Navigating the Future of Seattle's Healthcare Design and Construction

Seattle’s healthcare design and construction industry is at a pivotal moment. As the region experiences a surge in healthcare needs—driven by shifting demographics, aging infrastructure and the lasting impacts of the COVID-19 pandemic—leaders are being called to think differently about how, what and where we build. At the same time, they must confront the growing complexity of delivering these projects: ballooning costs, staffing shortages across the board and an ever-accelerating technology curve.

In response to these challenges and opportunities, healthcare and design leaders from the Puget Sound region gathered for an in-depth roundtable conversation with DPR Construction's Seattle, Washington, team members. The session brought together voices from health systems, design firms and construction partners, creating a candid dialogue on what’s working, what’s holding us back and how we can move forward—together.

The discussion surfaced key insights into the evolving dynamics of healthcare development, from the need for flexible, future-ready facilities to the reality of analysis paralysis in decision-making. Participants explored the critical role of early integration, the risk of operating in a stretched market and the importance of mentorship to sustain workforce pipelines.

What emerged was more than just a discussion—it was a shared call to action. Seattle’s healthcare leaders are ready not just to build better, but to build smarter, faster and more collaboratively. This roundtable is a first step in a broader, ongoing conversation focused on solutions, alignment and impact.

The Seattle market is anticipating a significant increase in large healthcare projects. Several factors drive this surge, including demographic shifts, the aging population and the lingering effects of the COVID-19 pandemic.

The conversation highlighted the need for flexible designs that accommodate various types of care and technology. Mandy Hansen from Seattle Children’s Hospital pointed out that despite predictions of a shift to outpatient care, inpatient numbers have not decreased as expected. This underscores the importance of building facilities that can adapt to changing healthcare needs and technologies.

Andrew Davis from Swedish Health Services highlighted that the demand for long-term acute care (LTAC) facilities is growing due to patients exceeding length-of-stay targets, placing more pressure on acute care demand. The extended stay could be a repercussion of delayed care during the pandemic, making patients sicker and taking longer to heal. The lack of “step-down” facilities, which would free up beds, compounds the issue. Depending on the healthcare system's financial model, this could mean a multi-million-dollar impact on the bottom line.

Staffing shortages and burnout are significant concerns in the greater Seattle healthcare industry. Davis also remarked that, depending on which study you look at, the Puget Sound is one of the country's most underserved primary care markets. This shortage of primary care doctors is created by low initial salaries and the region's high cost of living—primary care doctors cannot afford to live in Seattle. This has led many practitioners to focus on concierge medical services where they have more flexibility, control over their career and higher pay.

Molly Wolf from NBBJ emphasized that the demand for increased acute care is straining decision-makers who are already trying to address Seattle’s existing under-bedded and aging facilities. Now, decision-makers need to address the issue of needing more new beds AND upgrading the existing ones. These competing priorities require substantial investment and decisions on programming, putting healthcare systems into analysis paralysis regarding how to spend their money. Ultimately, we’re seeing projects get bigger and bigger; there is no such thing as small healthcare projects anymore.

Indeed, healthcare projects are growing in terms of square footage, cost and complexity. To add fuel to the fire, the rapid development of technology and the need to integrate the latest tech into projects further strain budgets and add more decisions to be made.

Technology is a double-edged sword in healthcare design. On one hand, it offers the potential to revolutionize patient care and facility management. On the other hand, the rapid pace of technological advancement creates challenges in implementation and integration. Carl Fleming from DPR Construction noted the difficulty healthcare systems, designers, and builders have in keeping up with the technology curve. Considering the pace of AI, that curve is essentially a vertical line now.

Mandy Hansen with Seattle Children’s shared that 15 years ago, they predicted their units would be paperless and would instead rely on tablets and computers. These prognostications didn’t materialize, and the units remain full of paper and printers—items initially designed out of the workspace. Technology’s rapid advancement further complicates the analysis paralysis that healthcare systems endure as they master plan their campuses or program their next tower. What technologies do they need to plan for, and what happens if they are obsolete when the new facility opens?

