Engineering

Engineering in Health Care Facility Design

Understanding an important role

BY Brent Wavra, PE – Mechanical Engineer

Engineering in Health Care

We start with the end in mind–each health care facility operates with its own idiosyncrasies that make up its unique nature and culture. As consulting engineers, it’s imperative we understand from the start what the stakeholders’ needs are when it comes to the day-to-day operations of their facility. We must also discuss the facility’s operational goals, energy use, care team function and overall patient satisfaction objectives.

Input from facility staff and stakeholders is valuable information as we start to lay out our system designs. Architects provide detailed renderings of different areas of the building, e.g., layouts of patient rooms, operating rooms and lobbies based on heavy input from the stakeholder group. Mechanical, electrical and plumbing (MEP) consulting engineers need similar guidance. For example, we need to know how the medical gases will be arranged on the headwall within a patient room, the preferred location of a med gas alarm panel, the optimal temperature setting in an operating room, emergency power needs for outlets, preferred equipment manufacturers–all of which make the workspace tailored to the needs of staff for an efficient and functional environment.



The character of a health care space is typically determined by what you see and physically identify within the facility. Elements like window locations, wall color, artwork and space layout tend to be the items that influence perception of the facility by patients and health care workers. However, nearly 40% of the building is located behind the walls, above the ceiling or in hidden utility spaces that have a higher impact on care, but have a less tangible impact on a person’s perception of the facility. The mechanical and electrical systems determine temperature, humidity, air filtration, infection control, water, medical gases, lighting, power, data, nurse call, way finding and other items. Many things play a significant role within the space without the users directly identifying them. The bricks and mortar of a facility are static and visibly noticeable; however, the mechanical and electrical systems are alive within the building, if unseen.

The cost for MEP generally accounts for nearly 40% of the cost of construction.

It is never too early to start understanding the MEP needs of a health care facility with the finished project in mind. Many MEP systems drive overall design decisions. For starters, the engineers need to understand and coordinate space requirements for MEP systems, because most of the equipment is located above the ceiling and determines the height of the building. In some hospitals, separate floors route the MEP infrastructure throughout the building. Another significant consideration is incorporating serviceability of the MEP infrastructure and the cost of doing so. It’s important to remember each square inch of building costs money and additional space to service equipment does not turn revenue like a patient room. Taking time to coordinate with facility personnel, the architectural design team and the construction manager will find the best solution and the right price, both of which are crucial for a successful project.

Secondly, MEP systems and supporting infrastructure are expensive. The cost for MEP generally accounts for nearly 40% of the cost of construction. Knowing the MEP needs of the facility early on helps the entire project team and owner understand the financial implications associated with these systems. For example, MEP systems can range from $50-$150 per square foot. Applying that to a 400,000 square feet replacement hospital means the systems cost can range from $30 million to $70 million. Having an early understanding of MEP systems needs for present and future use helps provide clarity into the project budget from the start and avoids the need to cut costs later. Communication during design is the path to success.

Engineers role on the Design Team

As health care engineers, we know the value we can provide from the start and our work with our architectural partners is a part of the process. Our goal is to be an integral part of the design team and bring a thorough understanding of how early design decisions can affect the engineering systems’ design and implementation for the project.

Understanding the goals, timeline and budget of a construction project is valuable information used early on during design of a new project. Each of these components is used to determine the correct type of heating, ventilation and air conditioning (HVAC) to coordinate with these criteria. For example, if the goal of the project is to provide an energy-efficient mechanical system, then a geothermal system might be considered. Coordinating a location of the geothermal well field with the civil engineer is a hurdle to work through, but possible when both parties are brought to the table early on. Another example is a project’s compressed construction timeline, which determines manufacturing lead times of mechanical and electrical equipment and may drive the system selection.



There are hundreds of scenarios like these, which if discussed at the beginning of the project with a consulting engineer, keeps the design process moving forward from the beginning. If not, there is the possibility of going backward to redesign parts of the project to accommodate the correct MEP system that fits the building needs. This can result in slowing down the design process and jeopardizing the construction schedule.

