Change is certain. Improvement takes intention and a system for building design standards.
By Becky Holden · Oct 8, 2026
Dear Leaders,
Can we talk about change? The waves of change’s uncertainty are upon us, but what if we took the wheel and steered the ship to take advantage of the wave’s momentum? With the rapid evolution of AI, medical care, regulations and reimbursement alongside an aging population increasing demand, health systems are facing an inflection point where change has become essential for survival.
Improvement is different. It is a choice. A decision to move in a positive direction, to learn from evidence and leave something better than we found it. Change happens to us. Improvement happens on purpose. There is a word for this. Kaizen is a Japanese term meaning good change.
I have spent my career dedicated to building better healthcare facilities, from helping design Cleveland Clinic Abu Dhabi to leading design for dozens of projects during Stanford’s largest expansion. That work has taught me that good change requires data, learning and intention.
Empowering data
Not so long ago our personal health information lived in scattered paper files that each provider kept. A patient with a complex condition saw a series of physicians, each capturing a piece of their health data, none of those data points connecting. No one could see the whole picture of a patient’s health. Things slipped through that should not have, a lab result that would have changed a diagnosis, a life-threatening allergy, two medications that should never have been prescribed together.
Then came a system of record. The electronic health record (EHR) structured, organized and connected those fragments into one picture of the whole person.
Before the EHR, the patient was the system. They carried their record folders from office to office, repeated their medical history for every physician, and hoped they did not forget anything. This is the job we hand our construction project managers. They are the guardians of a source of truth that is scattered across clinical, operations, IT, facilities, and a dozen consultants. They carry the folders. They repeat the history in every meeting. And things slip through, a room without the correct ventilation, a clearance nobody checked until the equipment arrived, a floor specified without knowing what rolls across it.
Patient care did not improve with a better filing system or one-off custom solutions. It improved when health systems adopted a shared system of record and committed to maintaining it. Meanwhile the design of some of the most complex, high-stakes buildings in the country is still governed by disconnected building requirements in PDFs and shared drive files.
The waste from this is real. U.S. health systems spend roughly $70 billion a year on construction, and by common estimates as much as $10 billion of that is lost to rework, change orders and construction delays that trace back to design requirements that were ambiguous, outdated, or scattered across documents that do not talk to each other. The stakes are not lower on our side of the organization. Delays and building downtime are paid for in deferred patient care, higher construction costs, and lost revenue.
What healthcare adopted was not a better document. It was a system of record, with structure, ownership and a version history. Our building requirements need the same thing. A building record that is one connected place where an organization’s design requirements live, where every requirement has an owner, and where the history of how it changed is part of the record.
Governed and reliable data is the foundation for the future and what will empower AI to support good change. It provides the context from which a machine can support complex processing and assist us in innovating within the parameters of our codes and standards. It can surface code discrepancies and uncover ways to innovate.
AI cannot tell you what your organization values, your goals and experiences. It cannot decide the quality of your environments or how you deliver care. These are decisions, judgements and context that has to be documented before any technology can use them. We must structure and govern standards first and then tools get useful fast.
How do we learn
A new carpet for the public hallways was selected and installed in a multi-phase effort that required significant coordination as it impacted every department. It wasn’t until the replacement project was completed that the nurses began to complain.
The new carpet’s backing was very thick and when the nurses pushed patient beds and heavy equipment across, it felt like quicksand. After identifying the problem, the hospital had to correct it. This resulted in another multi-phase project with work happening at night, behind barriers, with patient transport rerouted. It was expensive and disruptive, and none of it was in the planned budget.
Then the project closed out, the teams moved on, and that knowledge had nowhere to go. There was no standard to correct, because there was no standard for the existing hospital.
The next renovation at that hospital will be specified by people who may never hear this story.
Why does this happen? Because there is no receiving dock. Just like buildings need receiving docks, so does institutional knowledge. A specific place for lessons learned to land, a person whose job is to accept them, and a record of what came in and where it went. Otherwise, deliveries pile up until they are eventually lost.
The power of intention
What are we building toward? Every health system has a unique answer. A mission, values, a way it operates and maintains its buildings, a growth strategy and a master plan. Those should steer design decisions, and the decisions that result should be documented as design standards. That is how executive strategy becomes buildable.
