October 2026. These are designer demand briefs drawn from Healthcare Facility Hub’s hospital construction and renovation city series — one brief for each covered city, each sourced to its city piece. Every brief follows the same structure — what is being renovated, what is driving it, and where the design work sits — so cities can be read and compared side by side.
How to read these briefs: every project, figure, and driver comes from that city’s piece in the city series (linked as the Source in each brief). Nothing was added from outside the pieces; where a piece was narrow, the brief says so instead of padding. No readership or audience figures are claimed for any city.
Cities covered (17): Boston · Charlotte · Columbus · Dallas–Fort Worth · Denver · Houston · King County (WA) · Los Angeles · Nashville · Northern Virginia · Phoenix · Portland · San Jose · Seattle · Skagit County (WA) · Snohomish County (WA) · Whatcom County (WA)
The national frame
The series’ anchor — “What’s Actually Being Renovated in America’s Hospitals” — sets the pattern the city briefs sit inside: most hospital construction happens inside buildings that cannot close. Nationally it names systems renewal above the ceiling (air handlers, ductwork, medical gas, plumbing, sprinklers, electrical), imaging and operating-room rebuilds driven by technology turnover, the behavioral-health build-out (ED pods, med-surg conversions, freestanding psychiatric hospitals), energy retrofits sequenced by emissions-law deadlines, expansion threaded through live campuses, water-damage repair as a permanent background load, and care migrating outward to ambulatory and converted retail/office space. Its closing line for the series: “The mix is national; the emphasis is local.”
Source: https://healthcarefacilityhub.org/whats-being-renovated-americas-hospitals/
Boston
What is being renovated
- Mass General’s Ragon Building: two towers on a shared podium, roughly 1.8–2.0M sq ft — 482 private single-bed rooms replacing mostly double rooms, 23 cardiovascular operating/interventional rooms, 100 infusion bays, 120 exam rooms. Cost estimates run about $1.9B–$3.1B; first tower’s first patients fall 2027, second tower 2030.
- Dana-Farber / Beth Israel Deaconess cancer hospital: 14 stories, 450,000 sq ft, 300 inpatient beds; DoN-recorded capital cost of $1,675,700,000; construction began March 2026, first patient 2031.
- Brigham’s Braunwald Tower replacement: a new complex-care inpatient building replacing a 564-bed, ~50-year-old mostly-double-room tower; no cost or filing disclosed yet, beds targeted for the 2030s.
- A statewide behavioral-health layer: Boston Children’s $640M, 116-bed pediatric psychiatric hospital in Brighton (opening expected by 2029) and the Tufts Medicine / Acadia 144-bed behavioral health hospital in Malden ($65M joint venture, opened early 2026).
What is driving it
- Capacity: 27 Massachusetts hospitals at 90% occupancy or higher in April 2024; Mass General Brigham described its academic medical centers at “capacity disaster” status 95% of the time in fiscal 2024, averaging 102 ED boarders daily.
- The Determination of Need gate: projects above $27,668,903.99 (FY2025–26) need state approval, with at least 5% of capital directed to Community Health Initiatives.
- The 2024 Steward Health Care bankruptcy, which closed two hospitals and transferred six — reshuffling capacity across the region.
- Coastal flood rules: essential structures set lowest floors at the sea-level-rise design flood elevation plus two feet of freeboard.
Where the design work sits
- Implication — decant and phasing design: three megaprojects landing in the same Longwood blocks across the same decade, around hospitals running at capacity-disaster occupancy; swing space and enabling work are the brief.
- Implication — single-bed conversion: the projects convert mostly-double-room stock to single occupancy, so they re-plan capacity as much as add it.
- Implication — flood elevation, freeboard, rooftop mechanicals, and off-grid operation priced into every project (the Ragon is designed to operate off-grid for up to four days).
Source — https://healthcarefacilityhub.org/boston-hospital-construction-design-demand/
Charlotte
Scope note: this piece covers one program in depth rather than a metro-wide pipeline — the brief is correspondingly narrow, and says so rather than inventing breadth.
What is being renovated
- Atrium Health is converting an existing building in the University City area near Mallard Creek into a behavioral health hospital: 168 inpatient beds for pediatric and adult patients, a net gain of 102 beds. It is the centerpiece of $340M over five years announced October 15, 2026, opening target 2028 — 12 to 18 months sooner than new construction, per Atrium.
- The wider program adds a behavioral health emergency department, a larger crisis stabilization unit, and expanded outpatient clinics. No building, architect, or contractor has been named yet.
- Contested ground: Duke Health and CaroMont Health have proposed a 120-bed acute-care hospital in the same area, still awaiting state approval.
What is driving it
- Behavioral-health ED visits across Atrium’s system rose 13% over six years; adolescents made up 17% of those visits, and in 2025 pediatric patients accounted for 26%.
