July 31, 2025
On the rise: Meeting the unique challenges of high-rise healthcare construction in Seattle
By TODD PARKE
PCS Structural Solutions
Parke
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The increased demand for responsive and quality healthcare facilities combined with Seattle’s constrained geography gives rise to more high-rise construction to serve a growing population.
Providence/Swedish’s $1.3B North Tower is currently under construction. At 213-feet above grade with more than 40-feet of subterranean levels, it will be Seattle’s first high-rise medical facility in nearly two decades when it opens in late 2027. Harborview Medical Center’s new inpatient tower, part of a $1.7B bond funded expansion, aims to be the next. This is an exciting time for the healthcare design and construction communities as these expansions change the shape of the Seattle skyline.
WHAT MAKES HIGH-RISES UNIQUE AND CHALLENGING?
Planning, designing, and constructing high-rise buildings require large, complex project teams to address a variety of factors while achieving return on investment for Seattle’s valuable urban real estate.
Site constraints: Because high-rises are designed to maximize space where little exists, teams often work in cramped conditions to execute major site work, such as demolishing existing buildings; executing mass subterranean excavations for parking and/or utilities; installing complex shoring at property edges and adjacent buildings; and working around large underground civil utilities, utility tunnels, and tunnels. Work also requires massive tower cranes to support building erection, the installation of which requires its own complex process.
Building sub-groups and tasks: Different micro-teams may be assigned to tackle specific aspects of the project, such as cladding and envelope; foundations; interiors; and/or sustainability measures to make work more manageable. While this enables focused work, it also requires collaboration to coordinate multiple large drawing sets, conduct peer reviews, and obtain multiple permits for each aspect of the building and its critical systems.
Structural design requirements: A lot rides on the structural integrity of any building, and it’s even more critical in the high-rise environment as conditions within the earth, such as multiple soil strata and elevations, and in the air, such as wind, dramatically affect design decisions. Structural teams must deeply understand the unique environment to plan for and design effective and resilient foundations, lateral systems, and cladding systems that use the right materials.
For example, a high-rise building foundation typically requires deep piles or mats. Materials such as steel, rebar and concrete must be highest strength and non-combustible to meet fire and building code requirements.
Designers must effectively combine different lateral system options, such as core wall, moment frames, and braced frames, to meet different conditions and building uses. Cladding systems may require scaled testing and modeling to ensure they stand up to wind conditions hundreds of feet above grade.
ADDITIONAL COMPLEXITIES FOR HIGH-RISE HEALTHCARE
Healthcare facilities of any kind are already among the most challenging design and construction projects in the industry for several reasons:
Many healthcare facilities operate 24/7 with dozens if not hundreds of different departments. The larger the building, the more departments, each having their own specialized operational and programming requirements. Providence/Swedish’s North Tower will include 24 advanced operating suites, a new emergency department, a 72-bed acuity-adaptable intensive care unit (ICU), and new centralized imaging facilities, along with underground parking, retail and green spaces, and shell space on several floors to accommodate future expansion.
At all levels, the project team is working closely with department leads to understand their unique requirements, both for current operations and future workflows that incorporate rapidly evolving medical practices and technology. Structurally, this variety of uses makes vertical coordination challenging as columns, walls, and braces must meet integrity requirements while minimizing impacts to program spaces and subterranean parking. The taller the building, the more challenging this gets.
Healthcare buildings often exist within campus environments. This requires interconnections that promote ease of way finding and maximized program efficiencies and patient safety. Such interconnectivity can’t only exist at ground level, making skybridges and tunnels a key component in mid-rise and high-rise healthcare facilities.
The North Tower will connect to an existing tunnel and skybridge. The skybridge was extended and floor slope added to align with the first floor, integrating it into the campus circulation. The building will also include a new connector tunnel for material transport.
The campus environment also requires teams to be cognizant of impacts on ongoing operations and adjacent buildings. This includes backfilling programs before, during, and after construction, and construction methods and schedules that minimize noise, vibration and overall disruption. Vibration control is especially important in sensitive areas like the OR and ICU, but nearly all high-rise hospital programs require floor vibrational design exceeding that of a typical high-rise office or residential building.
Healthcare facilities require intensive mechanical, electrical, plumbing, IT, and other specialized infrastructure and systems. Floor-to-floor heights are typically 14-feet to 20-feet to accommodate routing and distribution for many systems. On the North Tower, these increased floor-to-floor heights imposed greater demands on the special moment frames as they must accommodate larger lateral displacements and satisfy code drift requirements.
Hospitals must remain operational with minimal damage and downtime after major earthquakes and natural disasters. High-rise hospital teams must understand and meet elevated design standards beyond a typical high-rise building to support resilience in the wake of disaster. This was accomplished for the Providence/Swedish North Tower project with the application of Performance-Based Design, enabling the structural design to withstand and recover from extreme seismic events through targeted performance-driven structural strategies.
THE VALUE OF THE RIGHT TEAM
At nearly one million gross square feet, including about 250K square feet of make-ready renovations and tenant improvements, Providence/Swedish’s North Tower is a major undertaking made that much more complex by being a high-rise in the congested First Hill neighborhood. When it opens, it will join a host of other high-rise hospitals in the United States: Jefferson Health’s Honickman Center in Philadelphia is 19-stories; Tower A and the M&D Tower at Memorial Sloan Kettering Cancer Center in NYC are 24- and 25-stories respectively; and the Herman Tower at Memorial City Medical Center in Houston is 33-stories.
Uniquely, however, Swedish North Tower will be the tallest all side-plate moment frame hospital tower in the United States.
Because tackling a high-rise healthcare project is high risk, teams must bring both specialized expertise and the ability to work in close collaboration to be creative while minimizing risk, ensuring safety during construction, and maximizing the building’s long-term performance.
“The North Tower project team exemplifies true teamwork, determination and innovative problem-solving. They have remained steadfast in their commitment to putting patients and caregivers first,” said Rachel Jenner, Providence/Swedish’s executive director of planning & design. “Despite tremendous external challenges over the past decade, we now watch with pride as this transformational building rises out of the ground.”
Keys to success include clear communication lines across the team to minimize redundant meetings and improve collaboration, extensive onsite review and validation of existing drawings, efficient coordination methods that included intensive 3D modeling, early user engagement and detailed integration to vertically cross-coordinate different programs, and patience to sustain a project of this magnitude over years or even decades.
A team that can flourish during the highs and persist and build trust during the lows will be able to rise to the occasion of successfully delivering high-rise healthcare construction. The health of our community depends on it.
Todd Parke is president of PCS Structural Solutions, and has spent his career leading cutting-edge structural design for major healthcare systems.
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