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By Jeanine Mansour, Healthcare Projects Director MENA / Biomedical Engineer, Leo A Daly
Repurposing existing non-clinical buildings into healthcare facilities is a strategy for providers to infiltrate the healthcare market quicker and offer services to new patient populations in need. While this is a great way to get project registration approval from a capacity master planning perspective, providers run into problems during the design and construction process in ensuring codes and compliances are up to standards with local licensing authorities. Try renovating a mall into a fertility centre or a bank into a neonatal intensive care unit or an office building into a long-term critical care facility and it is guaranteed challenging surprises will be encountered. This is when design firms get called in; specifically, creative teams who welcome challenges.
In 2015, we were appointed by the Department of Health (HAAD/Health Authority Abu Dhabi at that time) to conduct a third-party review on behalf of the authority for facilities seeking licensing at the Step 4: 90 per cent inspection stage. Many of the facilities seeking healthcare licensing were converting existing non-clinical spaces. Even the other facilities undergoing renovation were existing healthcare services that during the documentation review revealed that the original as-built drawings were a bank, hotel, office building, etc.
During the 90 per cent of inspections, there is a moment of empathy for all parties involved. From the Department of Health perspective, there needs to be a response to the current and future healthcare demands catered by service type and specialty where it is important these conversions are compliant with local requirements. In support of the providers, they are trying to expand their reach either from main branches or they are new to the market and the conversion is a quick prime location solution to deliver quality care to a new patient population where it is imperative to save cost and time. Maybe the most empathy falls within the selected design and construction team where it is imperative to implement innovative solutions to take advantage of reducing the carbon footprint by recycling built-environments for adaptive use yet must confront challenges that range from access, engineering, safety, security, infection control, waste management, etc.
Example 1: Office Building to a Long-term Critical Care and Rehabilitation Hospital
An entity out of the U.S. was exploring investing in healthcare in Abu Dhabi to convert an existing office building into an inpatient critical care and rehabilitation hospital. The intent of the project was to have both long term-critical care as well as acute physical rehabilitation inpatient services. Typically, office buildings are designed with features such as setbacks and large lobbies for access control, which can seem appealing to insert a healthcare facility. However, this building faced many critical items, such as ambulance access. It was difficult to provide ambulance access from grade level, yet it did not meet minimum height clearance on the ramp down to basement. Also, the elevator for stretcher circulation was explored in multiple locations. One location for the stretcher elevator impacted the fire escape strategy yet the other locations impacted programming and made the floor inefficient due to the existing structural grid not being ideal for healthcare facilities. At one point, the gurney elevator was explored to be built along the façade. However, the massing was not stacked to have a linear geometry impacting that the mezzanine floor would need to be extended to accommodate an external elevator. In the end, the programme was impacted, and the facility did not match the investor’s needs and other real estate options were then explored.
Example 2: Mixed-Use Development to a Fertility Centre
An established operator expanded their reach into the local market by inserting a Fertility Centre in a mixed-use development. The main challenge is that the development supports residential, retail, and commercial spaces, which are typically open social experiences with direct quick access. In contrast, this healthcare facility (In Vitro Fertilization Centre) is a space that requires extreme privacy, security, and infection control, as well as dedicated cultural and religious responsiveness. Upon initial facility assessment, the proposed floor level of the fertility centre was not viable due to access, circulation, and ceiling height. The ground floor was then reviewed, which presented a significant challenge between planning and engineering. The best location for the operating theatres and clean rooms being driven by lean processes of patient and staff flow was the worst location for Mechanical, Electrical, and Plumbing (MEP) due to existing drop-down beams with drainage pipes running under the drop beam. This space is optimal for rooms with low false ceilings, not operating theatres or clean rooms. This brought us to explore option three: extreme raised floor levels. Note that the development was originally planned to be retail and commercial spaces where variation in floor levels can provide playful architectural experiences. However, the best location for the engineering systems were in a zone with a major drop in elevation. The solution was to raise the level by two to three metres and identify an optimal location for the return ductwork early on during the space programming. Determining the transfer of genetic material, location for specimen collection, medical waste pick-up, and cultural and religious responsiveness were challenges that were successfully solved.
Conversation of Conversions
Recently, I had two interesting conversations; one with a former health authority official and one with a seasoned senior operations manager. Both have seen first-hand how healthcare in Abu Dhabi has evolved over the past few decades. The consensus was that conversions are more expensive and challenging than new construction. One example discussed was a comparison between new construction of a 200-bed hospital being substantially lower in cost than a smaller day surgery conversion in a retail mall with the added responsibility of renting the space rather than owning the plot in new construction. Factors such as getting into the market in six to 12 months for a conversion rather than approximately 24 months for a new construction is a major factor driving the feasibility assessment.
From the engineering perspective, it is more feasible to insert lower acuity wellness-based centres such as general clinics and primary urgent care centres to avoid issues. Inserting a CT or MRI in a villa has been very challenging on previous projects due to structural limitations and ADA patient circulation. There was one facility that had issues with the disposal of silver chloride from radiographic film (X-ray film) as it was cross-disposed with general residential sewage. Insertion of healthcare facilities in residential towers has presented challenges in the separation of peoples and goods as well as visitors and residents. Imagine a parent and their child in an elevator with an infectious patient. The frequency of infectious patients visiting that site is more likely increased to interface with parent and child’s regular daily activities. There is even one major hospital within the Abu Dhabi emirate that has 20 staff working the valet services at the main entrance to maintain patient and visitor access, and yet the entrance is still crowded and clustered. There is a continuous need that can drive cost to upgrade engineering systems such as outdated sprinkler systems, fire code strategies, and HVAC systems during conversions.
While there are many challenges in the trend to convert non-clinical buildings into healthcare facilities, as a healthcare consultant, I welcome a future project aimed to convert a fast-food drive-through into a retail pharmacy satellite clinic where you can receive your flu-shot or vitamin-infusion through the window!