Net Zero means providing renewable energy solutions along with onsite energy generation.

Knowing the best way to communicate our designs and the effects of design decisions to people outside of the design and construction community is an important part of our job. As consulting engineers, we prepare our design on 2D set plan drawings for the constructors to construct. We also work with the design team within 3D models to better understand how our designs affect the overall project outcome. Working within this 3D modeling medium is called Building Information Modeling (BIM). BIM has changed how we can work with the architectural design team, other consulting engineers and specialty consultants. We can effectively see how our design works within the space before it’s built, saving time and money during the construction process. Another benefit to 3D technology use within our industry is the ability to use virtual reality so an owner can see their project before it’s built. In the past, owners would try to imagine how a project would aesthetically look, feel and function based on the 2D design drawings. Now, they can “walk through” a project before it’s built and make design decisions based on what they are seeing in real time versus getting through construction and wishing they had made different decisions. From an engineering perspective, the locations of wall switches, lights, sinks, medical gas outlets or light levels are now easily seen and understood. This is useful for medical staff involved in the design process–they can see how they could work within the space and suggest changes to help improve their ability to provide better care.

Not all mechanical and electrical systems are as obvious as lighting, domestic water, and room temperature, but they are the backbone within a health care facility that make the building function. Systems like central utility plant–heating, air conditioning, steam, and power–along with terminal devices like air handling units for creature comfort and filtration for infection control. These unseen systems play a signification role for the life of the building and need to be discussed early during the design process. They don’t have the awe factor like other building components such as a grand lobby or granite counters, but they provide a safe, healthy, and functional environment for all. To provide the best solution, bringing in an MEP engineer in at the beginning of the process allows time for the MEP systems to be appropriately incorporated into the building. The required footprint of the MEP systems takes valuable real estate within the facility and the sooner this is accounted for the better it is hidden within the building and allows the beauty of the building shine through.

Benefits of Engineering in Health Care – Inside and Out of Your Building

Engineers contribute to many benefits within the facility for your patients and staff. We contribute to a healthy and safe working environment, as well as clean and healing spaces for your patients. We can be resources for your facilities teams to keep your building functioning at its best. But we also look beyond the ways we can provide benefit inside the building.

As good stewards of the earth, the MEP industry is working towards more energy efficiency solutions when designing buildings–including health care facilities. The term Net Zero is a buzzword right now but is often misunderstood. Net Zero means providing renewable energy solutions along with onsite energy generation to offset what the facility is consuming. Net Zero does not mean having zero energy consumption or being off the grid.

The first step in working toward Net Zero is reducing the building energy consumption to limit the cost of renewable and onsite generation. Many health care facilities have energy/water conservation goals outlined in their long term Environmental, Social, and Governance (ESG) plan, which sets conservation goals of the health care provider. Health care facilities have one of the highest Energy Usage Indexes (EUI) of commercial spaces. The high EUI is due to 24/7 operation and high concentration of outside air and power consuming devices, but there is still an opportunity for energy saving design solutions.

Systems that provide the greatest energy reduction include optimizing the chilled water plant used for air conditioning, using airside energy recovery, fine-tuning the HVAC control sequencing, implementing daylight harvesting and collecting rainwater for irrigation. But energy conservation does not sit solely on the shoulders of the MEP engineers. For example, the orientation of the building on the site in relation to the sun, the number and locations of windows and wall and roof insulation values all go into quantity of energy the building uses.

In Conclusion

Finally, the MEP systems are a critical element in the operations of a health care facility. These unseen systems play a significant role for the life of the building and need to be considered at the very beginning of and throughout the design process. It is important to discuss and set energy conservation goals as early as possible so the entire design team can find effective solutions.

Brent Wavra, PE, is a Mechanical Engineer and Director of Business Development for Obernel Engineering.