Beyond Strength: The Critical Elements of Structural Design for Healthcare Facilities

Hospitals are among the most demanding buildings to design, expand, and renovate. The structural design of a hospital or a medical facility requires conformance to the applicable codes and accepted professional engineering practices as with any other building, but structural adequacy is only the starting point. Healthcare facilities contain sensitive diagnostic and treatment equipment, extensive mechanical and electrical infrastructure, specialized clinical spaces, and, in the case of the renovation of existing facilities, medical procedures and critical operations that need to continually be in operation during construction.

For structural engineers, that creates a different set of challenges in addition to the basic structural engineering requirements —from designing a new hospital building to determining how a new MRI, CT scanner, cardiac catheterization system, rooftop mechanical unit, or other specialized equipment can be incorporated into an existing facility.

Gilsanz Murray Steficek (GMS) has worked with healthcare owners, architects, and project teams on both new and existing facilities, providing structural engineering for new construction, renovations, expansions, equipment installations, infrastructure upgrades, and ongoing facility improvements. GMS’ broader practice includes structural engineering, building envelope consulting, inspection and testing, and forensic engineering, allowing the firm to approach existing buildings from multiple perspectives.

Across these projects, several critical engineering considerations emerge: understanding the requirements of medical equipment, evaluating existing structures, coordinating structure with clinical and building systems, addressing serviceability and vibration, planning for constructability, and anticipating how healthcare facilities will change over time.

Medical Equipment Is Part of the Structural Design Problem

Modern medical equipment can impose requirements that go well beyond simply checking whether a floor can carry its weight.

MRI and CT systems, imaging equipment, overhead equipment, mechanical systems, and other specialized installations can introduce concentrated loads, unique support requirements, dimensional constraints, vibration criteria, and installation challenges. The structural engineer therefore needs to understand not only the building, but also how the equipment will be supported, installed, and operated.

At Saint Barnabas Hospital in the Bronx, GMS performed a feasibility study and provided structural design and construction administration services for a new Philips 1.5T MRI and CT scanner on the fourth floor of the existing hospital. The solution illustrates how equipment requirements can influence structural design in unexpected ways. The MRI required adequate distance between its isocenter and the existing steel framing in accordance with manufacturer requirements. GMS designed a ramp and new raised slab to establish the necessary relationship between the equipment and existing structure. The project also included structural support for new overhead injectors, review of loads from new rooftop units, and temporary openings through the existing exterior walls to allow the equipment to be rigged into the building.

The lesson extends beyond MRI installations: the equipment cannot be considered independently from the structure around it. Successful healthcare design requires the structural engineer to understand manufacturer criteria, equipment support, existing framing, access and rigging, and associated building-system modifications as interconnected parts of the same problem.

Strength is Only One Measure of Structural Performance

A structure can satisfy strength requirements and still perform poorly for its intended use.

That distinction is particularly important in healthcare environments. Floor movement that might be acceptable in a conventional building can potentially affect sensitive equipment, procedures, or occupant comfort. For this reason, serviceability, including floor vibration—should be considered when the intended clinical use demands it.

Standards and technical documents  such as “Guidelines for Design and Construction of Hospitals and Outpatient Facilities,” The Facility Guidelines Institute (FGI) and “Vibrations of Steel Framed Structural Systems Due to Human Activity,” American Institute of Steel Construction (AISC) Design Guide 11 provide a guideline and framework for considering vibration from a serviceability perspective. Depending on the facility, equipment, and applicable criteria, structural engineers may need to evaluate characteristics such as floor response and vibration performance in addition to conventional strength and deflection checks.

For healthcare projects, the first question should therefore not simply be:

“Can the structure support the equipment?”

It should also be:

“Will the structure perform appropriately for the equipment and clinical activity it supports?”

This distinction is especially relevant when evaluating existing buildings for new imaging, diagnostic, laboratory, or other sensitive uses. The requirements of the proposed equipment and space need to be established early so that structural performance can be evaluated against the appropriate criteria rather than relying solely on conventional building design limits.

Existing Hospitals Require a Different Kind of Familiarity

Existing healthcare facilities introduce another layer of complexity. The engineer is no longer beginning with a blank sheet. Existing framing, previous alterations, limited access, new penetrations, equipment routes, rooftop loads, and current hospital operations all become part of the design.

At Lenox Hill Hospital (LHH) and Manhattan Eye Ear and Throat Hospital (MEETH), both part of the Northwell Health Network, GMS’ work demonstrates the value of an ongoing relationship with a healthcare facility. Since 1999, the firm has provided structural engineering consulting for renovations and medical and mechanical equipment upgrades throughout the hospital. Projects have included the Facility Master Planning for MEETH, MEP Infrastructure upgrades for both MEETH and LHH, Operating Rooms, Cath Lab Suites, a Tomotheraphy Suite, MRI Suites, an IVF Facility  a new nuclear medicine suite, PET/C Suites, and a LINAC Treatment Room.

