Expanding access to health services demands healthcare facilities that create truly equitable outcomes.
Arial view of St. Elizabeths East Hospital

Our Health Infrastructure Needs Urgent Care. Public Spaces Can Heal Us

Expanding access to health services demands healthcare facilities that create truly equitable outcomes.
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Infrastructure is more than roads and bridges. While much of our work involves transit corridors, water management and the power grid, these public works are not the only systems necessary for a community to thrive. It took a pandemic to make the condition of our health infrastructure more visible. As with the condition of other basic services, we’re learning that Black and Brown citizens pay the price for inadequate healthcare facilities.

Health equity finally is getting more attention, though. States and cities are recognizing the impact that inadequate, outdated or nonexistent medical facilities can have on population health. Billion-dollar hospital construction and renovation projects are underway nationwide. The architecture, engineering and construction management industry will play a substantial role in driving solutions with positive and long-lasting health, economic and societal outcomes.

While the cost and quality of health care is a longstanding issue, its effect on underserved communities is now front and center. People of color are more frequently uninsured, which taxes the emergency departments of public hospitals. Minorities have shorter lifespans. They’re more at risk for severe chronic conditions often occurring together such as diabetes, heart failure and lung disease. The Affordable Care Act gave under-resourced communities more access to health services, often for the first time in years. Now the focus is shifting to the limited capacity of healthcare facilities themselves.

A Design for Health Equity: the Future of St. Elizabeths East

In our home town of Washington, D.C., Mayor Muriel Browser and Universal Health Services announced the development of a new St. Elizabeths East hospital and two new urgent care centers. McKissack & McKissack, in partnership with HOK, have been awarded the hospital design and engineering contract. St. Elizabeths Hospital,  a mental health facility that started before the Civil War, will become a state-of-the-art medical center for Southeast Washington, with a full slate of acute care and ambulatory services.

We’re grateful to be chosen for such a significant project. Like our past work in education, energy, hospitality and sports, St. Elizabeths will bring Anacostia River communities world class facilities that will attract new development. The HOK/McKissack team will invest 40% of design and engineering in partnerships with local Certified Business Enterprises, creating opportunities for more district employers.

Life expectancy in Southeast Washington’s Ward 8, where St. Elizabeths East is located, is more than 15 years shorter than in Northwest Washington’s Ward 3. Access to health services will go a long way toward closing that shocking gap.

Public Works Build Foundation for Health and Safety

The nation’s capital is not alone in upgrading public health facilities. Voters in Seattle overwhelmingly approved almost $2 billion to fund improvements to Harborview Medical Center, the only Level 1 trauma center in Washington state and King County’s only public hospital. Pre-COVID, Harborview operated at almost 100% capacity every day, and its inadequacies were further exposed by pandemic-driven surges.

Improvements will include construction of new buildings and renovation of existing structures to increase capacity for critical care, infection control and behavioral health services. The Harborview programs also address safety concerns unique to the Seattle region: Upgrades, overhauls and new structures will include seismic improvements to help the entire facility withstand earthquakes.

Community leaders in Newark, New Jersey plan to spend $1billion to build a new University Hospital. The existing facility is 42 years old, twice the age of most of New Jersey’s other hospitals, experiences flooding, a chronically overcrowded emergency room and a physical facility that is simply not suited for today’s team-based approach to medicine.

The Newark hospital will include modern operating rooms, a stroke center, new space for liver transplants and primary care. Just as importantly, it will function as something of a community health center that will help address the social realities of poverty, housing challenges and poor nutrition that drive those health issues among the population University Hospital largely serves.

Prescriptions for Community Health

For independent community hospitals, private development can be a lifeline. New York’s planned Brooklyn Hospital Center expansion relies on private partners to fund an estimated $1.2 billion in upgrades. Mount Sinai Health System is undertaking its own $1 billion New York improvement program, including a replacement facility for Mount Sinai Beth Israel on Manhattan’s Lower East Side. The list of major healthcare facility projects keeps growing, and so does the need.

The conversation on health services reminds us of how our 30 years of design practice expanded into not only healthcare and research facilities but also K-12education and other civic sectors. Public infrastructure is more than functional. The built environment expands the community’s engagement in issues and its capacity to solve problems. A stronger health infrastructure truly will transform the places where we work, live and play.


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