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A New Age of Adaptability in Healthcare Buildings

By Jason Moss, PE, AKF Group


Designing buildings that are both flexible and sustainable is a complex challenge that requires a unified vision and an understanding of the trade-offs involved. Today’s building designs must satisfy functional requirements while also incorporating sustainability measures driven by policy, optics, and practicality within a dynamic energy commodity landscape. In healthcare facilities, flexibility is a crucial aspect that is second only to safety and reliability. However, mechanical, electrical, and plumbing (MEP) building system designs in such facilities face the additional challenge of adjusting to the growing desire for adaptable acuity patient care spaces and sustainability in building energy. Building owners and designers must work together to create a unified vision for current and future planning while understanding the limitations and trade-offs involved in such designs.

Designing safe and reliable healthcare building systems is not only a necessity, but also a complex task that requires the ability to adapt to changes in patient care environments and accommodate continuous improvements in diagnostics and treatment. The COVID-19 pandemic has highlighted the need for adaptable spaces that can support a higher level of patient care. For example, a space intended for standard treatment use would be suitable for supporting critical care. To accomplish this, engineers must design for high ventilation rates and provide high-efficiency filtration beyond typical requirements. These improvements require significant heating, cooling, and power to achieve. A nominal spare capacity designed into building systems based on standard practice is swiftly exhausted by introducing adaptable, pandemic-ready programs.

Healthcare facilities, in addition to program adaptability, are grappling with incorporating measures for transitioning to sustainable energy-consuming building systems. High-efficiency electrified equipment is increasingly popular to improve building energy performance. Heat-pump equipment, for example, is being considered as an alternative to fuel-burning boilers in future heating designs. However, incorporating flexibility into system design can introduce challenges such as costs, space constraints, and distribution issues that require careful coordination. For instance, a facility that heats with boiler steam planning a transition to heat-pump hot-water must contend with thorough analysis of the connected equipment and the prospect of extensive upgrades or limitations incurred by changing sources. Designing healthcare facilities that are flexible and sustainable can be accomplished with creative and comprehensive planning.

Efficient heating and cooling systems are critical to improving building efficiency, and installing energy-efficient equipment is often incentivized by local, state, and federal governments. Some cities, such as New York City and Boston, have implemented policies with penalties for failing to meet energy performance benchmarks. However, the future availability of natural gas is uncertain due to potential fossil fuel limitations, making it crucial for building owners and designers to carefully consider energy sources when making MEP design decisions. Decisions like using electricity to create heat instead of fuel have a significant impact on system design considerations from electrical service to the building down to baseboard radiation size.

Designing safe, reliable, adaptable, and sustainable healthcare buildings requires a unified vision, an understanding of trade-offs, and careful coordination. To meet the growing demand for adaptable patient care spaces and transition to sustainable energy-consuming systems, building owners must carefully consider energy sources and implement high-efficiency electrified equipment. It is important to keep in mind the limitations and trade-offs involved while accommodating improvements in diagnostics and treatment and addressing fossil fuel limitations.

Jason Moss, PE is a project manager at AKF, an MEP/FP Engineering and Integrated Services firm with offices throughout the USA and Mexico.

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