"More important than changing the skyline"

A Builders Who Care interview with Peter Mulcahey, VP and Director of Healthcare and Life Sciences at JRM, New York City.

Part 1: What it takes to build in healthcare

"Builders who Care" is a series of interviews with construction leaders driving innovation in their field. These builders are committed to their craft and to positively impacting the communities they serve. From implementing sustainable building practices to deploying cutting-edge technology, these individuals are leading the charge in creating a brighter future for the construction industry.


This is a two-part interview. In the first part, Peter talks about how to succeed as a builder in healthcare construction. Part 2 (to be published around 21 June) is focused on the state of the sector, where it's going, and how innovative construction technology can help builders face current and future challenges.  

Disperse: Peter, please tell us a little about yourself and how you started. What inspired you about healthcare construction? And what keeps you going to this day?

Peter: Sure. I started working on projects as a kid to earn additional money. It was mostly sweeping floors and moving materials back then. But I also learned some carpentry and landscaping. By the time I was 19, I had been working on projects for about five years and had gotten familiar with all the disciplines on-site.

Through a high school senior project, I got to intern on a new construction site: a 450,000sf medical research facility at Yale New Haven University. It was, and still is, the biggest building Yale ever built: a 450.000 square-foot medical research facility. During my internship, I worked by day and went to school at night and on the weekend. It wasn’t a conventional path, but I wouldn’t have wanted it any other way.

Something important to do 

I was intrigued by all the different types of spaces and systems we were building. Up to that point, I enjoyed the technical challenge of it. Inspiration came when the university president gave his ribbon-cutting speech at the opening of the building. He talked about the importance of healthcare research and how this facility would serve to help educate some of the world's best doctors and surgeons. 

That was when I realized there was something important to do and decided to dedicate my  career to healthcare construction. While it's fun to build giant skyscrapers and change the skyline, I feel there is tremendous value in creating places where people come to heal, start families and go through important life moments together. 

I have since spent 23 years focused on healthcare and life sciences construction, ranging from brand new replacement hospitals and new research facilities to some of the most complex phased renovation projects where hospitals can't be shut down because of ongoing patient treatment.

Disperse: How are those particular projects challenging?

Peter: Construction, by nature, is dirty and noisy. It's intrusive. And to work in an environment where people are trying to heal, where some of the sickest people and their families are, it's a precarious and delicate job. We're always in close contact with the patients and their families to minimize disruption. 

There is a staggering amount of planning that goes into these projects. The preciseness with which we need to execute is crucial because the consequences can literally be life or death. In many ways, I also find these types of projects to be the most rewarding.

New York Presbyterian Hospital

As an example, we did an extensive eight-year program at the New York-Presbyterian hospital, the children's hospital of New York. We did infrastructure upgrades and some electrical upgrades. We installed new air handling units and set up new air distribution throughout the building. 

Switching out a piece of equipment in a building usually is not a big deal when no one uses the space. But especially in New York, everything is packed tight, and there is often no room to move departments inside a hospital. 

Air distribution is vital. It allows for clean air in each patient space, and it keeps diseases from spreading. Changing those units out is a high-consequence job. A lot of temporary work must be done to ensure we don't interrupt airflow throughout the hospital.

Neonatal care intensive unit

The most impactful programs were those in the neonatal intensive care unit. That's where the premature babies are that have a battle in front of them to survive the next couple of months. They are the most compromised patients in the hospital. 

We planned a phased renovation that also needed to allow for other programs to take place. You see, in spaces like that, because of the ongoing patient care, there is a lot of maintenance that needs to happen but gets deferred. You can't just go in there and replace the lights, upgrade the ceiling tiles and paint the walls. 

So the main project becomes an opportunity to allow those deferred maintenance programs to take place as well. We worked closely with the hospital to ensure everyone was aligned and the workers could get in there and do the upgrades. It took a tremendous amount of planning. 

Execution needs to be on another level, of course. We were working in a room with just a temporary construction partition immediately adjacent to where the sickest babies and their families were.