- Schedule: renovation-first was chosen explicitly to buy 12–18 months over new construction.
Where the design work sits
- Implication — behavioral-health conversion design: ligature-resistant fixtures and hardware, anti-barricade door swings, and elimination of anchor points, driven by a safety risk assessment.
- Implication — sight lines and zoned progression (public → clinical → inpatient) planned as a staffing tool, with pediatric, adolescent, and adult populations separated in one building.
- Implication — the existing-conditions survey as the real first design phase: the shell’s floor-to-floor heights, column spacing, and systems capacity bound what the conversion can hold.
Source — https://healthcarefacilityhub.org/charlotte-hospital-renovation-design-demand/
Columbus
What is being renovated
- Four systems building at once — Ohio State’s Wexner Medical Center, OhioHealth, Mount Carmel, and Nationwide Children’s — billions spent across dozens of projects over five years, construction running into 2028 and beyond.
- Ohio State University Hospital, opened February 2026: 26 stories, 1.9M sq ft, 820 private rooms, roughly $1.9B, replacing towers dating to 1951; 425 patients were moved in under eight hours. The James Cancer Hospital gained 148 beds partly by backfilling vacated space.
- Dublin: Mount Carmel’s $273M hospital campus (opened April 2025) and OhioHealth’s $250M Dublin Methodist tower expansion (broke ground February 2026), a large share of its new beds built as shelled space — the two systems building less than five miles apart.
- Specialty destinations: OhioHealth’s $600M, 555,000 sq ft Women’s Center at Riverside Methodist (on track for 2027) and its $226M comprehensive outpatient cancer center (late 2028).
What is driving it
- Regional growth, linked in the piece to data-center campuses around New Albany and a semiconductor industry arriving at scale; Dublin Methodist’s stated case is rapid growth in residents over 65.
- Competition and specialty consolidation — systems positioning capacity ahead of growth rather than behind it.
Where the design work sits
- Implication — activation and backfill planning: patient moves at scale, repurposed towers, and service-line reshuffles that follow every opening for years.
- Implication — shelled-space planning: beds constructed now and fitted out when projected growth arrives.
- Implication — MEP renewal in the tail: fire suppression, chillers, and a cath lab renovation at East Hospital running through 2028.
Source — https://healthcarefacilityhub.org/columbus-hospital-renovation-design-demand/
Dallas–Fort Worth
What is being renovated
- Moody Children’s Hospital — the joint UT Southwestern–Children’s Health campus: a $5B pediatric campus of more than five million sq ft, 552 inpatient beds across three towers, a 96-bed Level IV NICU, ninety emergency rooms, two helipads. Topped out September 29, 2026; first patients expected 2031.
- The public systems building in place: Parkland’s $54M build-out converting two shelled floors into 112 beds (first 56 opened June 2026, taking it past 980 licensed beds), and JPS’s $1.5B, 740-bed replacement hospital in Fort Worth (broke ground April 2026), centerpiece of a master plan whose budget has climbed past $2B.
- The suburban land rush: Methodist Celina ($237M, 51 beds on day one, master-planned for more than 300), Baylor Scott & White’s Frisco hospital at PGA Parkway, Texas Health Resources hospitals in Forney, McKinney, and Willow Park, and Medical City Healthcare’s $1.7B five-year program including a 90-bed vertical expansion at Plano.
- Cook Children’s new Fort Worth utility plant: two independent electric feeds, three 2.5-megawatt generators, a 45,000-gallon diesel reserve.
What is driving it
- Population: 8.48 million people in July 2025, adding 123,557 in a single year — the second-biggest numeric gain of any American metro.
- No permission gate: Texas has had no certificate-of-need law since 1985, so the market draws the map; for the public systems the stated constraint is construction economics, not permission.
- Resilience after Winter Storm Uri (February 2021), whose post-storm reviews found hospitals’ binding failure was water; ERCOT’s peak demand hit roughly 91 gigawatts in a July 2026 heat wave.
Where the design work sits
- Implication — expandability as the design principle: shelled beds, towers engineered for vertical growth, campuses master-planned at multiples of opening size.
- Implication — fit-out and phasing inside operating public hospitals (Parkland, JPS).
- Implication — resilience specification: water continuity, independent feeds, generator and fuel sizing, and cooling/load strategy as permanent design inputs.
Source — https://healthcarefacilityhub.org/dallas-fort-worth-hospital-renovation-design-demand/
Denver
What is being renovated
- Shelled capacity everywhere: AdventHealth Parker’s $300M, seven-story bed tower (60 med-surg beds, four ORs, two cath labs; floors five through seven shelled toward a designed capacity of 329 beds, first patients February 2027), plus shelled floors at St. Anthony North and a shelled cath lab and surgery suite at Swedish Medical Center.
