In 2016, Sweden will be home to a new hospital that will be a place of firsts. Based on the slogan “The Patient First,” the New Karolinska (NKS) will replace the existing Karolinska University Hospital in the Solna suburb of Stockholm. The goal of the new medical facility is to create an environment that supports truly translational medicine, i.e., an approach to healthcare that fosters strong ties between research, education, and professional practice.

The New Karolinska will seek to attain gold level Miljobyggnad classification, the Swedish equivalent to the LEED Gold standard in the U.S., or also known as Environmentally Classified Building (ECB), as well as LEED Gold. It also will be one of the first projects in Sweden to have been completed under a public-private partnership (PPP) agreement. Skanska is the project developer and design-build contractor, with Innisfree serving as investment and financing partner; Coor Service Management is responsible for facility management for the first 25 years after completion of construction.


From Karolinska to NKS

The Karolinska University Hospital and its neighbor, the medical university Karolinska Institutet, are already among Scandinavia’s most respected healthcare facilities. Founded in 2004 through a merger of Huddinge University Hospital and the Karolinska Hospital, which dates back to the 1930s, Karolinska is one of Northern Europe’s largest emergency and trauma centers as well as Sweden’s largest care unit for infectious diseases. The institution is also renowned for its integrative medical research.

Unfortunately, a side effect of this venerable history is a motley campus of 40 largely outdated, inefficient, and unattractive buildings, which, as a series of comprehensive studies and reports determined in the early 2000s, did not warrant renovation or expansion. Instead, the decision was made to replace the campus with a new integrated facility that would allow for development of the most cutting-edge clinical practices and delivery approaches known today.

The NKS will be an ultra-modern hospital with 600 inpatient beds, 125 of them part of dedicated intensive care and intermediate care units. The facility will include 100 outpatient beds, 36 operating rooms, and eight radiation bunkers. A 100-room patient hotel will provide outpatients coming in for treatment with the option of spending the night in proximity to the medical services they require without incurring the cost of actually occupying a hospital room.

The five new buildings will be between nine and 11 stories high, and will be complemented by a new technology building as well as a parking garage. The research and technology building will be integrated into the hospital complex with direct pathways leading from the hospital to the research facility and other Karolinska University laboratories. The hospital complex will be part of a larger urban redevelopment project, Hagastaden, around Norra Station, linking Stockholm and Solna across two major highways as well as local railway tracks.

The initial design concepts for the $2 billion project were delivered by White Arkitekter, the Swedish architectural firm that was also behind the redesign of the Stockholm Waterfront. It will be realized by Skanska under a design/build agreement with White and Tengbom Architects acting as architects of record.

Intended to be a landmark in Stockholm, the hospital’s façade will be clad in soft-white clinkers that include bricked components within a glass mantel structure. The complex is designed to integrate with the city, with expansive glass façades that face the city center. A large public square is being created in front of the new hospital, making it a natural part of the urban environment. Patients and visitors will enter the complex via a brightly lit, three-story-high indoor plaza that features cafés, restaurants, and lounges as well as a welcome desk and pharmacy.


A premiere public-private partnership

As a delivery model, Stockholm County Council chose a PPP approach to minimize the risk of delays and cost uncertainties, and to cut down on additional expenses for taxpayers. The PPP model goes hand in hand with a commitment to life cycle cost optimization, a key component of the intended sustainability certification for the project. Since the new hospital is designed to meet the needs of patients and researchers for another 100 years, its design and construction have to be durable enough to stand the test of time, while being sufficiently flexible to accommodate rebuilding easily in order to incorporate the latest developments in technology.

Since the design-build contractor is committed to handing over a fully functional building at the end of construction and the 25-year concession period, these principles have been driving the design/delivery approach. In an effort to “future proof” the hospital and build in flexibility, medical themes are organized vertically. Following a “brick design” concept, a single floor will have a few intensive care units, operating rooms, imaging equipment, several patient rooms, etc. This configuration decreases the amount of travel time and distance within the hospital, which in turn decreases the length of the hospital stay.

The use of fewer columns than usual means that departments can easily be moved around and new equipment installed without the need to take down walls or move power and IT connections. A deliberate over-standardization in the design means that the hospital can be reorganized without costly and complicated interior renovations that would interrupt daily operations. Current space allocations allow for a 20% increase in medical equipment; generators have an additional 20% capacity to support an expanded facility in the future.


Team innovation leads to sustainable benefits

Built and operated with the lowest environmental impact in new hospital construction that is known to exist today, NKS will be climate neutral and environmentally certified, and have a climate-smart infrastructure. The new hospital has 40% lower energy consumption than a comparable conventional facility.

Skanska’s Green Workplace concept stipulates that the construction will be conducted with the lowest environmental impact possible. For example, the construction site will have its own concrete station, eliminating the need for approximately 11,000 transports by concrete trucks. This is the equivalent to 535 tons of carbon dioxide, three tons of nitrogen oxide, and 198 tons of carbon monoxide. The site will also feature its own stone crushing machine, further reducing the need for 29,000 transports, equivalent to 1,000 tons of carbon dioxide, 6 tons of nitrogen oxide, and 350-400 tons of carbon monoxide.

The goal is to reach a near-zero impact rating for greenhouse gas pollution, even for power generators for heating and electricity. Estimated energy requirements for NKS will be approximately 124 kWh/m2/year, roughly half the amount of power a hospital of equal size would normally consume. At least 98% of the facilities’ energy needs will come from renewable sources with low carbon dioxide emissions or through in-house energy production. Thermal heating/cooling will be achieved through a heat pump plant that consists of 154 boreholes.

Advanced lighting control systems will save energy, while a controlled ventilation system will enhance air quality throughout the buildings. Strategically positioned transport bays will coordinate all shipments to and from the hospital. Internal distribution will be carried out by silent vehicles with zero emissions, creating an optimal indoor environment for staff and patients at all times.
All materials used in construction and during the hospital’s operational life cycle will be resource-efficient, including the concrete in the foundations, walls, floors, and ceilings, as well as light fixtures, bulbs, and switches.

The construction management team is also committed to using recyclable components based on renewable sources and is striving to be carbon neutral wherever possible. Vacuum and pneumatic tubes will be used to sort and transport disposable and recyclable materials, and any products or materials that cannot be safely discarded this way will be transported to a reprocessing center in specialized, fully contained automated vehicles.

Both healthcare and public transportation for the greater Stockholm area are managed by the Stockholm County Council. As a result, considerable emphasis is being placed on green ways of getting to the hospital. Public transportation for NKS will be fueled with renewable energy and be complemented by bike and pedestrian paths to the city center. Owners of electric vehicles will be able to recharge their batteries in the hospital parking garage.

When open to patients in early 2016, the New Karolinska will be an ultra-modern university hospital reflecting a patient-focused approach to healthcare delivery while realizing parameters resulting from evidence-based design. It will also be one of the first university hospitals in the world to be environmentally certified, wearing two crowns: that of LEED Gold certification and ECB classification. HCD


Steven Gressel is Senior Vice President, Global Healthcare Center of Excellence, Skanksa USA, Atlanta. He can be reached at