This is why owner requirements are necessary to define. Codes tell us what is required. Guidelines tell us what is advised. Neither one can tell you that your system transports patients down that particular corridor, or that your maintenance staff is stretched thin and cannot support a finish that needs specialty care, or that you are consolidating services and will convert that unit in four years.
Standards carry your strategy into every project creating the baseline expectations. Without them, every project starts with a scavenger hunt to uncover, rediscover or recreate requirements.
I have seen standards decrease the overall construction budget by 20%. I have seen compounding improvements across projects when lessons learned are shared and applied. I have seen energy use consumption reduced, resulting in millions of savings per year, all because of purposeful leadership in how we build.
Organizations are either growing or dying. We must change the way we are doing things, because what worked to get us here is not what will move us into the next twenty years. We must be intentional with where we are going and build the foundation to get us there.
Becky Holden
Becky Holden is the founder and CEO of Kaizen Design, an enterprise software company that helps health systems collect, improve and enforce their building design standards. Her career has been dedicated to building better healthcare facilities working with top-tier organizations including Stanford Health and Cleveland Clinic Abu Dhabi.
By: Keith A. Simon, FAIA, BECxP, CxA+BE, CPHC, LEED AP, CEI, OSHA 30
A hospital may be planned to operate for over a century, but almost nothing inside it is expected to last that long.
Clinical programs can change within a few years. Mechanical equipment may be replaced every 15 to 20 years. Sealant joints can require renewal well before that. A roof may go through several replacement cycles over the life of the building, while major wall assemblies can remain in place for decades.
Those timelines do not line up. Nor do they need to. The challenge for facility leaders is designing the enclosure so its components can be maintained, repaired, and replaced on different timelines without compromising the building as a whole and without compromising indoor air quality and comfort.
Selecting an enclosure material establishes expectations for maintenance and eventual renewal. Construction determines whether the completed assembly can perform as intended. Later changes to clinical spaces or building systems can raise new questions about assemblies that remain in service.
Looking at those decisions together helps hospitals consider enclosure performance beyond the day a project is completed.
Choose materials with future renewal in mind
Selecting enclosure materials involves more than first cost and initial performance. It also determines what the hospital will need to do with those components years into the future.
Consider a low-slope roof. Depending on its materials, installation, exposure, and maintenance, it may serve a hospital for approximately 20 to 30 years. A facility expected to operate for more than a century could replace that roof three or four times. A longer-lasting assembly may be available, but at a considerably higher initial cost.
A roof that requires periodic replacement can be a reasonable choice when future access is manageable, and the work can be coordinated around hospital operations. A longer-lasting assembly may justify its additional cost where replacement would be particularly difficult or disruptive.
Sealant joints present the same consideration on a shorter timeline. A polyurethane sealant may have an expected service life of approximately five to 10 years, while silicone can last considerably longer. The choice affects how often the joint may need to be inspected and renewed. In some cases, the design itself can reduce reliance on an exposed sealant joint as the primary means of keeping water out.
What matters is understanding the future work that comes with the selected material, not simply which one lasts the longest.
Actual conditions matter, too. Expected service life is not a countdown timer. Climate, exposure, installation quality, and previous maintenance can all affect how quickly a roof, sealant, coating, or other component deteriorates. Regular assessment gives facility teams a clearer picture of the actual condition and helps inform the timing of repair or renewal.
Hospitals add another consideration: the work has must be performed around ongoing operations.
Replacing a roof or renewing exterior components may require careful planning around access, phasing, noise, and the activities taking place below or adjacent to the work. A shorter-life component may be entirely appropriate when it can be inspected and renewed with manageable disruption. Where future access would be difficult, a longer service life may be critical.
Considering these factors maximizes flexibility for a project. The hospital is not only selecting how a component will perform when the building opens. It is also determining how that component will be maintained and eventually renewed.
Performance depends on more than the materials selected
A material can have the expected service life and performance characteristics on paper, but the enclosure depends on how individual materials, systems, and assemblies work together in the completed building.
That is particularly important at transitions.
