Acute Care Report: Healthcare evolves to meet the times – October 2024

By Ruth Simon McRae

Healthcare, a large and growing segment of the total floorcovering market, can be split into two primary categories-acute care and senior living. And acute care is itself divided into multiple segments-in addition to hospitals, there are five primary building types, including medical office buildings, specialty care centers, offsite clinics, free-standing emergency departments and micro-hospitals. Gwen Sandlin, Mohawk Group’s senior director of healthcare, defines micro-hospitals as “much smaller hospitals, usually with about 60 beds,” and their growth has been driven by the loss of rural hospitals in the aftermath of the pandemic.

Beyond these acute care segments are emerging creative venue sites for healthcare within existing retail, like the move of some medical offices to vacant retail spaces and CVS-Aetna’s plans to expand its retail clinic services.

Grand View Research anticipates that the U.S. acute care market, worth almost $1.6 trillion in 2022, will grow to $2.5 trillion by 2030, and the entire physical footprint supporting that growth will require flooring. As acute care continues to expand and evolve, flooring manufacturers must develop product solutions that both meet current needs and anticipate future ones.

THE RIGHT PRODUCT FOR THE RIGHT SPACE
Each flooring manufacturer addresses the needs of acute care in its own way, based on its toolkit of products. And manufacturers have deliberately expanded their portfolios to leave very few opportunities in the healthcare building space unaddressed.

Resilient sheet flooring, with welded seams and integrated cove base, is among the most bulletproof of the flooring materials offered into the healthcare market. It is ideal for spaces that need extreme infection control and durability, such as operating rooms, imaging spaces and ICUs, as well as areas adjacent to these departments. Resilient sheet vinyl is offered in homogenous and heterogenous constructions, while sheet rubber is all homogeneous.

Rubber has many unique, positive qualities. It has the sustainable attribute of being non-PVC, offers extreme comfort underfoot and has a never-wax surface. Homogenous vinyl is ideal for these applications, as well, and is also no-wax. Neither material harbors bacteria, even when accidentally cut by a dropped implement. Homogenous vinyl sheet is available in wider widths than rubber, needs fewer welded seams for the same floor space, and rubber is a bit more expensive.

Vinyl and rubber products are available in tile as well as sheet, offering many color and design options. Because heterogenous vinyl is made with a digitally printed film, it creates an opportunity for many patterns, material visuals and rich colorations.

LVT is experiencing a boom due to its tremendous pattern versatility across the flooring market with a huge amount of projected growth in the healthcare market sector. LVT is increasingly used in places where carpet would have gone in the past and is also often used in corridors and rooms in non-sterile areas.

Carpet use is decreasing in hospitals and clinical environments, although soft surface flooring does still have application in some waiting, administration and respite areas. In lobby and public space areas, Paul McKinney, Gerflor USA’s national sales director healthcare segment, is seeing carpet being replaced by hard surface materials such as epoxy and terrazzo.

Leslie Echols, healthcare market manager for Interface, estimates that some hospitals are still using soft surfaces in 20% of their campuses. She says, “We still do have a need for soft surface within the healthcare facility for certain space types where we need to consider noise levels for transfer information and HIPPA compliance. At the same time, we’re seeing most hospitals moving away from soft surface materials for infection control issues in clinical space types and even a large number of facilities that are almost 100% resilient.”

Some carpets offer strong performance stories, such as hybrid carpet like Powerbond from Tarkett and other dense carpet products with high-performance backings.

Non-treatment office areas still use a large amount of carpet, especially carpet tile, due to its flexibility in installation and replacement and the category’s wide design options.

Another material used throughout healthcare facilities is ceramic tile. Ceramic tile manufacturers now offer large format slabs, such as Dal-Tile’s Panoramic thin gauged porcelain. While higher in cost, these are becoming more the norm in healthcare because they have fewer grout lines and greater cleanability. Gauged porcelain is used on floors and walls in lobbies, in restrooms, and sometime on exteriors because it is freeze/thaw resistant. Dal-Tile also targets acute care with its Colorbody porcelain with Defend by Microban, an antimicrobial that is baked into the glaze.

The increasing number of elderly patients that require medical attention in hospitals will lead to additional flooring considerations. Sandra Soraci, director of segment strategy for healthcare and senior living at Tarkett, notes, “The National Institute for Health reports that over the last 16 years, patients 65 and over have had the highest rate of acute care inpatient stays. The 65+ population will double to 95 million people by 2060, which will continue to drive that need for acute care in inpatient settings. The aging population presents unique challenges, and the floor must rise to meet them in a purpose-built environment. However, by addressing cognitive issues in flooring design and selection, the floor now starts to support human-centered needs differently.”

