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Good Things Come in Small Packages

Health systems consider micro hospitals to meet patient demand.

If one thing is true, it is that patient attitudes toward healthcare are changing. As more individuals use high-deductible plans, they demand more transparency in pricing and greater information on their options. New research tools embolden patients to make choices regarding their treatment rather than simply following past protocol. Couple this shift with the tendency of many people to seek advice from their personal network of influencers (whether trained in healthcare or not) and the result is a growing demand for unconventional offerings.

The micro hospital
Micro hospitals are facilities with a smaller footprint than traditional facilities (usually 15,000 s.f. to 50,000 s.f. and between 5 and 10 in-patient beds). Like their larger cousins, they have 24/7 operations that typically provide an emergency department (ED), surgery, imaging, labs, diagnostics and other specialized services. These services may include orthopedics, oncology or maternity. The offerings in any location depends on the needs of the local community and future trends for the region.

The greatest benefit comes to individuals who might not need enhanced observation, yet still require rapid intervention at the first sign of complications. It’s clear that patients prefer “hospitality” more than “hospital” when it comes to their surroundings. Plus, focusing on community-based care means that the immediate demands of local residents are the primary focus in a micro hospital.

Bringing it together
As large systems research micro hospitals, many considerations are scrutinized to ensure the right fit, including: 

  • Is your micro hospital filling a service gap for a particular need or group of individuals?
  • Is the location conducive to this option providing easy accessibility (near shopping or restaurants usually in an urban or suburban setting)?
  • Is this truly a convenient, flexible and community-focused facility?

Healthcare leaders and facility managers alike recognize the many advantages of a smaller location. Reducing square footage means reduced construction costs; typically between $10M and $30M. The size is also directly correlated to a shorter building schedule, smaller and leaner staff plan and lower overhead with flexible amenities.

Five factors to due diligence
There are some specific points to consider as organizations evaluate the micro hospital option, including:

  1. Research regional needs and trends. Understand the people who reside in the area that will seek care at the facility. What are the overall demographics and correlated service requirements? How will this demographic shift over the next decade? With big-picture clarity, do patient needs match the mission of the system? A micro hospital can’t be everything to everyone. It’s important to make a plan for the majority and not overwhelm the initial objective.
  2. Know how the space will layout. Identify the requirements for each service. Then look to lean construction techniques to find efficiencies in floor-plans. Can swing-spaces serve two purposes during a single day? Can transition time or distance walked between areas be reduced? Is there a better layout for rooms and hallways? Seek flexibility in design, yet keep an eye on future expansion opportunities and their potential to alter the space.
  3. Follow the lead of your community. Double check, is this what is right for the residents? Only when they understand the benefits and willfully trust micro hospital locations will they enter your doors. Since no two micro hospitals will ever be the same, take time to understand the local perception. 
  4. Know your state regulations. Don’t be surprised by code and guideline requirements. As in a full-size facility, your micro hospital must follow all of the same rules. However, some states have specific certificate of need (CON) requirements that may affect your decisions. Get the facts before you build.
  5. Find the right partners. Once you have completed your homework, partner with a construction manager and designer who can ensure your micro approach benefits are realized. Look for organizations that understand lean techniques, schedule management, budget targets/value analysis and collaboration.

Micro hospitals are beginning to gain favor as they provide less expensive facility solutions while offering custom care. Maintaining a focus on total patient satisfaction, with today’s new self-directed consumer, offers health systems higher efficiency and patient loyalty.

"Our Take" by John O'Toole

Deciding whether or not to build a micro hospital is a system strategic choice with bottom-line advantages. Just don’t be caught off guard by denials from CMS due to low inpatient volumes which could remove the facility from qualifying for hospital level reimbursement.

After considering state licensing and federal law requirements a micro hospital might be a good investment. Choose construction partners who bring a full complement of services to your project. The Christman Company has experts in healthcare construction that can make the process less overwhelming while remaining on budget and schedule.

There are ways to optimize your construction, including prefabrication of portions of the building. Benefits of this method include:

  • Cost savings: schedule, productivity, procurement and workforce are major drivers of cost. Prefabrication methods better control these factors to provide optimal results which can influence savings.

  • Quality: when construction is in a controlled environment, specific quality standards are more easily met. This is done from inside a weather controlled factory to exacting measurements.

  • Schedule speed: prefabrication has been shown to significantly reduce construction time. This is because of pre-planning, elimination of weather factors and consistency of workmanship.

The Christman Company’s experience with prefabrication on healthcare campuses sets us apart. We offer guidance on programs ranging from BIM (building information modeling) to facilities planning and value analysis. If you have questions on prefabrication or micro hospital construction, please email me at

With 31 years of experience, John O’Toole is vice president of healthcare services at The Christman Company.