- The Broomfield race at I-25 and CO 7: UCHealth’s North Campus hospital (about 367,000 sq ft plus a 169,000 sq ft medical office building; groundbreak aimed for 2026, opening 2029), AdventHealth’s roughly 43-acre parcel at the same interchange, a 56-bed Ernest Health rehabilitation hospital, and Children’s Hospital Colorado’s North Campus.
- UCHealth Highlands Ranch: a $119M expansion (Pavilion 2) and a second tower with 70 inpatient beds — a hospital that hit its ten-year growth projections in three years.
- Intermountain’s $680M replacement Lutheran hospital in Wheat Ridge (opened August 2024, 226 licensed beds, Level II trauma), and a behavioral-health layer including the 144-bed West Pines hospital and a 120-bed HealthONE center in Aurora.
What is driving it
- No certificate-of-need law in Colorado — the gate is CDPHE licensure, FGI and Life Safety Code conformity.
- An eight-hospital AdventHealth–Intermountain joint venture (definitive agreement August 2026, expected to close early 2027) that will re-sequence capital plans across the metro.
- Growth skew: Weld County up 14.2% and Douglas County 11.35% in five years, against Denver County’s 1.87%.
- Weather memory: the Marshall Fire (December 2021) and a May 2024 hailstorm with about $1.9B in damage.
Where the design work sits
- Implication — a standing fit-out pipeline of shelled floors, delivered as phased, occupied-hospital work; the piece calls shell space the metro’s dominant design feature.
- Implication — entitlement and licensing-calendar fluency in a no-CON state, where races are decided in site-plan hearings.
- Implication — behavioral-health design (ligature resistance, sight lines, de-escalation space) as a standing specialty, and resilience — roofing, air handling under smoke load, utility redundancy — treated as non-value-engineering items.
Source — https://healthcarefacilityhub.org/denver-hospital-construction-design-demand/
Houston
What is being renovated
- Texas Medical Center’s flood-defense fabric, rebuilt after Tropical Storm Allison (2001): submarine-style flood gates sealing building entries, elevated electrical vaults, protected generators and pumps, and an on-site power plant — in a district that has subsided more than three and a half feet since the 1970s. In Hurricane Harvey (August 2017, more than fifty inches of rain), MD Anderson’s buildings took no flooding with roughly 550 patients riding out the event in their beds.
- Harris Health’s program: a $2.5B voter-approved bond (November 2023, more than 70% yes) inside a $2.9B strategic capital program. Its centerpiece is a $1.6B, twelve-story hospital on the LBJ campus — about 1.3M sq ft, 390 private rooms with shelled space for sixty more, fifteen ORs plus a hybrid suite — opening late 2028 as the county’s third adult Level I trauma center and the first outside the Medical Center.
- The program also renovates the existing LBJ facility, extends Ben Taub’s life and capacity, and adds three community health centers.
What is driving it
- Flooding and the standard it produced: the building is expected to operate through the disaster, not reopen after it.
- Growth against aging plant: Harris Health’s two main hospitals were built more than thirty years ago while the county grew around them.
- Decentralization — moving trauma care and capacity toward where the population actually grew.
Where the design work sits
- Implication — resilience as maintained systems, not one-off construction: flood gates are maintained systems and ride-out staffing is an operating model that every renovation inherits.
- Implication — elevation and MEP planning against a sinking, flood-prone baseline, with protected power and pumps.
- Implication — phased construction and systems renewal inside the most crowded medical district in the world, plus shelled-space planning in the new LBJ hospital.
Source — https://healthcarefacilityhub.org/houston-hospital-renovation-design-demand/
King County (WA)
What is being renovated
- EvergreenHealth, Kirkland — the 2-Silver surgery expansion: roughly 73,000 sq ft of shell build-out for seven operating rooms, six cath labs, and one hybrid OR, plus about 15,000 sq ft renovated into five endoscopy rooms and a new rooftop air-handling platform. The state application budgets $170M all-in; construction runs October 2026 to September 2027, NBBJ as designer of record. A separate $100M donation (Dean Weidner estate, September 2026) points to a future eight-story tower — no budget, size, or timeline published.
- Valley Medical Center, Renton — a phased cancer center (about $60M program): Phase 1A infusion opened February 2025, Phase 1B clinics under construction, Phase 2 radiation oncology and imaging aimed at late 2027 and explicitly contingent on fundraising. In Covington, an application would convert an occupied urgent-care floor into a freestanding ED plus urgent care, with about 9,400 sq ft of shell above built out as a multispecialty clinic ($17,961,032 application budget; an application, not an approval).
- Snoqualmie Valley Health: an approximately 85,000 sq ft hub beside its 25-bed hospital — imaging, immediate care, lab, pharmacy, clinics, and a four-OR ambulatory surgery facility — priced at $147M, opening expected fall 2026.
