The need for complicated, lifesaving services often drives the shape and layout of healthcare buildings. In contrast, parking structures are staid and solid and are at their best when they go unnoticed. Because of the utilitarian nature of parking structures, they are often given little attention.

When parking decks do come to the forefront, it is often because of an urgent need to provide additional parking or a specific need to relocate an existing parking deck to allow for the expansion of a healthcare center.

Parking and More

Generally there is one parking spot for every 200 square feet of space at a hospital. Medical office buildings generally require three to five spaces per 1,000 square feet.

Room for cars is not all that's involved in the construction of a parking structure. An owner generally wants an attractive, cost-effective, and easy-to-maintain structure, as well as one that functions well for patients, has minimal impact on hospital operations during construction, and can be completed as soon as possible.

These various requirements for a parking facility can actually work against one another. For example, a cost-effective structure might be square and plain, but an attractive structure might curve and require increased space for construction, which can be disruptive to operations, because a decrease in open space can clutter travel paths and confuse patients. Then there are the specific requirements of each healthcare facility's structure, such as those that affected Elmbrook Memorial Hospital in Brookfield, Wisconsin. That parking structure had to be able to support an 80,000-pound fire truck. The structure was designed so that a fire truck could pull into it and, with its ladders fully extended, could aid in the evacuation of the highest floors of the adjacent hospital building. The construction manager also has to keep in mind factors like clearance requirements for ambulances and how to shield neighbors from work activity and noise. Often measures such as planting foliage and operating loud machinery only during certain times can help. Good communication with neighbors is also essential.


The key to a successful project starts with the project team, which generally consists of an owner or an owner's representative, a designer, and a construction manager. The sooner the team is put together, the more successful the project will be. With the right construction team in place, guidelines can be implemented for the creation of a successful parking structure.

Typically, an owner selects the project's designer, who completes the parking structure's design many months before a construction manager is selected. However, a construction manager's early involvement can reduce cost escalations, facility disruptions, and schedule duration. Also, with a construction manager's early input, the structure's appearance and functionality can be maximized. Therefore, in a best-case scenario, the construction manager should be selected at the same time as, or shortly after, the designer is.

Stages Toward Success

While large construction projects in, or adjacent to, existing healthcare campuses will cause some disruptions no matter how carefully planned, a construction manager's early input can greatly minimize disruptions, as the planning carried out during the program stage directly affects the phasing and shape of the final structure.

Surveys and car counts may provide information that can be used to develop a parking plan so that disruption is minimal in duration and cost. In addition, with early warnings and clear communications to the hospital staff, employees might be asked to adjust to alterations in vehicular traffic, parking, and pedestrian traffic.

During the program stage of a project—which occurs before the structure is even designed—the project team evaluates the healthcare facility's parking needs. Considerations include how many parking spaces the structure should hold and whether the structure should be built for future expansions.

An experienced construction manager has handled most problems that can occur during construction and will be more than happy to provide a plan to avoid many of the construction-phase pitfalls that can mar an otherwise successful project. Common pitfalls include utility disruptions, traffic rerouting and confusion, unsanitary conditions, and extreme noise. Pedestrian traffic, accommodating employee shift changes, and rerouting and wayfinding issues also must be taken into account if the structure is being added to an existing campus.

Importance of Wayfinding

Good wayfinding measures—methods that ease users through confusing, unfamiliar routes—can solve many problems and are essential in light of the urgency of healthcare parking. A good construction manager can incorporate effective wayfinding measures into construction, such as signage, covered walkways, lighting, “You Are Here” signs, temporary partitions, and barricades. Some wayfinding methods for permanent parking structures include color, sounds, and art.

Some wayfinding measures are mandated, as they direct patrons to code-required exits and provide them with information regarding what to do in an emergency situation. Such signage is called life-safety signage. Depending on the jurisdiction, life-safety signage usually consists of lit “Exit” signs, “Area of Rescue Assistance” signs at stairwells, “In Case of Emergency” signs at elevators, and emergency-call station signage. The lighted exit signs will typically be required to have battery power or be connected to an emergency power circuit.