Rather than treating each improvement as an isolated structural assignment, longstanding involvement creates familiarity with the facility and the types of challenges that accompany its continued modernization.

That familiarity matters. Healthcare campuses rarely stop changing. New clinical programs are developed and implemented. Equipment is replaced. Mechanical systems are upgraded. Departments expand or relocate. Spaces designed for one purpose may eventually need to accommodate another.

For the structural engineer, supporting that evolution requires an understanding of the existing structural systems of the facility coupled with the ability to rapidly assess and evaluate the building for the proposed programs.

Healthcare Renovations Are Systems Projects

The structural scope of healthcare renovation can also extend far beyond the treatment room itself.

At Northwell Greenwich Village Hospital in New York, GMS provided structural engineering for a new 12-bed inpatient unit within an existing fifth-floor shell space and a new Cardiac Cath Suite on the fourth floor. The project also included a new food-service kitchen and supporting storage and office space, as well as cellar-level renovations for expansion of the Blood Lab and Pharmacy needed to support the inpatient beds. GMS additionally provided structural services and special inspections associated with exterior concrete wall panels and reviewed support to the base building for new signage.

The project illustrates an important characteristic of healthcare design: a new clinical capability often affects much more than the room in which care is delivered.

Supporting spaces, equipment, building systems, exterior components, and infrastructure may all be affected. Structural engineering therefore needs to be integrated into the broader planning process early enough to identify these dependencies and coordinate solutions with the architectural, MEP, equipment, and construction teams.

New Healthcare Buildings Must Support Both Care and Infrastructure

The same understanding applies on a much larger scale when the project involves new construction.

At Staten Island University Hospital, GMS worked with Northwell Health on a project combining a new 12,000-square-foot Central Utility Plant with a new two-story, 48,000-square-foot Maternity Center. The utility plant includes chillers, boilers, pumps, switchgear, cooling towers, and generators, while the new Maternity Center and adjacent loading dock are constructed above it. The steel-framed building is supported on piles and forms part of New York City’s resiliency investments.

Here, the structural challenge operates at several levels simultaneously. The building must support clinical space while accommodating substantial mechanical and electrical infrastructure. Equipment and structural systems must be coordinated. Foundations and framing need to respond to the building configuration and loads. And the facility must contribute to the hospital’s broader operational and resiliency objectives.

This is where experience spanning both equipment-level interventions and whole-building structural design becomes particularly valuable. The engineering principles behind an equipment support project and a new hospital building are connected: understand what the facility needs to do, understand the systems and equipment it must accommodate, and design the structure to accommodate those performance requirements.

Constructability Matters—Especially in Existing Facilities

Healthcare engineering does not end when the permanent structural solution has been calculated.

Equipment must reach its final location. Structural modifications have to be constructed. New systems are required to be connected to existing ones. In an existing hospital, much of that work may occur within or adjacent to an operating facility.

The Saint Barnabas MRI project is a useful example. Creating permanent support for the MRI was only one part of the problem. Our engineers also had to address temporary exterior wall openings needed to rig the equipment into the floor. That type of planning reinforces an important principle: designing the final condition without considering how it will be built can leave a critical part of the engineering problem unresolved.

Early consideration of access, rigging, temporary conditions, sequencing, existing construction, and coordination can help project teams identify constraints before they become construction-phase problems.

Designing for a Healthcare Facility’s Next Chapter

Healthcare buildings are rarely static assets. A hospital designed or renovated today will almost certainly accommodate technologies, equipment, and clinical needs that change over its lifetime.

That makes adaptability an important structural consideration.

For new construction, project teams can consider future equipment, loading, infrastructure, and flexibility while establishing the structural system. For existing facilities, the process begins with understanding what is already there and determining how it can safely and effectively accommodate a new use.

GMS’ healthcare work spans both ends of that spectrum: from new buildings and major infrastructure at Staten Island University Hospital to equipment installation at Saint Barnabas Hospital, new clinical spaces at Northwell Greenwich Village Hospital, and continuing modernization across Northwell Lenox Hill Hospital and MEETH.
The common thread is familiarity—not only with structural design, but with the specialized demands of healthcare environments.

Healthcare Structural Engineering Requires a Broader Definition of Performance

The structural design for healthcare is not limited to whether a building or structural component is strong enough.

The structure needs to meet demanding serviceability expectations. It must accommodate the required mechanical and electrical infrastructure. The project must be constructible within the constraints of the facility operations. And, increasingly, it needs to provide a platform for clinical and technological changes that may not have been anticipated when the building was first constructed.

That requires engineers who can move comfortably between scales: from a piece of medical equipment and its support to the structural system of an entire healthcare building.

Through decades of structural engineering practice and longstanding relationships with healthcare clients, GMS brings that perspective to both new and existing facilities. The objective is not simply to design structure for today’s program, but to understand how structure, equipment, infrastructure, construction, and long-term facility needs come together to support healthcare delivery into the future.