Modular construction photos provided by Starr Electric Company, Inc., North Carolina. Established in 1928, Starr Electric is one of the largest and oldest commercial and industrial electrical contracting companies in the southeastern U.S.  

A Project Manager’s Perspective

The Challenges and Rewards of Healthcare Construction.

Neil Westmoreland started his career in healthcare construction fresh out of college in 2005. A lifelong resident of the Greensboro, NC region, Neil has spent the last 13 years working his way from project coordinator to senior project manager.

Face to face, it’s easy to see why he is a favorite of our Southeastern healthcare clients. He has a soothing southern drawl and projects a calm, composed demeanor. He smiles easily and can make anyone—even a stranger—feel like a friend.

He has worked with Novant Health continuously since 2005, most recently acting as senior project manager on the $39 million Clemmons Medical Center Phase II addition. He’s worked at several other hospitals, along with senior living, rehab and laboratory facilities with clients like WellSpring and LabCorp.

Neil is a step above the rest in healthcare construction. He’s been interested in healthcare since childhood and built his career around constructing facilities that help and heal. Here is what he had to say in a recent interview about working in this distinctive market.

Q: What makes healthcare unique and exciting from a PM perspective?
In healthcare there is something new every day. Many types of construction, such as higher education or office space, share some of the same challenges. However, on a hospital renovation project, in many cases you have people in the room next to your work zone with highly compromised immune systems. Or you may have people preparing for open heart surgery. There are so many balls in the air that you have to juggle with your normal day-to-day construction activities.

Q: How do you keep jobs on schedule and minimize any impacts on occupied facilities?
Schedules are complicated. There’s typically a lot of phasing involved in working in or around an occupied space. You have to complete this task before you can begin that one. For example, you have to move the pharmacy before you can start on the surgical waiting room.

We always work closely with hospital staff to develop a phasing plan that they can work with without too much interruption to their day-to-day activities. We also take steps to have hospital staff involved with our tasks to eliminate any anxiety they may have due to the construction process. We want to build excitement around the project, not make jobs harder for the staff.

Q: What about infection control?
I’m very passionate about the infection control process. It’s very personal. When my grandfather went in for a knee replacement, he ended up with a staph infection and lost his leg. I know how important it is to maintain as sterile an atmosphere as possible.

The first step is always meeting with the infection control nurses. We perform a risk assessment and categorize the project into a risk category, from one to four—one being the least stringent and four being the most involved. Risk category four is typically a cancer center or operating room, where people have highly compromised immune systems.

In most all cases we construct temporary walls to separate construction areas from occupied spaces, or we might build isolation anterooms (between the existing hospital and our construction area). Usually we run negative air machines (hepa carts). These methods are designed to keep our air out of the hospital. We do particle counts in and around our work area daily as well as install differential pressure monitors to insure we maintain a clean work environment.

Q: When you’ve completed the work, what is the most rewarding part of the experience?
I think it’s when you walk the space with the doctors, nurses and patients after everything’s complete—watching their faces and hearing their comments. It’s often their first time seeing the finished project.

Recently we worked on a dialysis center at Forsyth Medical Center. There was one woman in particular that had been on dialysis for thirty years. She came to the ground breaking and spoke at the ribbon cutting. She was very grateful, because it’d been such a huge part of her life for so many years.

Q: How does Christman use technology for clients?
Well, we really use technology to make the most of our schedules. We also use it for close-out and post-construction services. BIM in particular allows us to get everything laid out virtually, prefab all our materials and plan out all of our systems well in advance of actually needing that material onsite.

One of things we did on the Clemmons Expansion project is have personnel come in and do owner training on all the systems. We hired a videographer and handed over a file with hyperlinks to all of these videos. If they have a question about an air handler or chiller, they can open these videos and replay the owner training.

Q: What advice do you have for healthcare clients that are planning a construction project?
Select your construction manager as early as possible. Get them involved in the design and preconstruction. That’s super important, to make sure you get the most bang for your buck.

The Christman Way

Our team goes above and beyond to make sure clients have the best possible experience. At Christman, one of our core values is having a passion for the work. Neil exemplifies the dedication and the relationships we build. He believes that the Christman team holds themselves to a higher standard, and for that, he takes great pride. Check out project photos from our Southeast US region in our project portfolio.

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Ask a Healthcare Construction Expert

Brian C. Crissman, LEED AP, AVS
As vice president in Christman's West Michigan region, Brian is known for the energetic leadership he brings to the projects he directs - particularly large, complex ones, such as the Western Michigan University College of Engineering, Michigan Street Development, Spectrum Health Lemmen-Holton Cancer Pavilion, and the Spectrum Health Blodgett Hospital expansion.  Read more...