How nature is influencing healthcare design and construction

As Earth’s temperatures continue to rise, more frequent and extreme weather events are impacting coastal and disaster-prone communities. Additionally, more scrutiny to meet higher seismic standards is influencing hospital building codes. Healthcare facilities must stay online and provide vital care to their affected patient populations when disasters strike, and the impacts of climate change are influencing how we build hospitals. Here are a few ways Skanska is helping our customers and design partners shape more resilient healthcare buildings.

On the West Coast, facing earthquakes, wildfires and more


One of our healthcare projects in San Francisco, California.

In California, we worked with a prominent healthcare provider to add redundancy in critical building systems even when not required by local building codes. This meant adding emergency backup generators for their medical office building (MOB) projects. Typically, this type of investment occurs at inpatient facilities or outpatient facilities with a surgical component. Having emergency backup generators for the client’s MOBs meant that they could continue being a resource to the community during a natural disaster.


Our Samaritan North Lincoln Replacement Hospital project in Lincoln City, Oregon.

Operating under a design-build contract, our team took seismic resiliency to the next level on the Samaritan North Lincoln Replacement Hospital in Oregon. In preparation for a potential Cascadia Subduction Zone earthquake, the new facility was built to withstand a 9.0 magnitude earthquake. Supported by deep steel piles and an innovative dual-fuel system, the building can remain operational following a disaster and is quoted by The Lund Report as setting a new earthquake readiness standard for the state.

Currently, Skanska is working with the design team and Columbia Memorial Hospital to provide preconstruction services for a new 182,500 square-foot expansion and renovation in Astoria, Oregon. Once complete, the hospital expansion will be designed and constructed to remain resilient in the face of tsunamis, landslides, wildfire smoke, earthquakes, high wind and other future climate change events. 


Our Columbia Memorial Hospital project in Astoria, Oregon.

In areas that are prone to wildfires, we are helping our clients implement higher indoor air quality measures. The pandemic taught us that we need 100 percent outside air to reduce infection, but that doesn’t work in areas with poor outside air quality. Customers in wildfire areas can overcompensate indoor air quality by installing additional HEPA filters.

Additionally, it’s important to invest more in water filtration systems and onsite water containment in areas that are prone to drought. Some water municipalities are forced to switch sources when water supply runs low. For example, they may switch from a nearby reservoir to one farther away or from deep wells to more shallow ones. This shift can cause water quality to vary greatly depending on the source and can require more complex filtration for certain operations and processes like equipment sterilization.

We encourage onsite water containment for toilet flushing, etc. as the alternate water sources might also be greatly impacted by a severe drought. Additionally, onsite water containment benefits the construction phase in drought-prone areas as there is a greater fire risk and more dust control measures and perimeter moisture necessary to protect the site. 

On the East Coast, facing snow, hurricanes and other weather events

When renovating older hospital buildings in winter weather prone areas such as the Northeast, it’s important we work with our design partners to help our customers make appropriate roof membrane upgrades to accommodate the heavier snow loads we have experienced over the last several years. This is critical to prevent leaks and maintain proper infection control protocols for patient care areas.  

Skanska constructed an innovative flood mitigation solution for an academic medical center client in New York. In 2012, the city and a local emergency department sustained significant flood damage from Superstorm Sandy. To accept the innovative technology, which is one of only a few in the United States, our team installed a new structural areaway by excavating two floors below grade and opening the foundation wall.

Simultaneously to the structural modifications for this state-of-the-art medical equipment, the team took lessons learned from Superstorm Sandy and built a flood gate system that benefited the project because it didn’t require moving the utility room higher in the building.  


Our Lee Health Gulf Coast Medical Center project in Fort Myers, Florida. 

In Florida, Lee Health Gulf Coast Medical Center took a direct hit from Hurricane Ian in September 2022. The hurricane was the fifth strongest on record in the state of Florida and caused tremendous devastation to the Fort Myers community.

Skanska built the original hospital in 2009 and completed a major renovation and expansion for the hospital in late 2021. When Hurricane Ian made landfall, Fort Myers experienced 150mph winds and a 10-15ft storm surge. In addition to the storm prep in the days leading up to landfall, proactive planning during construction activities a year earlier paid off in keeping the hospital and emergency department operating. For example, the team had the foresight to repair and update the existing roof, exterior caulking and expansion joints during the recent expansion and renovation project.  

With extreme weather becoming more frequent, and most recently Hurricane Ian devastating the Florida coastline, the state of Florida is updating its building codes to address higher flood elevations and wind speeds. We anticipate seeing more areas near coastlines make similar changes to their building codes.

For construction, it’s important to understand how changing building codes can impact material testing requirements on future expansion and renovation projects. When Skanska built the original Lee Health Gulf Coast Medical Center project in 2009, it was designed to accommodate a future vertical expansion. However, when the expansion occurred, the building codes had been updated to include stricter wind load requirements. This meant that our team would have had to install additional micro piles to enhance the building structure.

HKS took the lead in having a complete model and wind tunnel test performed to measure actual wind loads on the building. The wind tunnel test identified the highest areas of concern for wind loading of the roof and exterior cladding systems. The results of using wind tunnel tests enabled structural engineers to complete the design without the requirement of micro piles that could disrupt hospital operations.

As codes change, manufacturers must retest building materials to comply with new codes and receive state approval. This can be a lengthy process, so we recommend working with designers, manufacturers and trade partners early to review anticipated testing needs during constructability discussions.   

Want to learn more about Skanska’s healthcare construction experience? Click here.