What is driving it
- Public hospital district ownership: four districts (Valley, EvergreenHealth, Snoqualmie Valley, Vashon) own the map, and two passed levy lid lifts in 2025 — EvergreenHealth’s District No. 2 at 60.83% and Valley’s District No. 1 at 57.53%, the latter its first increase requested in twenty years.
- Washington’s regulatory stack: certificate of need for services, Department of Health Construction Review Services approval (with ICRA and interim life-safety plans in the submittal), and the Clean Buildings Performance Standard’s reporting deadlines from 2026.
- Out-migration: Snoqualmie’s CON filing rests on valley residents traveling to Bellevue or Seattle for routine procedures.
Where the design work sits
- Implication — work inside a fully operational hospital: the EvergreenHealth filing describes ICU above, ED below, and rooms adjacent at all times; phasing, ICRA/containment, and continuous operation of critical systems are the central constraints.
- Implication — public-works delivery: elected commissioner decisions, prevailing wage, and GC/CM procurement shape where design decisions actually get made.
- Implication — shell-to-clinical conversion and rooftop MEP tied to existing structure, in Kirkland and Covington alike.
Source — https://healthcarefacilityhub.org/king-county-hospital-renovation-design-demand/
Los Angeles
What is being renovated
- Harbor-UCLA Medical Center replacement, Torrance: a $1.806B program on a 72-acre campus — nine-story, 555,000 sq ft tower with 347 licensed inpatient beds, a psychiatric emergency department, and a rooftop helistop; 78% complete in July 2026, patient care beginning early 2028, explicitly preparing to support the 2028 Olympic Games.
- LA General: $118.7M approved June 2025 to seismically retrofit the historic 19-story, 1.2M sq ft General Hospital building — closed as a hospital, being abated, stabilized, and prepared for reuse through 2028.
- Cedars-Sinai’s swing strategy: a nine-story, 405,000 sq ft tower with up to 203 beds (approved 2022, not yet started) whose purpose is swing capacity so the roughly 50-year-old North, South, and Professional Towers can be retrofitted; plus a nine-story Marina del Rey replacement hospital opening at 96 beds, expandable to about 160.
- UCLA Resnick neuropsychiatric hospital: conversion of the former Olympia Medical Center — $352M, 119 inpatient beds against the 74 it replaces, a 61% increase in psychiatric capacity. Children’s Hospital Los Angeles takes the opposite path: removing older buildings from acute care by the seismic deadline and concentrating on the Anderson Pavilion.
What is driving it
- The seismic deadline: on January 1, 2030, every California general acute care building must meet the state seismic standard or stop housing acute care; AB 869’s relief (to 2035) does not cover LA County’s large systems. RAND’s estimates put county compliance at $9B–$39B.
- A paradox the piece documents: county population down 3.2% since 2020, while ED visits run near their all-time peak; MLK Jr. Community Hospital’s ED, built for 25,000 visits a year, now handles roughly 120,000.
- Fire: the January 2025 Palisades and Eaton fires destroyed 16,251 structures.
Where the design work sits
- Implication — the decant as the product: swing towers, phased campuses, and footprint subtraction are three versions of keeping a hospital licensed and occupied while it is rebuilt around its patients.
- Implication — the HCAI compliance filing itself as a design deliverable: retrofit-vs-rebuild-vs-subtract decided building by building.
- Implication — ICRA inside occupied seismic retrofit, plus smoke, air handling, and emergency power as first-order design inputs alongside seismic.
Source — https://healthcarefacilityhub.org/los-angeles-hospital-construction-design-demand/
Nashville
What is being renovated
- Vanderbilt’s Jim Ayers Tower: $500M, 495,000 sq ft, 180 beds with shelled space for more, opening floor by floor from October 2025 to early 2027 — plus 44,000 sq ft of operating-room space in Medical Center East and a two-story bridge. Monroe Carell Jr. Children’s Hospital completed a 160,000 sq ft expansion in early 2025.
- TriStar Skyline’s $133.6M, 122,000 sq ft tower (broke ground June 2025): 30 progressive-care beds, 14 ICU beds, four ORs including burn ORs, and a shelled third floor. Ascension Saint Thomas’s $537M capital program centers on a $120M transformation of Saint Thomas West — ORs, cath labs, thoracic surgery, imaging, entrances — through roughly mid-2028.
- The Clarksville land rush: Vanderbilt’s $600M acquisition of the 270-bed Tennova hospital (closed February 2026), TriStar Clarksville ($286M, 68 beds expandable to 224), and Ascension Saint Thomas Clarksville ($148.5M, 44 beds designed to grow to 132) — both new hospitals expected to open in 2028.