We were in constant communication with the caregivers who could tell us at any moment, "Today is not a good day to be in there, doing what you do because we've got a family and caregivers dealing with a hard case today."

It adds a whole other element to what we need to do.

Keeping construction contained


I like to go above and beyond to keep our construction separated and contained. And a lot of training goes into helping our staff understand that the construction schedule is not the most important thing.

The patients always come first, and if we need to stop construction because it's too disruptive, then that's a far better consequence than affecting the patient experience around us. 

Disperse: That seems almost opposite to prevailing attitudes in construction.

Peter: It is. You joke about it. But many builders are trying to get into construction, and they 'send in the cowboys' to get it done. They don't take the time to understand the environment or the consequences. That's when bad things happen in our business. 

Healthcare requires a certain kind of builder, and not everybody's the right mentality for this type of construction. Many construction people just want to go-go-go and don't have the patience to deal with the communication, coordination, planning and care that comes with this type of construction.   

Investing in builders who care

Disperse: How do you recognize if somebody's made of the right stuff, and how do you train them?

Peter: We walk through the same corridors the patients, doctors and nurses use. The kind of care tradesmen exhibit as they travel from place to place is really a telltale sign. We make sure they act as if their own children or spouse are being treated there. 

It takes quite a long time before workers really own that; before they understand the gravity of what they are doing and can walk without supervision.

That's where it starts. We also look at how carefully they set up separation between their job and the hospital's activities. Then it becomes evident if they take the appropriate steps and measures.

But we don't just throw people in at the deep end and let them figure it out for themselves. A lot of our training is done by seasoned Supers and Project Managers that shadow those new hires. They work next to them until confident they can do things with 100% efficiency and accuracy. Only then will we allow them to lead the project themselves.  

The last component is formal education, learning about the healthcare environment and how to build in accordance with protocols and best practices. The American Association for Healthcare Engineering has a few programs that teach those skills. I regularly hire new staff, and we prioritize that they undergo that training as soon as possible. 

The courses are taught by clinicians that do a phenomenal job of helping people  understand what's going on from the hospital's perspective and how to provide a clean and safe environment for the patients. 

Altogether you are talking about a sizable investment in bringing up the best healthcare builders we possibly can.  

Disperse: What sets healthcare and regular construction apart?

Peter: Building for healthcare is slow and strategic, more like chess than checkers. And it takes a lot of planning to get the right results. It does not happen nearly as fast as other construction types.

Healthcare construction people want to plan everything all the way to the end and derive satisfaction from executing precisely as planned. 

An abundance of caution and communication

It's about thoughtfulness, patience but also communication. On an average healthcare project, not even a large one, we might deal with 30 or 40 people from the hospital. 

We are not just interfacing with the health system's construction department but also with environmental services that maintain the spaces and keep everything clean. We have to work with the infectious control department to ensure that people don't contaminate  sensitive hospital areas. Then there are other safety concerns like fire risk. And we must consult with all those responsible before we consider mobilizing for a project .

Interacting with so many people, managing the information flow, and communicating effectively, so that everybody knows what is going on, takes significant effort. At every point in time, we have run through all possible scenarios to ensure we've covered all the risks associated with what we are about to do. Then we have to make sure that on the day the activity takes place, everybody knows their role and what is expected of them to make it efficient.

Disperse: Last question for this part of this interview: do you have any sage advice for new college graduates entering healthcare construction?

Peter: There is something precious about spending time in the field, and seeing how things come together, how everything interacts. 

Many new graduates are tethered to a computer and doing the process and paperwork part of the job. But getting out in the field, seeing the grieving families, understanding the impact of our actions. That helps you connect. And I think it's the only way to keep the passion level high, keep people engaged and make the results as predictable as possible.

Disperse: Thanks for this masterclass in healthcare construction, Peter. We look forward to part two, where we will focus more on construction technology and healthcare construction's current and future state.

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