Construction ahead as health systems seek more space

Most health systems are gearing up to either renovate existing facilities or construct new ones, with the bulk of these plans set to take effect within the coming year.

In a November survey of NEJM Catalyst Insights Council members — clinicians, clinical leaders, and executives at healthcare organizations around the world directly involved in care delivery — 61% said their organizations are planning to renovate existing healthcare buildings and 51% said they will build new buildings. The majority of these respondents said they plan to do so within the next year.

In the U.S., 56% of respondents indicated plans to renovate healthcare buildings while 48% plan to build anew, compared to 24% and 36% who respectively said they have no plans for renovating or building. 

Capacity needs (62%), improved patient access (62%) and expansion of geographic footprint (36%) are the most common drivers for capital plans in the U.S. Only 22% of respondents said technology upgrades drive renovations or construction. 

"For as long as I can remember, there has been a need for more hospital beds," Andrew Ibrahim, MD, professor of surgery, architecture and urban planning, and vice chair of health services research at the University of Michigan, said in the Feb. 21 NEJM Catalyst report. "Even with the increased focus on preventative care, a shift from inpatient to outpatient services, and the transition to digital care models, we still have a shortfall."

There are about 920,000 staffed beds across U.S. hospitals. Although inpatient volumes are projected to see a smaller increase than home care volumes through the next decade, many hospitals today are struggling with capacity constraints and throughput problems related to boarding and post-acute care shortages. At the same time, the case mix index — reflecting patient severity — is up 5% since 2019 while the average length of stay for patients admitted to a hospital has risen 10%, according to Sg2

Many health systems delayed their capital projects throughout and shortly after the COVID-19 pandemic as hospital finances saw big swings, returning to those plans in the past year as finances have stabilized or improved.

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