A single portion of the enclosure may involve multiple materials and trades. A wall system may connect to a window, flashing, membrane, or roofing system installed by different contractors. Each piece of work may fall within an individual scope, but the building depends on the connection between them.
Problems can arise even when individual materials perform as intended if the connections between them do not.
That is where design review, construction observation, and testing can be valuable. Design-phase review can anticipate details that do not clearly establish how materials and systems connect. Construction observation allows critical work to be examined while it remains accessible. Testing can verify whether representative portions of the completed assemblies perform as intended.
Correcting a detail while construction is underway is generally simpler than modifying concealed work after finishes are installed and adjacent areas are operational. The value lies in focusing attention on transitions where performance depends on coordination among materials, systems, and trades, rather than adding review to every piece of construction.
When conditions change, reassess the assumptions
Design and construction are not the only points when enclosure performance may need to be considered.
Hospitals change over time. Clinical spaces are renovated, equipment is replaced, mechanical systems are modified, and temperature or humidity requirements can change with a new use.
Those changes can create conditions that were not part of the original design assumptions.
On one healthcare project, two operating rooms were separated by a shared partition. Their environmental conditions could differ substantially at the same time: one room was cooled in preparation for a procedure, while the adjacent room remained warmer after its previous case. Neither condition was unusual on its own. Together, however, they created a temperature and humidity gradient across the partition that raised a specific question: where would the dew point fall within the wall, and could conditions support condensation and biological growth?
The project team evaluated the assembly by modeling over a 5-year period how heat, air, moisture, and vapor would move through it under the specific interior conditions required by the two operating rooms.
That type of durability analysis can be useful when a project introduces conditions that an existing assembly has not previously experienced. A change in clinical use, environmental setpoints, or mechanical operation may create a question that cannot be answered simply by observing that the assembly performed adequately under its previous use.
Not every renovation requires this level of analysis. Repainting or re-equipping a department without significantly changing its temperature or humidity conditions is unlikely to raise the same questions. But when a project presents an unusual combination of conditions, evaluating the retained assembly can help the team understand how those conditions are expected to affect the assembly’s performance.
Evaluating an assembly does not assume that a change in use will create a problem. In many cases, the analysis confirms that the existing construction is suitable. Where it identifies a concern, the project team has an opportunity to address it while design decisions can still be adjusted.
Keep the building enclosure in mind
Once the building is occupied, the building enclosure may be largely forgotten until a leak, failure, or renovation brings it back into focus. Decisions around interior finishes could be 5-to-10-year decisions. Decisions around mechanical equipment could be 15-to-20-year decisions. But building enclosure decisions could potentially be 100+ year decisions with dramatic future impacts regarding building performance, maintenance cost, and owner stress.
A hospital does not need to predict every future clinical use or anticipate every building modification. It can, however, recognize when a decision creates a future obligation, and when a change to the facility warrants revisiting an earlier assumption.
For facility leaders, that means looking past the initial performance of an enclosure component: understanding how it will be maintained and renewed, confirming the completed assembly performs as intended, and recognizing when changes to the hospital create conditions worth evaluating.
An experienced building enclosure consultant can help connect those decisions across design, construction, assessment, repair, and renovation—particularly when the hospital does not have that expertise in-house.
Those decisions happen at different points in a building’s life. Treating each one as part of that longer timeline gives hospitals a clearer basis for managing the enclosure as the facility continues to change around it.
For hospitals, accreditation is more than a one-time event—it’s a continuous commitment to delivering safe, high-quality care. Understanding accreditation readiness is essential to maintaining compliance and protecting the healthcare organization’s reputation.
In this article, we’ll break down what accreditation means, why it matters, and how hospitals can stay prepared—not just for surveys, but for everyday excellence.
What Is Hospital Accreditation?
Hospital accreditation is a formal evaluation process conducted by independent organizations to assess a hospital’s adherence to nationally recognized standards. These standards cover many areas of performance from patient safety and infection control to staff training, facility operations, and beyond.
The Purpose of Accreditation
Promote patient safety and high-quality care
Drive continuous improvement and operational excellence
Enhance public confidence and organizational reputation
The accreditation process results in official recognition (or accreditation status) that a hospital meets or exceeds the standards. However, accreditation is about more than passing a survey. It’s about integrating quality and accountability into every aspect of hospital operations.
