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.

Tony Esposito is managing principal at TLC Engineering for Architecture (Philadelphia) and has over 17 years of experience designing mechanical systems in the healthcare environment. Here, he shares his thoughts on the impact of USP 800 on pharmacy design, balancing HCAHPS scores with energy efficiency, and new power system requirements driven by the demand for more resilient healthcare facilities.

  1. Emergency preparedness and resiliency

The recent tropical storm season reinforced the trend to harden healthcare facilities from the effects of extreme weather, which may well soon become the new normal. We’ve seen new requirements for essential power systems in sub-acute settings extending to comfort heating and cooling. The most recent example being in Florida where the governor instituted new requirements for nursing homes to provide back-up power systems to support the heating and cooling systems in areas of patient care in the wake of patient deaths following Hurricane Irma. This is leading to new capital spending projects for generators, fuel systems, transfer switches, and panelboards.

  1. Wellness-driven space needs

As more outpatient facilities expand their services to focus on wellness, we’re seeing more gymnasiums, natatoriums, and locker facilities in healthcare settings. These spaces have much higher fresh air ventilation rates than we usually see in outpatient facilities. The higher quantity of fresh air introduced into the building triggers building code requirements for heat recovery equipment that wouldn’t otherwise be required. This equipment helps save energy, which is good, but the space requirements are nearly double the size needed for air handler systems, which challenges architects to accommodate these additional space needs.

  1. Budget battles

We continue to struggle with capital budgets being separate from operating budgets, with different groups managing these budgets. Often, the goal of reducing operating cost would lead us to provide more efficient, and consequently more expensive, systems into a building. This is at odds with the goal of designing a project with a limited capital budget. This problem is made worse when capital budget managers are rewarded for certain actions, such as saving capital by choosing cheaper systems with poor efficiency, that result in higher operating costs. It’s important to set clear project goals at the outset of the project and identify an owner representative that can reconcile project decisions where conflicts arise between capital and operational issues.

  1. Impact of USP 800

Drug compounding spaces are essentially mini-clean rooms with very high air change rates and high efficiency filtrations systems. In cases where existing pharmacies must be upgraded to meet these changing requirements, particularly regarding isolated exhaust systems and increased air change rate requirements, we’re finding that the existing HVAC systems serving these areas are often incompatible with these more stringent requirements, with inadequate overhead space for larger ductwork and air handling systems that don’t have the capacity for higher airflows. Ultimately, compliance will require much larger and more disruptive renovations than the owner initially anticipated.

  1. HCAHPS scores are driving design decisions

HCAHPS scores related to patient, family, and staff satisfaction with the environment of care are now greater financial drivers than the cost of energy to operate these spaces. We’re balancing the need to be energy efficient with providing a pleasing healing environment for patients that includes low noise, fresh, non-drafty air, and the ability to control room temperature, light levels, and window shades from the bedside.