- Nashville General Hospital remains undecided: renovate in place at roughly $500M, or build new at $500M–$1B; its lease expires in 2027.
What is driving it
- Capacity: Vanderbilt University Hospital operates at more than 90% capacity year-round, its adult ED growing about 4% a year; metro population is up 8.7% in five years to 2,197,416.
- A certificate-of-need sunset written into law: CON ends for satellite EDs and cardiac cath July 1, 2028, and for acute-care hospitals July 1, 2030.
- Disaster memory: the May 2010 flood (Cumberland River cresting at a record 51.86 feet) damaged six of Davidson County’s ten hospitals; tornadoes hit in 2020 and 2023.
Where the design work sits
- Implication — phased-occupancy expertise as the local differentiator: towers opening floor by floor inside live campuses and wings rebuilt in sequence, with infection control, interim life safety, and swing-space planning as baseline.
- Implication — the CON calendar as a bid calendar: approved projects sequenced through 2028, then a wave of smaller, faster satellite ED and cath projects after the July 2028 sunset.
- Implication — weather-driven program requirements (protected utilities, emergency power, surge capacity) on new campuses, and post-acquisition standards work after ownership changes.
Source — https://healthcarefacilityhub.org/nashville-hospital-renovation-design-demand/
Northern Virginia
What is being renovated
- Inova Health System is building two hospitals simultaneously, both scheduled to open late 2028, at a combined investment Inova puts at $2.5B: a 1.1M sq ft Alexandria campus on the former Landmark Mall site (192-bed hospital, cancer center, specialty care center, inside the mixed-use WestEnd district), and the 110-bed Franconia-Springfield Hospital attached to an existing HealthPlex. The current Alexandria hospital, on Seminary Road since 1962, closes when the new ones open.
- Inova Loudoun Hospital, Leesburg, recently completed the final phase of a $300M master plan: a seven-story, 382,000 sq ft patient tower with 228 beds and an expanded NICU.
- On the former Exxon Mobil campus in Merrifield (117 acres), Inova is renovating four office buildings into medical and research uses — including an ambulatory cancer facility and a wet-lab research building side by side — while seeking approval for a first phase of new construction measured in millions of square feet.
What is driving it
- Growth and capacity: Loudoun County is one of the fastest-growing counties in the US; state health-planning records state Inova Loudoun’s inpatient volumes ran at the region’s highest and exceeded its licensed capacity in 2025.
- Replacement of a 1962 hospital, and adaptive reuse of suburban office stock built for a workforce that no longer fills it.
Where the design work sits
- Implication — conversion design: threading the thirty specialty systems a clinical building carries through structures designed for desks, and re-planning access and wayfinding on a campus designed for corporate security — in the piece’s words, “re-envisioning it to let people in.”
- Implication — two-hospital activation planning for 2028, and mixed-use site planning where a retail development and a healthcare development share a single site plan.
Source — https://healthcarefacilityhub.org/northern-virginia-hospital-renovation-design-demand/
Phoenix
What is being renovated
- Mayo Clinic’s Phoenix campus expansion: $1.9B committed in March 2025, described as the largest investment in its Arizona history — roughly 1.2M sq ft including a new procedural building, a four-floor vertical and horizontal expansion of the Specialty Building, 11 operating rooms, and 48 beds across two new patient units, growing clinical space by nearly 60 percent. First services open as early as 2027; full completion runs to 2031.
- Valleywise Health opened a replacement medical center in June 2024 — 673,000 sq ft, ten stories, housing the county’s Level I trauma service and the state’s only verified burn center — funded by a 2014 voter-approved bond of $935M.
- Valleywise’s Proposition 409, approved November 2025 at $898M, will expand behavioral health services, rebuild and expand its community health centers, and replace its Comprehensive Health Center.
What is driving it
- Capacity against population growth: Mayo’s Arizona leadership is quoted in substance — demand for its care exceeds its capacity in a metro that keeps adding people.
- Heat as a clinical and plant driver: 31 consecutive days at or above 110°F in July 2023 (month averaging 102.7°F), and heat-associated deaths in Maricopa County setting records across seven consecutive years of county tracking.
- Public capital on a schedule: the 2014 bond and Proposition 409 form a funded pipeline, not speculation.
Where the design work sits
- Implication — MEP and plant design as the central brief: cooling redundancy sized for a grid under peak stress, because the cooling plant never sheds its load in Phoenix heat; envelope and shading as clinical infrastructure.
- Implication — live-campus phasing at scale: a multi-year build on a destination-medical campus that never stops delivering complex care, through 2031.
- Implication — space planning for the voter-funded behavioral-health and community-health pipeline at Valleywise, and a standing water question wherever evaporative cooling draws on the Colorado River system.
