone for clinicians so they are not crossing back and forth," she explained. "There are precautions you can take to reduce the likelihood of falls by having caregivers decentralized in terms of location."

Medical technology has changed so dramatically that hospitals need more room just to accommodate it. In Meriter's new surgical services department, the hospital will expand the size of operating rooms to 650 sq. ft. so there is room for additional technology. Jerry Rabas, construction manager for Meriter Health Services, said monitors for anesthesiology, surgical and patient monitoring equipment, and computers with electronic medical records are placed on booms, which are workstations that hang from the ceiling to save room.

"The complicated cases just use more equipment," Rabas noted.

Clinics are built differently, too, with smaller waiting rooms to reduce the spread of germs, and other configurations built more with the patient in mind. Mondy Aeschlimann, primary care manager for the UW Medical Foundation, said UW Health's Yahara Clinic will be designed for patient "self-rooming," which should reduce wait times. Each exam room will have two doors, one for the patient to enter and one for clinical staff to enter from "behind it, from backstage, if you will," she said.

Burchill said the "design-build" of Dean's future clinics will be centered on patient expectations. For example, Dean's new Waunakee clinic probably will be designed to accommodate the information technology-enabled medical home concept.

The business driver for Epic Systems' expansion, which also will include a larger auditorium by 2013, is a growing client base. Steve Dickmann, chief administrative officer for Epic, said the organization now has between 800 and 1,000 customers per day coming in for training on its electronic health records. "We are absolutely maxed out," he said, "of training space in our existing facility."

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