SUBSEGMENT GROWTH AREAS
Although hospital construction and renovation seem to be maintaining at a steady pace, the post-pandemic world has created some huge additional areas of need.

Behavioral health-both inpatient and outpatient-is the largest area of growth. Health Facility Management Magazine’s Construction Survey for 2024 projects a 48% growth in behavioral health centers and psychiatric hospital projects over the three next years. Manufacturers are seeing this as well. Along with behavioral healthcare for the general population, there is now a greater emphasis on the need for supportive environments for hospital workers, also known as respite care.

Steve Hadrych, Mannington’s senior director of healthcare, notes that “behavioral health is a primary additional focus and will continue to be a prime focus for the individual healthcare delivery networks. Every major client we’re working with, and we work with 23 of the top 25 Individual Delivery Networks, has a movement to behavioral health.”

“Of the most active current sub-segments, number one would be behavioral health,” notes McKinney. “Behind that, the data shows strong growth in facilities supporting cancer treatment, children’s hospitals, rehabilitation hospitals, cardiac or heart hospitals, orthopedic hospitals and centers, and dedicated women’s care. Within the acute care hospital itself, there’s a substantial amount of construction and planning in imaging/radiology. Imaging is a big umbrella that can include MRI, CT, PET scans, things of that nature. This also includes interventional radiology (IR), which some hospitals call ‘special procedures,’ where they don’t make a full incision like surgery, but they do ‘intervene’ with a wire or port etc. Another growing trend is ‘hybrid’ spaces, where they combine surgery and imaging in areas known, for example, as Interoperative MRI rooms.”

The next largest area of growth projected over the next three years in the Hospital Construction Survey is cancer treatment centers at 29%, followed by children’s hospitals at 20% and rehabilitation facilities at 19%, followed by heart, orthopedic, women’s and neuro medicine, reports Health Facilities Management Magazine.

The federal government has healthcare areas in some places not commonly considered, such as ships and submarines. Air quality is a key issue in these spaces, and only PVC-free and halogen-free products are allowed. PJ Hughes, vice present strategic accounts for HMTX/Teknoflor, says, “Keep in mind that every naval surface ship and submarine in the fleet has a medical surgical suite within it. They have operating rooms and dental facilities. These areas typically use PVC-free homogeneous sheet, such as Teknoflor’s CS Sheet and Naturescape.”

TRENDS IN HEALTHCARE
From a design perspective, far and away the largest and longest-standing influence in acute care is biophilia. Sandlin explains, “I think most design firms center their design process around biophilic design, trying to bring as much nature inside, with materials that feel familiar to the patient and offer a warm character to a space. From an aesthetic perspective, we do see a real toned-down environment these days, with materials that are soothing. The interior needs to be light and bright, with a level of calm soothing materials that feel spa like.”

Evidence-based design also has long been a positive influence on design and specification. An early advocate and leader in this design strategy is the Center for Health Design, which has developed a library of over 600 case studies that support its principles, based on eight primary criteria for measurement. And it offers certifications to A&D, healthcare providers, product manufacturers, end users and other stakeholders.

In evidence-based design, products like flooring are more than design features-they’re investments in health and safety. Echols notes, “Part of what we look at in evidence-based design is our ability to support outcomes for the health system, and we do that through looking at performance characteristics of the floor itself. Some of the things that evidence-based design has highlighted, for example, are baseline reduction of slip, trip, falls, and making sure that we are designing materials that are going to help with reduction of noise levels and staff fatigue. These characteristics enhance that overall positive patient experience and are the best return on investment for the hospital system.”

Hadrych contributes a slightly different perspective. “Twelve years ago, if you spoke about evidence-based design, it was the new trend, a purposeful way of thinking finding its way into being incorporated into design, bringing the holistic attributes of what good care and design could deliver,” he says. “Today, it’s been adopted. And it’s in the DNA of every design firm, and it’s in the DNA of how we manufacture and look at design. It just is. I would say it’s just more intentional and subdued, but it›s understood.”

The federal government uses Key Performance Indicators (KPIs) as a basis for its product selection, which is different from the evidence-based design framework. Hughes notes, “The federal government and military have been looking at products from a KPI perspective to see whether a product will last the life expectancy of that space. Key performance indicators are an objective ways and means to evaluate similar products when creating a specification that must have ‘or equals’ on them. In all publicly funded work, proprietary specifications are not allowed, and the ‘rule of three’ applies. This method quickly analyzes and compares the ‘physical and technical performance properties’ of similar/like products to objectively determine which product performs the best for the space designed. This becomes the number one priority for government, followed by country of origin, aesthetics and cost.”

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