Who Accredits Hospitals?
Several organizations are approved by the Centers for Medicare and Medicaid Services (CMS) to accredit hospitals, including:
Hospitals can choose the accrediting organization that aligns best with their culture and goals. Accreditation by these bodies grants what’s known as “Deemed Status,” meaning CMS accepts their survey in place of its own, as long as federal requirements are met. This streamlines compliance and helps hospitals maintain uninterrupted access to Medicare and Medicaid reimbursement.
Is Accreditation Required?
Accreditation is technically voluntary at the federal level, but in practice, it’s often essential—especially for hospitals that want to receive Medicare or Medicaid reimbursement.
In some states or for certain specialty healthcare facilities (e.g. behavioral health), it may be mandatory for licensure or insurance participation. For example, a state health department might require accreditation for hospital licensure, or an insurance provider might only contract with accredited facilities.
Core Responsibilities for Accreditation Readiness
To remain accredited and survey-ready, hospitals must:
Meet or Exceed Standards – Hospitals must comply with CMS Conditions of Participation (CoPs), which set the baseline for operating a safe and effective facility. Most accrediting organizations go further than that by incorporating clinical best practices, evidence-based practices, and quality frameworks like ISO 9001.
Adopt a Continuous Readiness Mindset – Accreditation isn’t a once-every-three-years event. Hospitals that rely on “survey prep mode” often scramble to update documents and coach staff last minute. The best-performing organizations build compliance into daily routines for continuous readiness—engaging staff regularly, updating policies, and using data to drive improvement. This creates a culture where being ready for a survey is a byproduct of doing the right thing every day.
Use Accreditation to Drive Better Outcomes
Beyond compliance, accreditation improves:
Care Quality – Achieving accreditation requires holding staff to high standards for patient care.
Operational Efficiency – A survey conducted by the Harvard Business Review found that management issues were the biggest challenges facing healthcare providers.
Liability Insurance Risks – Preparing for accreditation requires a comprehensive review of how your organization functions, and lets you see the areas where you are most at risk.
Community Trust – Accreditation shows your patients that they can trust your organization to take care of them.
Competitive Advantage – Since accreditation improves the quality of care, it also improves patient satisfaction.
The Survey Process: What to Expect
Surveys typically occur every 36 months and can be:
Unannounced (most common)
Announced (some specialty or initial surveys)
Virtual (typically used during emergencies or follow-ups)
Surveys may occur more frequently based on findings or complaints. Being survey-ready every day—not just every three years—will make the process go smoother.
Surveyors Focus On:
Documentation and Records: Policies, audits, incident reports, credentialing files
Staff Knowledge: How well team members understand policies, apply standards, and describe safe practices
Physical Environment: Life safety compliance, infection control, cleanliness
Performance Improvement: Use of data for safety and quality
The survey is not just a paper trail—it’s a full-system evaluation, assessing how well your people, processes, and environment align with your policies and accreditation standards. The survey validates both your systems and your culture.
Tools for Continuous Readiness
To stay accreditation-ready, consider implementing these tools into your everyday practices.
Mock Surveys
Simulate the accreditation visit to identify blind spots and prepare staff for interviews.
Internal Audits
Ongoing reviews of policies, documentation, and compliance, often led by internal quality/risk teams or external consultants.
Best Practices
Rotate departments and surveyors through the mock surveys and include realistic walkthroughs and questions
Offer real-time feedback and coaching
Debrief after audits and track follow-up actions
Remember: Practice doesn’t make perfect—practice makes prepared.
