Essential Planning Considerations for Medical Devices in Healthcare Facilities

The pace of healthcare technology is rapidly evolving to the point where even the most cutting-edge medical equipment can become obsolete seemingly overnight. We recently held a roundtable with three members of PMA’s healthcare sector team: Eric Hoffman, Vice President and Healthcare Sector Lead; Rob King, Project Director; and Gerard Peduto, Senior Project Manager at PMA. As experts with collective decades of experience in the space, they discussed how healthcare leaders can best create flexible, adaptive built environments that accommodate the latest in medical technology and help healthcare systems ensure buying decisions are future-flexible. Their conversation is below. 

How do healthcare systems think about medical equipment and devices and their role in the built environment? How do you categorize the tools, machines and instruments that fall under this broad category? 

Rob King (RK): There are two primary categories of medical equipment and devices: fixed and movable. Fixed equipment is the big machinery—MRIs, CAT scans and X-rays, cardiology catheterization labs and interventional labs for other minimally invasive procedures. This equipment is so large, with such exact requirements, that the space must be purpose-built for it.  

In radiation oncology practices, therapies such as linear accelerators and gamma knife require large shielded rooms to house the equipment. However, they also require control rooms, pre and post treatment areas, exam spaces, treatment planning areas, and a whole host of other space requirements. The physical environment must be planned and built in a way that supports the equipment and the workflow of the people who use it, including the supplies they need on a day-to-day basis. 

Gerard Peduto (GP): The other category of medical equipment is movable devices, like pumps, portable X-rays, EKGs—basically things that are small enough to move in and out of rooms. While these devices are meant to be readily available and move to the patient, they still have built-environment requirements.  

A portable X-ray, for example, may need shielding in patient rooms for safe use. Dedicated storage for these items is also important, as without it, movable devices often end up shoved in a hallway or otherwise left in the last place they were used, which can make them difficult to locate or retrieve quickly.  

What are the built-environment considerations healthcare systems need to keep in mind when making medical equipment decisions? 

RK: Timing is critical—when do you think about equipment in terms of the development project? Many healthcare systems will wait until the design stage or later to consider the space needs, which can result in delays and cost overruns. There’s always a balance between the project team, who wants these decisions made as early as possible, and the administrators and care providers, who want to wait for the latest and greatest equipment to come online before they put in their purchase order. 

Every project breaks down to who, what, when, where and why. It’s the why that’s most important. Why are you building this? What business purpose does it serve? 

As projects move along, people can become untethered to the “why”. They get lost in the details of plans, materials, contractors and subcontractors. But the further you get from your “why” the more likely you are to introduce mistakes that need to be corrected later, and that always comes at a cost of both money and time.  

Eric Hoffman (EH): That “why” also has to be future-focused. The pace of change in healthcare is so fast, facilities need to think about why they want this equipment now and how they might use it in the future. Often planning comes down to assumptions about growth, but if a disease is cured or the innovation around equipment outpaces the construction process, how are you going to deal with that? Healthcare systems must consider how their needs will evolve to keep their space future-flexible. 

How can project teams help healthcare systems keep their medical equipment decisions future-flexible?  

GP: Forward-thinking healthcare systems will not only build the space for the machine they have today but include considerations for how they will replace it, 10 or 15 years down the line in the initial development plan. For example, if an MRI is located in an area where you’d have to rip half of the building apart to replace it, that becomes a major problem in terms of cost and feasibility.  

RK: There are also issues of redundancy—how do you ensure your equipment is up and running as frequently as patient volume or regulations demand? An outpatient imaging center may opt to run a three-MRI suite off one chiller and if the chiller goes down, taking all the MRIs with it, so be it. But a stroke center or Level 1 trauma center that needs an MRI that is operating 24 hours a day would require cooling redundancy to make sure that no single point of failure would take out all of their scanners.  

EH: Proper space planning can help healthcare systems decide where to go above and beyond the requirements to best serve their business goals and patients, and when to do the minimum to meet regulatory requirements and maintain status. 

How do the physical plans for medical equipment help healthcare systems meet their goals and realize ROI? 

EH: When the physical layout of a room is off, it messes with the flow of healthcare delivery and that has revenue impact across the board. There are only so many cost centers in a healthcare facility. Imaging is a money maker, so many facilities want to tie their imaging equipment purchases to workflow and overall productivity. Space planning helps to maximize staff productivity, enhance patient and staff experience and minimize machine downtime, which in turn boosts revenue. 

GP: When hospitals invest in these major pieces of equipment, they’re betting they can serve a certain number of patients per day or year to make up for the cost. If patient volume changes due to alternative therapies or bottlenecks in the workflow, it can upend their entire revenue model. 

