By Jeff Wardon, Jr., Assistant Editor

As climate risks intensify, healthcare organizations are being tasked with ensuring their facilities can remain operational during floods, storms and power disruptions. That reality is pushing hospitals to think beyond code requirements and toward long-term resilience. Healthcare Facilities Today spoke with Jennifer Mahan, associate at Thornton Tomasetti, to discuss how healthcare facilities are rethinking infrastructure, redundancy and capital planning to better prepare for future hazards. 

HFT: How are healthcare organizations rethinking facility design or infrastructure to improve resiliency against floods and storms?   

Jennifer Mahan: We see this play out in a few ways. Healthcare operators and healthcare organizations are often among the first to recognize that their facilities—and their role and reputation in the community—mean that meeting code minimums simply isn’t enough. Just because they meet code doesn’t mean they’re meeting their own performance expectations, or the expectations the community has of them. 

Because of that, hospitals are often operating in the resilience space. They’re the first to think about redundancy—things like backup power, alternative power, microgrids—and really taking a holistic view of energy, power and utilities. Again, not because code requires it, but because of the performance levels they expect of themselves and what the community expects of them. 

We see them going beyond code minimums and toward N+1 redundancy, continued functionality and higher performance levels overall. They also tend to understand the full life cycle of a system very deeply. They know that operations and maintenance don’t always match the original design intent, and that sometimes simpler is better. It may be worth a higher upfront investment in a more robust or thoughtfully designed system if it makes operations and maintenance easier over time—especially if facilities teams are already familiar with it, it’s more dependable and parts are easier to replace. 

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Hospitals are unique in that they often manage large portfolios with many different building types, both new and existing. Combined with their resources and their responsibility to the community, this pushes them to think beyond what’s required by code. They’re looking for higher performance and evaluating solutions through a full life-cycle lens, weighing the pros and cons not just for functionality, but for the broader community they serve. 

HFT: How can facilities incorporate resiliency planning into ongoing maintenance and capital planning—not just emergency response?   

Mahan: I think this is an optimal time to look at these issues because energy redundancy can feel very intimidating and cost prohibitive. For example, a hospital may realize that its generator no longer has the backup capacity it needs due to growth over the past five years or increased system demands. Replacing a generator outright can be far outside the budget for a single year. 

However, as part of ongoing maintenance and capital planning, if you’re approaching the end of a generator’s life cycle, that becomes a prime opportunity to step back and ask bigger questions. Instead of simply replacing the system with what you had before, you can assess current needs, current hazards, and also anticipate future hazards. 

Maybe the design flood elevation is now two feet higher than it was when the generator was installed 20 years ago. Maybe wind loads or heat demand are greater than they used to be. With better data and climate projections, we can see that these conditions may worsen over the next 20 years—well within the design life of a new system. Planning for that additional capacity now, when the system already needs to be replaced, helps avoid a situation where you’re forced to pay twice: once for a new generator, and again a few years later because it wasn’t designed for the hazards you’re actually facing. 

From a capital planning and life-cycle perspective, this means upgrading systems not just to past standards, but to what’s anticipated in the future. At the same time, it’s important to recognize that systems like HVAC or generators typically have a 20- to 30-year design life. There’s no need to design them for 100 years out. Instead, we can reasonably plan for what conditions might look like over the next few decades, with the understanding that even higher-performing systems may be available at the next capital cycle. 

That same thinking applies beyond mechanical and electrical systems to structural and architectural elements. Flood elevations today, for example, are very different from what FEMA maps showed 20 or 30 years ago. If a hospital is already repairing exterior walls or constructing a new building, those moments create an opportunity for what we call adaptive design. 

When you’re replacing foundational elements that are difficult and expensive to retrofit later, you can design them with additional capacity—perhaps a 10 percent increase over current requirements. That modest increase can mean that in 30 years, you don’t have to come back and replace a wall that fails under higher flood conditions, because it was already designed for the anticipated future levels. 

At its core, this is about using the capital planning process to think a bit more strategically. We already know what needs to be upgraded, how often those upgrades occur, and what standards apply. Adding a resilience lens means looking not just at what has happened or what’s happening now, but at what’s likely to happen in the future—and upgrading appropriately without creating prohibitively high costs for the hospital. 

Jeff Wardon, Jr., is the assistant editor of the facilities market.