When Washington Hospital opened in 1958, it served a community of 18,000 people; today it serves more than 350,000 residents and is expected to grow over the next several years. Upgrades were needed not only to ensure the hospital is able to continue to provide care in the event of a disaster, such as an earthquake, but also as a result of the growing population throughout the District. The first project in the multi-year master plan development was the completion of a new 37,000 SF Central Utility Plant to provide heating, cooling, laundry and many other services for the existing new campus buildings.

The new three-story Center for Joint Replacement building, which houses the new Institute for Joint Restoration and Research, opened in May 2012. The new joint replacement center features 30 private patient rooms, 30,000 square feet of space and eight examination rooms.

Brio Engineering has provided all civil engineering services for the Central Plant and CJR buildings and is currently involved in the design of the first phase of the Hospital Replacement. The project has been particularly challenging due the extensive amount of new and existing utilities to be coordinated and relocated while keeping the current hospital operational. The CJR is connected to the CP with an underground utility tunnel that will eventually serve the new replacement hospital. The county of Alameda has an existing underground flood control channel running next to the CJR which complicated grading and planning of major utilities.