For example, if you have four MRIs side by side, it’s really difficult to replace anything that might break on those machines. Shielding door seals, mechanical support equipment, electrical systems, and coolant filters will require servicing well before the 10–15-year lifecycle of the machine. How are you going to get that equipment in and out without interrupting workflow to and from adjacent MRIs and support spaces? We’ve found ways to do it when we’re working on a replacement project, but it’s better to think of these complex issues before you make final layout decisions. 

RK: That’s why it’s so important to bring in end users early in the project. Doctors, nurses, support staff (facilities, safety, etc.), and other caregivers provide critical insight and spot issues that others don’t. The project team has to make good use of their time, but waiting until the end to consult them can cause project delays. 

I was working on a cardiac catheterization lab suite where the clinical team wasn’t involved in the project. When they came to look at the nearly complete space, they saw the doors weren’t wide enough. We had built the doors to accommodate stretchers, but sometimes admitted patients would require an emergency procedure. Those patients would be arriving in wider hospital beds! In an emergency, there would be no time to move a patient from a bed to a stretcher. 

This minor detail in the grand scheme of things required a change order to fix and delayed finalization of the project. 

How else does the built environment affect the flow of service and productivity for caregivers? 

GP: Every healthcare space works when people and process fit together. Medical devices just add a level of complexity to that formula. Machines have a pre-determined footprint, and they need support space like control rooms with sight lines for the people working those machines to have eyes on the patient.  

EH: Basic functionality is important. If an MRI requires cleaning between patients, and the cleaning supplies are located down a 100-yard hall, it creates problems for staff and can even create security concerns depending on who has access to that area and the supplies. You don’t want one full-time person on your books just to manage cleaning a single MRI because the supplies aren’t in the right place. 

RK: Storage for consumables, like catheters or contrast solution, is often overlooked in design plans, because the team is trying to optimize every square inch of space. But storage becomes a huge issue once a building is operational. There’s never enough space for these things, which typically don’t live in treatment or diagnostic rooms.  

EH: Another consideration is how the equipment ties into the facility’s data collection. Artificial intelligence, data collection and data analysis all require a physical footprint. Where is that going to live in regard to equipment? Are the connections in place to make sure all these systems are talking to each other? Is the equipment you’ve selected able to communicate with other systems? 

We talked a little bit about timing in regard to including equipment decisions earlier in the design process. Why else should healthcare systems make procurement decisions earlier in the process? 

RK: Equipment decisions need to be made early because they require purpose-built rooms that have different specifications based on a particular piece of equipment’s manufacturer and model number. We need specific info on conduits, structural support, cooling features, power requirements, HVAC, and infrastructure needs. You can’t switch equipment in the middle of a project without serious consequences. 

GP: Medical teams want the latest and greatest, and that’s understandable. But I’ve worked on projects where we’re designing for a head CT scanner and then later, they change it to a PET MRI. Those are two totally different animals. The cost impact of that mid-project shift was over $2 million, and that’s not accounting for project delays. 

RK: Technology is evolving faster than the design and construction process. Sometimes, you get a researcher who wants a new piece of equipment, or there’s a major shift in how services are performed, and you have to change the plan to accommodate that.  

Vendors often offer deals at the end of the fiscal year or quarter based on their sales quotas, so hospital administrators will try to hit that window. But if you’re saving 5% and holding up the project for months, that might not be a good trade. Vendors won’t release their site-specific drawings until they have a purchase order, so timing is important. 

GP: Delaying or changing the order may also mean you get a later manufacturing slot than necessary. All of this equipment is manufactured to “Just In Time” standards, so it’s possible a deadline will slip, and you’ll wind up with equipment later than expected, again delaying the entire project. 

What are the benefits of considering the built environment when making decisions about medical equipment and devices? Why should healthcare systems prioritize connecting equipment purchasing and development decisions? 

RK: It’s not a matter of why should they – they almost have to. If they want their equipment to function, they need to purpose build the space to accommodate it. I spent part of my career as a medical equipment vendor and routinely had to talk to clients about why their space plans just wouldn’t work. Having a team that understands the space needs, the support space needs, how the business operates, and how equipment ties to the project’s ultimate purpose is essential. 

GP: Hospitals need flexibility, but it is in short supply when dealing with large equipment purchases. Planning for flexibility at the outset can help manage changing patient volumes, reduce downtime and ensure equipment is producing the expected ROI. And, even in areas like storage or ensuring proper accessories in patient rooms, it helps to think through these things early in the process, rather than retrofitting later. 

EH: Thinking through the built environment when making equipment purchasing decisions is essential to connecting patient care to the business of running the hospital. Equipment that is well positioned can grow revenue and treat a higher volume of patients. It’s also essential for informing data collection systems and analysis for smarter care and more efficient healthcare systems. 

Connect with this article’s contributors:
Eric Hoffman, Vice President, National Healthcare Sector Lead
Rob King, Project Director
Gerard Peduto, Senior Project Manager