Roundtable participants agreed that placing all the tech available in a project isn’t financially feasible, nor will it future-proof your project. Instead of implementing technology for technology’s sake, healthcare systems should identify how technology can enhance care delivery. Furthermore, designers and planners can use technology to design infrastructure, buildings and experiences that maintain or improve levels of care with fewer employees and doctors, as an opportunity to solve staffing shortages predicted across the industry.

One potential solution discussed was creating testing/incubation-type areas for technology instead of deploying new tech across a building or system. For example, a single nursing unit or floor could be dedicated to testing and deploying new technology. If proven useful, that technology could then be scaled. This approach reduces upfront capital costs to build and limits potential disruptions as technology is proven.

The discussion also explored the impact of the current downturn in general construction on the healthcare market. Andy Hill from DPR Construction noted that, as other sectors have slowed and the pipeline of future work is diminished, contractors in Seattle are winning work on slimmer margins. Healthcare is a bright spot in the market, attracting greater competition from contractors driven to pursue work outside their typical expertise, needing to land work, even though they may not be qualified or have the right teams available. This will inevitably lead to stressful situations for healthcare systems, designers, builders and potential failures.

It's understandable that healthcare systems, which have a lot of building to catch up on, may be attracted to low upfront costs to move projects forward. However, this is a risky choice of cost versus expertise. As projects progress, and the builder cannot meet requirements or complete the project, everything becomes at risk: the project, the firm and the industry. This underscores the importance of selecting the right partners and ensuring they have the necessary experience and understanding of healthcare projects.

Making matters worse, the construction industry continues to face a labor shortage, like healthcare. While waiting to build the next hospital, many of the qualified healthcare builders in the area have pursued work in different sectors, like mission-critical projects driving the AI revolution. This places more pressure on contractors to build more with less skilled labor, which can stress employees and lead to burnout and leaving the industry.

This shortage, which is also felt in the design industry, highlights the need for mentorship. Molly Wolf from NBBJ recommended that experienced staff partner with less-experienced staff to help build professional skills and expertise while bringing continuity to a project. There are many opportunities to address staffing shortages by lifting people up and helping them grow in their expertise. This ensures projects have all the requisite expertise at all stages.

Successful healthcare projects require collaboration and integration among all stakeholders; the earlier the better. The roundtable participants agreed that early involvement of design and construction teams can help bring down costs and improve project outcomes. However, this requires a commitment from owners to invest in the upfront costs of Integrated Project Delivery (IPD) models. Participants noted that an Integrated Form of Agreement (IFOA) isn’t necessary to be successful. Instead, dedicated support, early engagement and durable decisions from the owner’s project management team are instrumental in advancing projects and reducing construction costs.

One key takeaway from the roundtable was the need to streamline processes and enhance healthcare design and construction efficiency at all levels. Participants stressed the importance of setting clear expectations and deadlines for stakeholder engagement and highlighted the need for clinical champions who can advocate for projects and ensure alignment with organizational short- and long-term goals. This point was reinforced by a story Victoria Nichols from ZGF shared about a successful multi-year capital project that included an engaged stakeholder group from concept through closeout. Everyone agreed that teams and overall project delivery will be more successful and avoid analysis paralysis if they establish firm timelines and require durable decisions and sign-offs at key project stages.

The roundtable conversation provided valuable insights into the challenges and opportunities facing healthcare design and construction. To be successful, the industry must navigate the complexities of technology, staffing shortages and market pressures while remaining flexible in facility design. Early and durable decisions paired with collaboration and integration among stakeholders are crucial for advancing projects and enhancing efficiencies, ultimately delivering healthcare to communities quickly and on budget.

As healthcare evolves, professionals must remain agile and open to new ideas. By addressing challenges head-on and leveraging the collective expertise of industry leaders, the future of healthcare design and construction looks promising.

Encouraged by the conversation and camaraderie, the roundtable group agreed to continue meeting. However, moving forward, they will focus on creating solutions instead of rehashing challenges. Their first topic: streamlining project delivery through decision-making, owner engagement and cultural alignment.