High-Rise Hospitals: Elevating Healthcare Delivery in Urban Settings

By Douglas King and Nicole Welch

As the COVID-19 pandemic subsides, cities are reawakening and returning to the bustling vibrancy of the pre-coronavirus era. In the field of healthcare construction, the “vertical hospital” trend continues to gain momentum around the globe.

The high-rise hospital offers attractive advantages over “horizontal” architecture—particularly in urban areas where acquiring additional land for expansion purposes can be cost prohibitive.  But the benefits aren’t limited to healthcare systems.

For those working within the hospital—particularly physicians and other staff whose roles include both clinical and research functions frequently found in academic medical centers—traveling between separate campuses can be inconvenient and unproductive. Hospitals are gravitating toward co-locating research, education and clinical space in a single building, and a vertical design facilitates connecting these units in a stack that removes barriers between each task.

Vertical construction can better serve the community as well, bringing much needed retail and services to neighborhoods and driving more people into the hospital environment, especially when they’re not sick. Even patients can benefit from some of the advantages of building tall, which centers patient care by bringing more services to diverse populations in a vertical environment. From every stakeholder perspective, the future of the vertical hospital is looking up.

Design That Serves a Plurality of Stakeholders—From The Ground Up

In a vertical hospital, the ground floor is one of the most crucial spaces. Hospitals located in an urban environment must serve not only the patients, doctors and staff within its own walls, but also the surrounding community. Greater porosity of the hospital boundary can benefit all of these populations.

Ground floor offerings like pharmacies and other retail, restaurants, conference centers, and even parks or outdoor spaces connected to the health facility can bridge the gap between populations, as well as establish the hospital as a more welcoming destination. A hospital doesn’t just have to be a place associated with illness and trauma—it can also put itself forth as a center for health, wellness and community growth. A vertical hospital that comprises a variety of spaces can be a place where community members grab a quick lunch, attend an educational event, shop at a weekend farmer’s market, or visit their doctor for a checkup or outpatient procedure.

These draws can be critical to the people within the hospital as well. Healthcare employees perform demanding jobs within the hospital and are pressed for time during the workday. Ground-floors offering quick access to a nourishing meal on their break, or a place to step away from their unit and regroup in a sunny outdoor plaza, can significantly improve morale, performance and even patient outcomes. This is particularly true for staff members who have emotionally intense or otherwise draining responsibilities. Finally, patients and visitors can also benefit from the respite of outdoor space—in fact, research shows the more outdoor space a longer-term patient has access to, the shorter their stay in the hospital.

Construction Innovations Enhance Safety, Efficiency

Building a vertical hospital presents unique challenges in multiple areas, including where to situate mechanical, electrical and plumbing (MEP) and fire protection (FP) systems, as well as how to transport people and equipment efficiently. Fortunately, new advancements on the construction side are making high-rise hospitals more efficient and safer.

Firstly, improvements in vertical transportation systems are making stacked facilities more accessible. As a rule of thumb, high-rise hospitals typically need one elevator for every floor served. However, elevator controls systems are leveraging Internet of Things (IoT) technology to allow the individual elevator cars to communicate with one another, creating efficient responses. Destination dispatch technology helps keep elevator traffic running smoothly and efficiently to and from high floors. Rather than stepping into the first open elevator car and pressing the button for their desired floor, the passenger enters the floor number on a keypad or touchscreen in the elevator bank, which then directs them to a specific elevator, grouping travelers by their destination, rather than when they arrived at the elevator bank.

Also in the area of vertical transport, automated guided vehicle (AGV) technology enables hospitals to transport supplies and equipment via elevator without requiring a person to be onboard. Combined with mobile robots, AGVs can save time and alleviate some of the problems currently associated with chute-based systems for linen and garbage removal.

On the exterior side, new advances are proliferating to combat the challenge of “stack effect.” When warm air rises and escapes the top of a tall building, humidity accumulating on the facade can cause freezing and damage, particularly in precast buildings. Humidity trapped behind the facade can lead to mold, which presents a serious problem in hospital environments with high standards for cleanliness and air quality. Updated approaches to control design and techniques such as predictive balancing can anticipate seasonal stack effects and automatically adjust settings accordingly.

Furthermore, the highly controlled movement of air in a vertical hospital can help mitigate spread in a viral outbreak, and the pressurized smaller footprint of a high-rise facility allows air circulation to be isolated by floor. With an airborne pandemic not fully behind us, these considerations will play a key role in healthcare development decisions moving forward.

High-Rise Hospitals Cultivate Community

For hospitals in urban areas, the best way to build a thriving facility that attracts the best and brightest minds is by contributing to a community where people want to live and work. A vertical hospital that co-locates education, research and clinical settings makes all these resources more accessible, and with engaging ground-floor offerings, helps bridge the divide between the hospital ecosystem and surrounding community. Finally, thanks to advances in construction technology, high-rise hospitals are becoming ever more safe and efficient.

In this rapidly evolving industry, the “stacked” approach to hospital design and construction offers the flexibility, security and efficiency to usher in the future of healthcare delivery.

Douglas King is Vice President, Healthcare Sector for Project Management Advisors Inc., a national real estate consulting firm providing services as the owner’s representative. He delivers more than 40 years of international experience in complex, large-scale healthcare projects as a designer, educator and researcher. Nicole Welch is a senior project manager with Project Management Advisors, Inc., supporting international projects across industries.