By Douglas King
Once a novelty, the idea of the vertical hospital has gained traction over the past decade as healthcare providers looked to serve patient populations in urban centers. Given the high cost of urban land, building up rather than out is the most feasible approach in a densely populated urban center. While the COVID-19 pandemic has raised new concerns about disease spread in high-rise buildings, leading practices in vertical healthcare design can help safeguard patients and caregivers alike.
Safe and cost-efficient vertical hospitals are becoming essential for quality of life in the world’s most dynamic urban centers. While the pandemic may have motivated some consumers to leave urban environments, long-term trends suggest that cities will continue to appeal to the best and brightest in-demand talent—and the companies seeking to hire them. Young workers want their live-work-play neighborhoods to include healthcare, too.
Verticality also lends itself to the evolution of healthcare service delivery. Many services have migrated from inpatient to outpatient offices or require some combination of both settings. Hospitals and health systems have acquired physician practices or established affiliate relationships to generate referrals, creating a need for co-locating physician offices, exam rooms and inpatient facilities within a single structure, along with a hospital pharmacy, laboratories and other support services.
Also worth nothing is that a vertical urban hospital may offer ancillary revenue opportunities unavailable to the traditional sprawling suburban hospital campus. One vertical hospital in downtown Chicago has leased much of its lower public floors to retailers seeking to exploit the foot traffic on the sidewalk and inside the facility itself. Some vertical hospitals have also incorporated meeting and conference space with ready external access—another revenue generator.
The Challenges of High-Rise Hospital Development
For a successful project, vertical design requires innovation in design, construction and operations, including infrastructure prowess, creative vertical transportation solutions and robust structural engineering to support HVAC/Electrical and medical equipment that may weigh many tons. Meanwhile, healthcare providers must consider wayfinding and the flow of services, patients, caregivers and, in some instances, researchers throughout the facility.
The technical challenges are significant. Any high-rise structure is an engineering challenge, but designing for healthcare service delivery adds a layer of complexity. HVAC systems must be designed to reduce the risk of hospital-acquired infections, which means incorporating air systems moving large quantities of air though HEPA filters and creating negative air-flow capabilities in infectious disease units and surgical suites along with positive pressure rooms for other kinds of patients.
Adding to the challenge today are the financial pressures created by the pandemic. Cost, of course, has always been important in healthcare construction—and perhaps never more so than now. Smart engineering can help control costs, while optimizing the space available for the mission of healthcare.
Innovative Engineering Saves Space, Reduces Cost
In a typical high-rise building, more than 12% of space is consumed by infrastructure, including mechanical, electrical and plumbing systems (MEP) and fire protection (FP) systems. Add structural elements like stairs, elevators and exterior walls, and more than 25% of the space is filled. A leading practice is to plan these “forgotten spaces” early in the design and development process to prevent costs—and wasted space—from spiraling out of control. In a healthcare facility, the infrastructure space demands are even higher, since most require redundant HVAC, electrical and IT equipment.
A major challenge of MEP/FP planning is that the cost of building in multiple locations for equipment must be balanced against the cost of creating horizontal connections between the equipment and points of distribution. One cost-effective solution is to place cooling towers, boilers, chillers and other mechanical equipment in mid-level areas or on the roof, as long as the space is thoughtfully designed with safety enclosures and acoustical slabs to mitigate equipment sound. Technology rooms, generators, fuel oil storage, fire pumps and incoming water services also can be strategically located in the parking garage or loading dock to reduce costs and minimize visual impact.
On the other hand, one advantage of the vertical hospital is that the primary MEP/FP equipment can be located much more closely to the spaces served than it would be in a horizontal facility. If service demands grow in one area of the building, facility managers can add equipment to serve the specific area rather than having to add a much larger system to serve an entire building.
The Next Era of Vertical Hospital Design
Through thoughtful stacking of functions, vertical hospitals offer healthcare providers the opportunity to increase efficiency by integrating clinical, medical training and research functions in a single facility. Given continuing demand for multi-faceted vertical hospitals, more advances in the design, engineering and construction of these facilities will undoubtedly emerge to further solve the technical challenges. For vertical healthcare development, there’s nowhere to go but up.
Doug King is vice president, healthcare for Project Management Advisors Inc., a national real estate consulting firm. He delivers more than 40 years’ experience in complex, large-scale healthcare projects as a designer, educator and researcher.