How CommonSpirit Health is optimising its estate to help deliver best-in-class healthcare

Travis Messina is Senior Vice-President, National Real Estate Services, at CommonSpirit Health. Travis leads a dynamic team that is developing and operating an optimised healthcare real estate portfolio across the United States. We spoke to Travis to understand more about what strategies his team are implementing to effectively deliver the portfolio.

Q. How does CommonSpirit Health’s work fit within the healthcare sector in the United States?

A. Access to healthcare in the US is extremely varied, depending on factors including geography, state legislation and employment. With an ageing population, access to consistent care is becoming increasingly critical not just to the wellbeing of individuals but also to the strength of local communities and the wider economy.

CommonSpirit Health is a not-for-profit health provider in the US with 174 hospitals in 24 states – one in five US citizens has access to our services. Encompassing more than 100M square feet, our portfolio spans the full spectrum of the integrated delivery network from small, rural clinics to large 500-bed urban hospitals, as well as state-of-the-art, academic medical centres where we’re developing new clinical innovations and global standards for the industry.

For us, the importance of sharing best practice goes beyond clinical innovations too. It’s vital that companies do not become short-sighted in their outlook and allow for opportunities to enhance and improve ways of working, learning from other organisations, global markets and industries. Doing so has been transformative for us and can be for the healthcare industry as a whole.

Q. What are the major challenges for the programme?

A. One of the most significant challenges is managing stakeholder engagement. All of our stakeholders have a deep understanding of healthcare, but from different angles – part of my team’s role is to bring them together and demonstrate exactly how investment in our assets and portfolio can impact and support their clinical or financial goals.

To help us do this, we’ve been working to enhance our digital capabilities and integrate a capital programme management platform to allow us to collect and analyse data across all of our assets and projects more effectively. This type of transformational change isn’t easy, particularly given the scale of our portfolio and the amount of data there is to gather and assess.

Ultimately it will enable us to drive earlier and better decision-making around the strategy, planning and development of our portfolio. It will also allow us to educate our stakeholders alongside us, as we provide them with the evidence and business case behind everything we do to get buy-in across the board.

The pace of change is another challenge. Healthcare is constantly evolving and, particularly with a footprint of our scale, it can be extremely difficult to keep delivering the care we want to provide with, often, ageing or outdated assets. As a healthcare provider at scale, we have to constantly balance the delivery of transformative care to build healthier communities with cost efficiency in mind.

This has been made all the more difficult in recent years as we’ve faced resource and capacity shortages alongside high levels of inflation.

Q. How do you strike the balance between cost pressures and CommonSpirit’s mission of delivering the care that communities need?

A. As well as focusing on data to make the most effective decisions, strategies like a programme approach that enables consistent, standardised modules are so essential in this context – enabling solutions to make our budgets go further.

Modular is the future for our industry, but the market hasn’t quite grasped its potential. Generally, there is a lack of consistent demand. Unlike areas such as residential and hospitality, programmes in our sector simply aren’t happening at the scale required for modern methods of construction (MMC) manufacturers to consider healthcare a significant enough business opportunity.

Equally, issues exist around where capacity lies geographically as populations shift. With more people – and therefore development – moving to the Sun Belt in the southern half of the US, MMC contractors are following, creating contractions in the former industrial states like Ohio and Michigan. High-quality healthcare facilities are still very much needed in these lower-population-growth areas but the local supply chains to deliver are limited.

MMC can be a vital solution to the industry as we look to get the most out of our estates and our budgets. As a sector, we need to work together to provide a consistent pipeline of demand and scale to encourage MMC manufacturers to work with us going forward.

If we can do this, modular construction will also help us to mitigate the growing problem in construction of our ageing workforce, while maintaining consistent, high-quality buildings.

Q. To what extent is adaptability being factored into the portfolio to mitigate future costs?

A. In the past, adaptability revolved around obtaining more space with the idea that this, in turn, increases the future possibilities of a building. However, the exponential growth in construction costs in recent years means that simply buying more land is not always viable or efficient.

Instead, future-proofing assets will rely on more strategic decisions. For example, consistent design across patient rooms, whether these are then built in a modular or more traditional way, allows the scaling up or down of certain facilities to respond to changing clinical requirements, reducing the need for major overhauls further down the line.

Q. In what way do environmental and social value considerations factor into the programme?

A. We have committed to reach net-zero carbon emissions by 2040 – an ambitious, but crucial target, that requires us to look carefully at how our assets impact the environment, in terms of both embodied and operational carbon. This comes back, in part, to data.

Across the programme, we examine various metrics to enable full analysis of the operational performance of our sites and where efficiencies can be improved. For example, we’ve been investing in replacing equipment like high pressure steam boilers which reduces our use of natural gas and lowers our FTE counts, this reduces our reliance on fossil fuels in Scope 1 and 3.

We’re also incorporating remote asset management to reduce our scope 3 emissions – by managing aspects like lighting, heating and cooling remotely, we’re minimising the need for our people to drive to and from sites to manage the operations, this enables more efficient system usage and reduces commute time for staff and vendors.

When it comes to social value, the nature of our organisation and business model means that we’re always thinking about our impact on society and how we can drive positive change. We’re strong believers in prevention being better than cure and helping to build healthier communities who need our services less frequently. In many cases, we are the largest employer in the communities where we operate – this employment base is helping people buy homes and feed their families.

As a non-profit organisation, every dollar we make is reinvested back into our platform and programmes in our communities. This drives local economic growth and helps minimise wider societal issues, such as homelessness and poor nutrition.