Structure Tone has been aiming at such smaller and medium-sized projects with success in Connecticut, says Guillorn, but the larger plan is to develop relationships with clients that should have the big jobs when the downturn ends.

Firms also have to read the tea leaves on the healthcare reform act, which among many provisions aims to extend health coverage to tens of millions of uninsured Americans, as well as encourage more preventative care as a way to curb healthcare costs. “That means that more chronic conditions could be better managed in a general practitioner’s office,” Van Horn says.

The practical impact of that shift might be more demand for medical office buildings – known as “MOBs” in industry parlance – and community clinics, some of which could be sponsored through new partnerships with hospitals, she adds.

The changes may also spur demand for expanded emergency room facilities, because millions of newly insured people will now be able to seek care when they need it, Guillorn says. “Will they go to the emergency room?” he asks. “We don’t know, but in today’s facilities, there just is not enough space to handle another 40 million patients.”

He says ambulatory care, imaging facilities, and surgery centers also could be in more demand.

The need for upgraded infrastructure also will probably continue, particularly at older facilities or those with outdated information technology and security systems, Caretsky says. There is a big focus on data centers because of new requirements for healthcare facilities to have robust storage and transmission systems for medical records, imaging, billing, insurance, and financial data, he adds. “That could create a lot of work for our subcontractor friends,” Caretsky says.

Local and state guidelines are also pushing healthcare owners to upgrade building systems for energy efficiency, says Michael Glatt, managing principal at Macro Consultants.

A longer-range design idea making the rounds now, meanwhile, calls for facilities to have flexible space – a priority in an era of rapidly evolving medical technology. That’s part of the planned NYU projects, with even patient rooms primed for standardized but adaptable formats to switch between acute care, intensive care, or “step-down” uses.

The game plan for firms getting ready for this new environment is to recruit top healthcare construction talent now and prepare their expertise for the design trends of the future upfront, Caretsky says. “We want to position our firm to move ahead, not be reactive,” he says. “We don’t want to just tread water and see what happens.”