Wayfinding is particularly crucial when a parking structure is being built adjacent to an existing facility or on an existing campus, so that staff, patients, and visitors can become acquainted with new routes and can navigate any detours.

Parking Efficiency

The number of spaces possible for a healthcare structure, or its parking efficiency, is affected by several factors. Not only does a site's geometry affect a structure's efficiency, but handicapped- accessible stalls, the configuration of revenue-collection-control equipment, the functional ramping system, and other variables also have to be kept in mind. For example, a parking structure located in an open rural site, with no parking-revenue-control equipment and a low number of required accessible stalls, might be able to achieve a parking efficiency ratio of 300 square feet per car, or even less. On the other hand, a structure located on a small site might only be able to realize an average parking efficiency of 360 square feet per car or more. This might be the case with a hospital campus that has outpatient services, revenue-control equipment, and retail and other mixed uses in the structure.

The local zoning code typically will provide a required ratio of parking spaces for visitors, based on the type of services offered by the facility and the facility's size. A parking supply/demand study may also be used to determine the number of spaces to be provided. For example, Walker Parking Consultants, Inc., a company specializing in serving the needs of the parking industry, which CG Schmidt regularly works with on healthcare facilities, has developed an extensive database for determining the number of needed parking spaces. They can also track when peak volumes will occur.


A parking structure's lighting design should always comply with the latest edition of the National Electrical Code, as well as requirements of local, state, and federal agencies. The intensity of lighting is measured in foot-candles. Two foot-candles is generally the minimum intensity required by code for a parking structure. However, Robert Stanley of Walker Parking Consultants says, “For patron comfort and as a means of passive security, we usually recommend ten foot-candles at parking areas and drive aisles.”

Stanley adds that a key to lighting design is the uniformity ratio between the average and the minimum light levels. This ratio should not exceed 1. “Other areas of the parking structure, such as stairwells, storage areas, and entry/exit points, should have higher light levels,” he says. Stanley points out that painting a parking structure's ceiling white also greatly enhances lighting, because white paint reflects light.

Which Concrete?

A construction manager can provide insight regarding the best choice of building materials. Such knowledge is important, as various components can drastically affect your project's lifecycle, cost, and construction schedule. Concrete is the material of choice for parking structures, but there are two very different choices: precast or cast-in-place concrete.

Precast concrete structures are erected on-site with preformed, poured, and stressed pieces. Typically, these slabs are quite large, ranging from 6,000 to 80,000 pounds, and are formed into columns, planks, double tees, and spandrels. The precast concrete pieces are manufactured in a tightly controlled environment at precast concrete plants and then shipped to the construction site.

The advantage of a precast parking structure is the speed at which it can be completed. Precast concrete also has a lower initial cost. Its disadvantages, however, include intricate staging scenarios, increased maintenance costs, lack of flexibility, and a shorter life cycle.

Cast-in-place concrete structures are built on-site, with the concrete delivered in mixing trucks and then placed into shoring and forms. Advantages of a cast-in-place parking deck include greater design flexibility, longer life cycle, and decreased maintenance costs. Disadvantages include higher initial costs and, in most cases, a longer construction schedule.

Also available are hybrid systems that use both precast and cast-in-place systems to achieve an economical design. Walker Parking Consultants' experience has been that these hybrid systems are the most economical for extremely large parking facilities.

Planning With the Construction Manager

When involved early in the project, a construction manager can help with the selection of structural systems, construction sequence planning, and improved wayfinding and can help maximize the value of a project's budget. With the construction manager looking out for the owner on these issues, and with designers concentrating on the design, appearance, and function of the new parking structure, an owner will benefit from having an attractive and cost-effective parking structure, and the staff, patients, and visitors reap the benefits of a user-friendly parking structure. HD