By: Douglas Frey, PE, LEED AP, Vice President
Increasingly, engineers and their clients are discussing electrification mandates, performance-based energy codes, and AI-enabled modeling tools.
Individually, none of these factors are new. What is new is how they are redistributing engineering effort across the full project life cycle — particularly in healthcare.
Consider a new hospital bed tower pursuing partial electrification of its central plant. In schematic design alone, the engineering team may now evaluate:
- Heat recovery chillers versus traditional chiller/boiler plants
- Electric boiler integration versus campus steam
- Emergency power implications for electrified heating loads
- Utility capacity constraints and upgrade timing
- Multiple resiliency scenarios
Five years ago, system direction was often clearer earlier. Today, early-phase design frequently requires modeling three or more viable architectures before committing. That shift is structural.
Evolving Scope Distribution
If we map engineering effort across a typical healthcare project today, compared with even five years ago, the distribution has changed:
- Early-phase modeling intensity has increased
- Construction-phase coordination remains high
- Post-construction operational involvement has expanded
Yet engineers’ fee allocation often still reflects historical assumptions — with schematic design commonly structured around 10 to15% of total fee.
In complex electrified healthcare projects, early technical cognition can now approach 25 to 30% of total engineering effort if energy modeling, infrastructure analysis, and resiliency planning are required before system selection.
That is the first compression point.
Digital tools accelerate iteration. They do not reduce decision complexity. As modeling becomes more powerful, owner expectations rise. A single baseline comparison becomes a multi-scenario analysis. Electrical infrastructure implications are pulled forward. Mechanical system decisions are evaluated in parallel with decarbonization and resilience goals.
The work shifts upstream. Often, the fee structure does not.
When responsibility expands without corresponding clarity in scope and compensation, the impact is not limited to engineering firms. It affects decision velocity during design, continuity of staffing, and ultimately the reliability of systems once the building is occupied. Misalignment at the front end often reappears later as reactive troubleshooting.
Then comes the second shift: downstream.
Expectations Are Changing
Healthcare owners increasingly expect post-construction system analytics and continuous commissioning. For critical environments, this can include:
- Verification of air change rates and pressure relationships
- Chilled water performance monitoring
- Fault detection analytics tied to BAS data
- Periodic recommissioning aligned with regulatory and accreditation requirements
From a building performance perspective, this is entirely rational. From both an operational and economic perspective, it extends engineering accountability into the occupied life of the building.
Many mid-sized MEP firms either cannot provide these services internally or provide them as extensions of traditional design scope. When operational analytics and ongoing commissioning are bundled into the original fee rather than structured as life cycle services, margin pressure shifts to the back end of the project.
The life cycle now looks different:
- Increased early-phase modeling effort
- Persistent coordination density during CDs and CA
- Extended post-occupancy engagement
All these objectives are generally supported by fee models largely built on historical effort distributions. This situation creates life cycle compression.
In short, the scenario often combines upstream effort inflation, downstream responsibility expansion, and middle-phase fee allocation stability.
Divergence among engineering firms over the next 12 to 36 months will not primarily be about who adopts AI tools fastest. It will be about which firms recalibrate governance, staffing, and pricing models to reflect this redistributed effort.
Electrification and operational analytics are not incremental scope additions. Rather, they expand the temporal boundary of engineering responsibility.
Accountability and Outcomes
Firms that separate life cycle services — design, commissioning, operational analytics — and define responsibility accordingly will create clearer accountability and more predictable performance outcomes. Conversely, firms that continue absorbing expanded responsibility into traditional fee structures may experience increasing volatility in project profitability, particularly in healthcare and other critical environments.
Going forward, it will be interesting to observe how (and whether) firms are adjusting early-phase fee allocation on electrified healthcare projects, and whether post-construction analytics are being structured as distinct life cycle services or absorbed into standard design scope. Clients should strive for clarity in discussions regarding these topics when considering retaining consulting engineering firms.
