Leviatan Group specialists’ vision on the development of safe and sustainable hospital infrastructure in Romania was included in an interview conducted in early April 2025 by the Professional Association for Geotechnical and Structural Monitoring (APMGS) within the #SafeHospitals campaign, which we invite you to read below.

How do you relate to structural health in terms of hospital infrastructure? What is important to you on this issue?

We regard the structural health of hospital infrastructure as an essential element for the safe, continuous, and adaptable operation of healthcare facilities. Hospital infrastructure includes projects with a high degree of complexity at all stages—from concept and design to execution and budget management for the implementation of technological solutions. Hospitals become living ecosystems in operation, where architecture, structure, facilities, equipment, and medical processes function in an almost organic interdependence, with the primary goal of ensuring patient health.

To meet the high requirements of safety and seamless operation, it is essential to involve a multidisciplinary team – architects, engineers, epidemiologists – from the initial phase to integrate the durability and rigidity of the construction and the flexibility to adapt to evolving technologies and medical processes. Hospitals, classified as of Class I importance, are designed with additional safety measures, such as a high-importance factor in seismic design, in-plane, and vertical regularity, as well as advanced structural analysis methods. Hence, buildings remain operational in extreme situations.

Emphasis is placed on structural compliance – the optimal arrangement of strength elements, structural joints, clear heights to integrate complex installations, and seismic isolation systems to reduce the forces transmitted to the structure and limit damage. At the same time, hospitals must allow for rapid re-compartmentalization to adapt to new technologies and changes in medical flows, such as in the event of epidemics. Such an integrated and anticipative approach guarantees the infrastructure’s sustainability, efficiency, and adaptability to benefit patients and the continuity of care.

How do you consider and analyze what our hospital infrastructure projects look like regarding tracking behavior over time? Is this a priority in the operation of these types of projects? Why?

In Romania, many hospitals date from periods when design rules and safety standards were less stringent. More than 60% of hospitals fall into the worst performance categories, and 21 operate in buildings with high seismic risk (class I). At the same time, another 68 are classified in risk class II, with the potential to suffer significant damage in an earthquake.

In this context, performance monitoring and preventive maintenance should be a significant priority. Hospitals must remain functional even in critical situations such as earthquakes, floods, or fires. Proper monitoring allows for early detection of problems such as subsidence, cracks, or corrosion and rapid interventions that prevent significant degradation and contribute to safe operation. In addition to the obvious safety benefits, this practice also brings economic advantages: identifying defects early means lower intervention costs and reduces the need for significant and costly repairs.

Although legislation requires monitoring performance over time, a lack of financial resources and specialized staff means that systematic monitoring is not a priority. Continuous and integrated monitoring—from the resistance structure to the facilities and functional flows—is essential to maintaining a functioning and safe medical ecosystem. A conscious and transparent approach, based on modern monitoring solutions, can prevent severe degradation, reduce maintenance costs, and ensure continuity of care, thus protecting patients and medical staff, including in critical situations.

What are the main risks that make these types of projects that need to be closely monitored structurally? And what are the main challenges?

Hospital infrastructure projects carry significant risks that require careful monitoring. Hospitals must remain functional even under emergencies, such as earthquakes or other natural disasters, requiring superior structural strength and sustained maintenance. Even minor failures can seriously affect the functioning of septically sensitive spaces or compromise expensive medical equipment, jeopardizing patient safety and continuity of care.

Another significant risk is posed by the high loads and variable stresses to which hospital buildings are subjected. Heavy equipment such as for medical imaging (CT, MRI) and the heavy traffic generated by staff and patients lead to additional loads that can lead to deformation and increased vulnerability to earthquakes. The uneven distribution of loads, coupled with a lack of proper maintenance, favors the development of cracks, subsidence, and other sensitive points in the structure. In addition, concrete, steel, and masonry degrade over time due to moisture, corrosion, and environmental factors, and late interventions or lack of essential repairs lead to the weakening of the structure, especially in sensitive infrastructure areas.

Hospitals frequently undergo renovations or expansions to integrate new wards and technologies, which can alter the distribution of tasks and require structural reassessments. Avoiding significant risks—such as shutdowns, evacuations, or compromising patient safety—requires continuous monitoring, rapid problem identification, and immediate intervention. In this way, hospital infrastructure can remain functional and sustainable in the face of all challenges.

What recommendations can you make when it comes to the topic of structural health?

Recommendations related to the structural health of infrastructure must start from a proactive approach and rigorous long-term planning. It is essential to have a comprehensive program for monitoring building performance, including regular inspections, clear milestones for monitoring and intervention, and immediate responses to significant events – such as earthquakes, explosions, or fires – through detailed inspections to confirm that structural capacity is being maintained or restored.

Another key aspect is the integration of advanced monitoring with modern technologies. Structural sensors that measure vibration, deformation, or moisture, accelerometers, and 3D surveying techniques allow real-time data collection. This information is processed by early-warning systems and specialized software, which signals when critical parameters are exceeded, allowing rapid and targeted interventions. Moreover, using digital platforms for data collection and interpretation supports informed decision-making and directly prevents high-risk situations.

Finally, a safety-oriented organizational culture is essential. Training staff to recognize damage – cracks, leaks, or problems with doors and windows – and having clear inspection procedures contributes to early intervention. At the same time, allocating dedicated funds for monitoring, maintenance, repair, and strengthening activities should be seen as an investment of equal importance to medical equipment, thus ensuring the functioning of the infrastructure and the protection of human lives.

The Professional Association for Geotechnical and Structural Monitoring (APMGS) is a non-profit organization that brings together specialists, companies, and institutions dedicated to geotechnical and structural monitoring. Through expertise, collaboration, and innovation, APMGS aims to improve the safety and performance of built infrastructure.