Working with existing structures in the healthcare sector: Key considerations for refurbishment and expansion

Recent events have highlighted the importance of having access to modern and well-equipped hospitals and healthcare facilities. Northrop’s civil engineers Nick Gill and Mitch Blyth, and structural engineer Craig Hinton discuss the key considerations involved in upgrading or renovating healthcare facilities.

Both Nick and Mitch agree that one of the biggest challenges when working on existing buildings, is that the structure and underground is often decades old and therefore unknown.

“The information provided from the original design is often incomplete, incorrect or just missing,” Nick said. “This is compounded when there have been a number of upgrades or projects that have been staged during delivery as there is no singular source of information.”

“When the data you’ve got on the existing structure and as-built underground services is not forthcoming, the battle becomes sourcing enough information to answer the critical unknowns in order to develop an informed engineering solution,” Mitch added.

Before commencing any works, it is of vital importance to understand how the facility operates and what is trying to be achieved.

Mitch says the best way to understand these goals is to be heavily involved in discussions with all user groups, from key business stakeholders to the hospital representatives working on the ground and utilising the facilities daily.

“Civil engineers need to engage with stakeholders early in the project to fully understand things like the vehicle and pedestrian conflict points for the end users,” he said. “Carpark access or safety concerns with vehicles traversing the site for example, can be resolved or enhanced during an upgrade.”

The importance of these discussions increases further where the old design no longer complies with current building codes, as this can impact the security of the site and the safety of those using it Nick added.

“Sometimes there are design solutions and sometimes it’s a matter of making the client aware there are still shortcomings outside of the scope. It’s deciding early on whether the design could incorporate those requirements or address them by other means,” he said.

When working on an existing healthcare facility, from a structural perspective, Craig highlights the need to inspect the local area of works to locate any areas requiring rectification. “This will ensure the existing structural capacity is still per the original design and will also highlight any issues that could become a problem.”

Typically, large hospitals have been built in stages over many years, hence, the buildings have seen many changes in materials and construction methodology.

“Asbestos and lead contamination are the common hazards to be controlled,” he said. “Additionally, if we are relying on the existing building for any type of support, we need to ensure that the structure is in good condition and has the capacity to support it.”

Following the initial inspection of a facility, it is important to consider the round the clock service a hospital is required to provide. Facilities must remain fully functional throughout the refurbishment process, so staging a project must be carefully planned out to minimise disruption.

“Out of hours work is typically required as noise and vibration can be an issue. If a surgeon is operating on a heart, it isn’t acceptable to be drilling into the concrete floor above,” Craig explains.

Along with selection of appropriate working hours, consideration of how new building materials are delivered is crucial. This can include ensuring the path of travel within the existing hospital has the capacity to fit in lifts and corridors that do not overload the existing structure. Alternative or multiple travel paths for supplies coming in and out of the hospital need to be considered.

Unlike other refurbishment projects, when changes occur within a hospital, significant loads such as MRI machines, x-ray machines, including the lead lining weight for shielding the room and records storage, must be considered and checked to ensure the existing structure has capacity. And if not, structural strengthening will be required.

When working on a hospital building that was having a top floor demolished for extension, Craig was challenged with ensuring the top level remained structurally stable while sections were being demolished. Not overloading or impacting the slab below was also critical, as it was directly above an operating theatre.

“This was largely achieved by introducing a grid of temporary steel beams above the existing floor level and transferring all loads back to columns,” he said. “This involved input from the temporary steel works provider, demolition contractor, builder, architect and hospital stakeholder.”

Now, more than ever, state of the art hospital facilities are vital. Ensuring an expansion or refurbishment project runs smoothly from start to finish is key. Northrop’s engineers work closely with key stakeholders across all disciplines, to better understand the requirements, priorities and motivations behind the ever-changing uses of existing healthcare facilities. This ensures our solutions are mutually beneficial to all involved.



Civil Engineer
Associate, Team Lead, Senior Civil Engineer
Associate Senior Structural Engineer
Nick GillMitch BlythCraig Hinton

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