By Jenny Freeman
The COVID-19 pandemic forever changed the healthcare landscape, exposing infrastructure vulnerabilities and marking a shift in how hospitals approach expansion. Instead of growing larger, many institutions are now thinking smarter—prioritizing flexibility, efficiency and adaptability. Master plans are evolving to meet the need for more dynamic utility and power systems that can accommodate advanced medical technologies and newer patient-care models.
Hospitals are increasingly relying on uninterrupted power to support advanced diagnostics, life-saving technologies and data systems. As such, resilient and redundant energy systems are critical. Many are prioritizing upgrade and expansion projects for existing district energy and power plant infrastructure, elevating equipment above flood-prone zones, incorporating cogeneration and thermal energy systems, and designing for energy efficiency. These solutions ensure reliability while improving sustainability and operational costs over time.
In developing flexible master plans, phasing and sequencing are essential. Hospitals operate 24/7, and construction activity must be coordinated to avoid interfering with critical services. Before a project begins, teams should engage with impacted departments to understand the operational parameters. Key questions must be addressed:
- Will there be infrastructure shutdowns?
- What equipment is sensitive to noise, dust, or vibration?
- How will access routes for staff and patients be affected?
These assessments enable teams to develop construction plans that are minimally disruptive and preserve the integrity of patient care.
Technological integration is another core element of master planning today. For example, imaging departments routinely work around ongoing construction due to more frequent innovations in diagnostic equipment. Designing with flexibility in mind—such as incorporating modular ceilings and additional raceways or isolated power panels—allows spaces to be quickly upgraded as new technologies emerge, without extended periods of downtime. This ensures hospitals remain competitive and capable of delivering the best care possible in an ever-evolving field.
Avoiding Disruptions to Patient Care
Construction in active healthcare facilities demands caution. Infrastructure upgrades and plant work should be completed early in the project, where possible, to create a backbone that future phases can easily connect to. This enables smoother transitions and, when designed with the proper redundancy measures, avoids service interruptions. Another effective strategy is the use of swing spaces—temporary spaces where departments can operate while their primary spaces are under renovation. This method keeps services running while work progresses elsewhere.
In some cases, swing spaces can be previously relocated departments or floors. And in others, mobile solutions such as MRI trailers are deployed. A methodological approach that minimizes disruption is the use of confined construction zones that impact only two or three patient rooms at a time. While effective, this does increase timelines (and, therefore, costs), making early planning all the more critical.
Of equal importance is anticipating the collateral effects of construction. For example, relocating sinks and toilets on one floor can affect venting and drainage systems on the floors above and below. Addressing these interdependencies alongside architects and engineers in early planning helps minimize delays or the need for re-construction in the middle of the project. It’s important that the project manager helps facilitate these conversations from day one, so that sequencing stays on track.
Clear, proactive communication with hospital staff and patients is also critical. A comprehensive communication plan should be developed at the outset of a project, with high-level updates shared regularly and more detailed notices given as needed. Realistic timelines—with built-in contingencies—and thorough pre-construction assessments are key to building trust and ensuring seamless transitions.
Collaboration With Stakeholders
Successful healthcare projects rely on effective collaboration among many stakeholders—including hospital administrators, clinicians, facilities staff and community members. However, not all stakeholders speak the same language. To bridge the gap between technical planning and end-user experience, visual communication tools have become invaluable. Assets such as 3D renderings, BIM models, VR360 tours, and video animations help non-construction professionals to understand proposed designs, provide meaningful feedback and help ensure the final product meets operational needs.
Construction timelines and expectations should be transparently communicated with clarity and consistency. Establishing shared goals and setting achievable milestones builds confidence across teams. As a project nears phases that will affect specific departments, detailed briefings help prepare staff and minimize confusion.
Creative solutions often arise from collaborative engagement. For example, modifying shifts to restrict noisy or vibration-heavy work to certain hours can preserve a healing environment. These compromises reflect the value of transparent dialogue and inclusive planning.
For the Ruth Bader Ginsburg Hospital in Brooklyn, N.Y., Group PMX served as a program manager alongside STV Inc., on behalf of the New York City Economic Development Corporation (NYCEDC) and NYC Health + Hospitals/South Brooklyn Health. The $923 million FEMA-funded project involved constructing an 11-story, 350,000-square-foot inpatient tower designed to replace facilities damaged by Superstorm Sandy. The new structure was built with resiliency in mind—from elevating critical departments above flood zones to integrating redundant utility systems—ensuring the hospital can remain operational during extreme weather events while meeting today’s standards of care.
Sustainability and Historic Preservation
Modern hospital expansions should balance operational goals with environmental stewardship, which often work hand-in-hand to the benefit of both patients and their providers. Incorporating sustainable building practices—such as high-efficiency systems, green roofs or low-emission materials—helps reduce a facility’s long-term carbon footprint and its energy bills. Green space, when located strategically in view from or in close proximity to patient rooms, can even aid in the healing process. Engaging all stakeholders in these conversations is key to adopting these solutions without compromising patient care or adding undue burden to already-stretched budgets.
When hospitals with historical significance are expanded or redeveloped, adaptive reuse can be a sustainable approach, but this can introduce a different set of challenges. For example, an existing architectural or artistic element—such as wall art or a historic embedment—must be preserved. Project managers can ensure that features are protected during construction and that surrounding renovations are designed to complement and seamlessly integrate with it.
This strategy benefits from extended preconstruction planning. Teams must probe and uncover as many existing conditions as possible, recognizing that these may not be well documented or regularly updated. Codes evolve over time, and a change in building use may trigger new (and sometimes unforeseen) compliance requirements. As such, flexibility, regulatory due diligence and contingency planning are essential to balancing modernization with preservation.
Operational Efficiency and Cost Management
Hospitals face pressure to control costs while maintaining high-quality infrastructure. Value engineering—when done correctly—can strike that balance. This often involves right-sizing infrastructure to current and anticipated needs. Particularly in cases where landmark designations limit the scale of architectural changes allowed, it may not be possible to widen doorways or expand equipment rooms to the extent needed by a new program. Understanding what will be needed for future construction, project managers can work with building engineers to design systems that are scalable and allow for future expansion without overbuilding upfront.
Risk mitigation is also important, especially as infrastructure upgrades take up larger portions of capital budgets. Strong project management practices—including clear milestones, budget tracking, and cross-functional coordination—ensure projects stay as on time and on budget as possible.
Jenny Freeman is managing director of buildings for Group PMX.