Source — https://healthcarefacilityhub.org/phoenix-hospital-renovation-design-demand/
Portland
What is being renovated
- OHSU’s Vista Pavilion: $650M, 530,000 sq ft, 14-story inpatient tower dedicated entirely to Knight Cancer Institute care — opened April 7, 2026 with 128 inpatient beds and shelled space for 56 more, backed by the $2B Phil and Penny Knight gift. Also at OHSU: renovated heart units, 42 additional brain-care beds scheduled December 1, 2026, and an ED expansion adding 17 beds by January 2028.
- Kaiser Sunnyside replacement tower, Clackamas: about $1.66B per Kaiser’s state filing — 615,000 sq ft, seven stories, 308 beds in 100% private rooms, broke ground April 2, 2026, completing March 2029; described as Oregon’s first fully electric hospital, targeting LEED Gold.
- Providence: St. Vincent’s $47M ED renovation (84 treatment spaces, completed 2025) and roughly $85M main-tower renovation including seismic retrofitting; Providence Portland building out 96 med-surg beds from shelled ninth and tenth floors (48 opened September 2026, 48 follow in 2027).
- Legacy Emanuel’s West Tower shell build-out (four-year program begun fall 2025, first phase adding 14 ORs plus recovery and sterile processing) and the new Legacy Oregon Burn Center (33,000 sq ft, 16 suites, opened June 2026). Capacity also left the map: Vibra Specialty Hospital (73 beds, Oregon’s only LTACH) closed February 2026.
What is driving it
- A staffed-bed shortage, not a physical one: Legacy reported about 129 fully equipped beds sitting empty in 2024 for want of staff; HB 2697 staffing ratios have been in statute since June 2024, tightening to 1:4 on med-surg July 1, 2026, with penalties up to $10,000 a day — a hospital that cannot staff to ratio cannot legally open the beds it built.
- Operating losses alongside building (Oregon hospitals lost about $300M in Q1 2025), and the failed OHSU–Legacy merger (terminated May 2025), which left two independent capital plans.
- Documented resilience record: June 2021 heat to 116°F, September 2020 wildfire smoke at AQI 509, a January 2024 ice storm cutting power to more than 238,900 Oregonians; seismic evaluation triggers at a low construction-cost threshold ($386,338 as of February 2026).
Where the design work sits
- Implication — space planning for phased opening: units that open as hiring lands — all-private rooms that flex acuity, observation units to decompress EDs, shell space fitted out later.
- Implication — phased construction in occupied hospitals on constrained incumbent campuses, with infection control and interim life safety running for years, under Oregon’s older FGI edition (2018, with state amendments).
- Implication — two regulatory systems on one market: the metro spans Oregon and Washington, each with its own CON and code regime.
Source — https://healthcarefacilityhub.org/portland-hospital-construction-design-demand/
San Jose
What is being renovated
- Santa Clara Valley Medical Center: HCAI lists roughly fifty active projects at the center alone, with construction costs around $719M; the county capital program includes seismic upgrades to existing buildings and demolition-and-replacement of others, with lease revenue bonds authorized for the seismic and emergency-department work.
- Regional Medical Center, East San José: purchased by the county in April 2025 from HCA Healthcare for $150M and folded into the county system as its fourth hospital — 258 beds. The county returned it to Level II trauma status, restored stroke and heart-attack care, nearly doubled its emergency beds this year, and has announced maternity care to follow.
- The county also opened a new public health clinic on the San José–Campbell border this fall, and the piece documents an amenity layer inside hospitals — food, coffee, retail and respite space, family accommodation — treated as a facilities program.
What is driving it
- Seismic compliance on a statutory calendar: retrofit drawings were due this past March, permits by March 2028, completed compliance by February 2030.
- Public capital committed in the open: a county deciding, with bond money, to rebuild its hospital system rather than let it shrink.
- Competition for staff and patients against tech-industry standards — amenities as competitive surface, not decoration.
Where the design work sits
- Implication — structural work in occupied facilities, sequenced against a statutory calendar: “structural surgery on buildings that cannot stop being hospitals.”
- Implication — service restoration as renovation: each restored service line at the acquired hospital is renovation work in a live building, alongside systems standardization across the merged system.
- Implication — amenity space run as a serviced program: leased, ventilated, secured, and kept open for the night shift.
Source — https://healthcarefacilityhub.org/san-jose-hospital-renovation-design-demand/
Seattle
What is being renovated
- Harborview Medical Center, First Hill — the only Level I trauma center for a four-state region (Washington, Alaska, Idaho, Montana): a new ten-story inpatient tower with 360 single-bed rooms and an expanded ED, a new behavioral health building, renovations across the existing hospital, and seismic retrofits of Harborview Hall and the Center Tower. King County voters approved a $1.74B bond in November 2020; the county owns the hospital and UW Medicine operates it. Per the County Auditor’s March 2026 update, tower move-in has slipped from late 2028 to at least 2032, and current cost estimates (the county’s roughly $2.25B) exceed what the bond can deliver; design and enabling projects proceed.
- Seattle Children’s: a South Lake Union research institute past 1.1M sq ft, anchored by the 540,000 sq ft Building Cure with a GMP cell-therapy manufacturing plant; the Janet Sinegal Patient Care Building raised main-campus capacity from 208 to 250 beds; a $103M ambulatory surgery center is under construction in Federal Way (completion expected late 2027).
What is driving it
- Capacity and role: a chronically overcrowded hill carrying a four-state trauma role.
- Seismic exposure — the piece’s summary: “a seismic story wearing a capacity story’s clothes.”
- Cost pressure: a bond sized in 2020 dollars meeting 2026 construction economics, with permitting, leasing, and long timelines named among the delay causes.
Where the design work sits
- Implication — phasing inside a 24/7 trauma center that remains fully operable throughout, and seismic retrofit of the existing buildings sequenced independently of the tower debate.
- Implication — MEP design-build delivery on a dense campus (the named Mortenson/Perkins&Will and Hermanson–McKinstry teams), and specialist planning for GMP manufacturing held to pharmaceutical standards inside a children’s research campus.
- Implication — program and scope re-planning under a funding gap, since officials may have to revisit scope.
Source — https://healthcarefacilityhub.org/seattle-hospital-renovation-design-demand/
Skagit County (WA)
What is being renovated
- Skagit Valley Hospital’s decanted outpatient surgery: a three-story, 60,000 sq ft surgery center (opened December 2023) with four ORs, three endoscopy suites, imaging, and 62 exam rooms — the district’s $23,367,584 of approved capital bought equipment, technology, and fit-out. 2026 conversions already in bid turn a pain procedure room into a fifth OR and a conference room into a third x-ray room.
- Plant renewal inside the main hospital: a kitchen renovation (June–October 2026, meals from temporary kitchen units meanwhile; “much of our kitchen infrastructure dates back to the 1950s”), an MRI renovation that cranes an owner-furnished Siemens 1.5T scanner in through a removable concrete roof panel with chiller and floor replacement on the same pass, and a south-campus cooling plant replacing an R-22 air-cooled chiller with a water-cooled machine, new pumps, and a building-automation upgrade.
- Island Health, Anacortes (43 licensed beds): a dedicated cesarean OR built into an existing courtyard (about $1.6M), an endoscopy renovation (about $4M), and about $9.8M to gather orthopedics, sports medicine, physiatry, physical therapy, and imaging — today dispersed across campus — onto one floor.
- Station Square, a 30,000 sq ft medical office building bought outright in April 2024 for $26.4M, and a third 30,000 sq ft medical plaza under construction beside Cascade Valley Hospital in Arlington, due fall 2027.
What is driving it
- OR capacity: Skagit Valley’s six mixed-use ORs run above the state’s capacity standard — “bumping, delays and rescheduling are common” — and the hospital runs near 89% occupancy; the piece prices in-hospital surgical space above $1,200 a square foot before infection-control risk, which is the stated rationale for decanting.
- Island Health’s levy lift (passed April 2025, 34 cents to the 75-cent statutory ceiling, about $4M a year) against operating costs up 21% since 2020.
- Site rules: Mount Vernon flood code treats hospitals as critical facilities (lowest floor at least three feet above base flood elevation where no out-of-floodplain site exists), Seismic Design Category D1, and Clean Buildings deadlines reaching the surgery center in 2028.
Where the design work sits
- Implication — the decant as design strategy: moving outpatient surgery, endoscopy, and imaging out of the hospital OR suite into a separate fit-out, reducing in-hospital construction exposure while the hospital ORs keep running.
- Implication — MEP-heavy phased back-of-house work in a hospital that does not close: temporary kitchens, roof-panel crane-ins, refrigerant retirement.
- Implication — conversion design inside an operating surgery center: medical gas, ceiling boom, sprinkler and fire-alarm revisions, and disinfection-system extension for rooms becoming licensed ORs.
Source — https://healthcarefacilityhub.org/skagit-county-hospital-construction-design-demand/
Snohomish County (WA)
What is being renovated
- EvergreenHealth Monroe replacement hospital (application): a new 190,000 sq ft hospital beside the old one — buildings do not touch — with beds in service rising from 26 to 48, at least six ORs and five procedure rooms, at least 24 private ED rooms designed to convert for behavioral-health patients, and a helipad; the old building comes down after a same-day move-in. The application totals $382,559,442 and names NBBJ as architect; schedule in the application runs construction March 2028 to March 2030.
- Providence Regional Medical Center Everett: a new infusion center that gave its first treatment in September 2025 and is growing from four chairs toward fourteen; earlier state approval to grow from 501 to 571 acute beds by finishing shelled tower space is cited as history. Swedish Edmonds’ infusion center doubled from 19 to 38 chairs in June 2026, and its renovated outpatient behavioral-health clinic raised capacity from 12 patients to 30.
- The behavioral-health layer: Compass Health’s Marc Healing Center in Everett ($71M, opened September 2025 — 16-bed evaluation-and-treatment unit plus 16-bed crisis triage designed for ambulance and law-enforcement drop-offs), Smokey Point Behavioral Hospital grown from 115 to 145 beds, and Fairfax units inside general hospitals.
- Service removal as renovation: Cascade Valley Hospital (Arlington) ended labor and delivery in August 2024; six birth-center beds became medical-surgical beds and OR time went to other surgery.
What is driving it
- Monroe’s plant and capacity: the only full-service hospital between Everett and Wenatchee, running 26 medical-surgical beds in service with a 14-treatment-bed ED seeing 60–80 patients a day, in a plant described as a decades-long accretion of additions.
- The bond rule: Washington requires 60% for a hospital district bond; Monroe’s Proposition No. 1 drew 55.63% on August 4, 2026 and failed, and the same $382M measure is on the November 3, 2026 ballot.
- Ownership splits: district landlords (Verdant, District No. 3) hold roofs, HVAC, and reserves while operators (Swedish, Skagit Regional Health) hold clinical fit-out, under long leases — one at ten dollars a year.
Where the design work sits
- Implication — occupied-site replacement design: a non-touching new hospital beside a 24/7 operating one, shutdowns coordinated with clinical operations, and a same-day cutover.
- Implication — scope follows the lease: whether a project is landlord capital or operator fit-out decides its design route and procurement.
- Implication — behavioral-health space planning for secure drop-off and co-location inside acute campuses, and conversion design where services are removed rather than added.
Source — https://healthcarefacilityhub.org/snohomish-county-hospital-construction-design-demand/
Whatcom County (WA)
What is being renovated
- The Peter Paulsen Pavilion at PeaceHealth St. Joseph Medical Center, Bellingham: six stories, 120,000 sq ft, 80 beds in all private rooms, a rooftop helipad, advanced inpatient floors, two floors for women’s and children’s services, and a unified emergency department replacing a split one. Certificate-of-need capital is $336,323,637 from reserves and philanthropy; a separate $64.8M of garage, central utility plant, and ED renovation work puts the all-in program at about $401M. Piles began September 2026, drilled as far as eighty feet; public opening 2028. Designed by Savely Healthcare Architects, built by Turner Construction.
- Surgery spread out around it: a state-approved six-OR ambulatory surgery center on Squalicum Parkway ($12.5M approved capital, July 2023) and endoscopy consolidated into the Mt. Baker Imaging building in July 2026.
- The behavioral-health and tribal pipeline: the Anne Deacon Center for Hope (32 crisis beds, opened January 2021), a county-designed 23-hour crisis relief center (24,000 sq ft, recliner bays instead of beds) paused in early 2025, and on the Lummi Reservation a 16-bed secure withdrawal and stabilization center opened August 2026 alongside the tribal health center, funded by $23M of state commerce money, $10.6M from Indian Health Service, and $4M from Lummi Nation.
What is driving it
- A single-hospital county with no hospital district: St. Joseph (255 licensed beds, the county’s only Level II trauma center) sits outside every public district, so expansion is financed from reserves and philanthropy — $74M counted toward the project, half of it and more from Peter Paulsen.
- Capacity pressure from the hospital’s own CON filing: acute beds fixed at 207 for over twenty years while county population grew past 230,000; midnight occupancy 10–18 points above the 70% target since at least 2017–18; ORs ran at 118% of capacity in 2021, producing “scheduling delays and bumped cases.” The next higher-level hospital when full is Providence Everett, 64 miles away — described in the same filing as also full.
Where the design work sits
- Implication — phasing and occupied-site logistics beside a live Level II trauma ED: the piece’s construction log lists 33 ED stalls closed for stormwater infrastructure, temporary fire egress marked across the cafeteria floor, pedestrian rerouting, and noise mitigation (ear plugs, earmuffs, white-noise machines) during pile driving.
- Implication — wayfinding and vertical circulation for a unified ED and rooftop helipad: Airlift Northwest patients come straight down into the building instead of a ground pad plus ambulance transfer.
- Implication — separate design briefs in parallel: crisis design built around recliner bays and a 23-hour stay limit, and culturally specific design on the Lummi campus (cedar log house form, healing room, views to planted ground), distinct from the acute pavilion.
Source — https://healthcarefacilityhub.org/whatcom-county-hospital-construction-design-demand/
Every brief traces to its linked city piece; figures are quoted as the pieces state them.