Common Accreditation Issues
General Hospital Challenges:
Incomplete documentation (patient records, policies, and staff training records)
Infection control lapses (improper hand hygiene and sterilization, ventilation system inefficiencies)
Medication errors (storage, labeling, and administration)
Environmental safety hazards (blocked fire exits, improper storage of hazardous materials)
Facilities-Specific Issues:
Improper maintenance of utility systems (HVAC, electrical, and medical gas)
Blocked or unsafe egress routes
Deficiencies in the building’s physical condition (damaged walls, ceilings, and floors)
Fire protection system failures (fire alarms, sprinkler systems, and fire doors)
Incomplete or missing life safety documentation and record keeping
Medical gas storage, handling, and ventilation problems
General life safety code violations (improper storage of hazardous materials, inadequate fire drills)
Final Thoughts: Keys to Accreditation Success
Accreditation readiness is a team sport—and a year-round effort. To stay ahead:
Stay up-to-date with changing standards
Train and empower your teams
Embed compliance into daily routines
Learn from mock surveys and internal audits
Keep documentation current and accessible
Ultimately, a culture of continuous readiness is what sets great hospitals apart. It’s not just about passing a survey—it’s about making safe, high-quality care your standard every day.
Want to have a deeper conversation about accreditation and how your hospital is staying prepared? Contact us to talk to one of our healthcare experts.
Author
Bill Ledger, AIA, ACHA, NCARB, EDAC, LEED AP, LSSGB
“The work we do helps caregivers be at their best—for their patients’ best.” Bill is Design Collaborative’s Healthcare Market and Studio Leader. He was one of the first architects in the state of Indiana to be board-certified in healthcare architecture by the American College of Healthcare Architects (ACHA). He is a recognized thought leader in…
By: Heather Hayes, Senior Advisor, McMillan Pazdan Smith Architecture
Healthcare organizations have more options than ever when determining where care should be delivered. New ambulatory models, growing demand for community-based care, and increasing pressure to improve access have created opportunities to expand beyond the traditional hospital campus. At the same time, health systems face mounting pressure to make every capital investment count.
Yet many site decisions are still made reactively. An attractive parcel becomes available. A retail building hits the market. A community offers donated land. Rather than beginning with a long-term strategy, organizations can find themselves asking how to make a particular property work.
Successful right-siting flips that approach. Instead of starting with the site, it begins with evaluating where care is needed, what care should be delivered, and whether a property can realistically support that vision over the long term. A successful right-siting decision places patients in the most clinically appropriate setting while also creating a convenient, accessible experience that supports the organization’s long-term goals.
That often means rethinking where services belong. As healthcare increasingly shifts toward outpatient care, organizations have opportunities to move appropriate services away from centralized hospital campuses and closer to the communities they serve. This strategy, often referred to as decanting, is one approach to right-siting, but it represents only one piece of a much broader planning process.
Every project follows a different path. One organization may have a defined clinical program and need to identify the right property. Another may already own an available site and need to determine which services make the most sense there. Regardless of where the process begins, successful right-siting requires evaluating every opportunity through the three complementary lenses of opportunity, integration and development potential. Together, they help determine whether a proposed site can truly support the care being planned.
Lens 1: Opportunity
On paper, two communities can look nearly identical. Both may be growing, have compelling market conditions, and appear to have room for another healthcare facility. Yet one may support a successful long-term investment while the other struggles to generate sustainable patient volumes.
The difference often lies beyond demographic data. Every right-siting decision begins with understanding the market that the proposed facility is intended to serve. Demographic and healthcare utilization data helps establish whether demand exists today and where it is likely to grow in the future, but it represents only one part of the picture.
Understanding opportunity also requires evaluating the competitive landscape. Organizations shouldn’t limit their evaluation to providers offering identical services because different care settings frequently compete for the same patients. A freestanding emergency department, for example, may compete with nearby urgent care centers for lower-acuity cases, while primary care practices offering same-day appointments may influence demand for urgent care services. Looking beyond one-to-one competitors provides a more accurate picture of how a proposed location is likely to perform.
Market dynamics also shape the financial picture. Payor mix can significantly influence a project’s long-term viability. A proposed facility serving a market with a high concentration of commercially insured patients may have a very different financial outlook than one serving a market with larger Medicaid or uninsured populations. Assessing those conditions early allows planning teams to evaluate financial feasibility before committing to a site.
Lens 2: Integration
A favorable market doesn’t automatically justify every healthcare service. The next step is determining how a new facility fits into the broader healthcare ecosystem. Every location should strengthen the health system by delivering the right services in the right place, supporting referral relationships and complementing, rather than competing with, existing assets.
This distinction has become increasingly important as health systems expand care beyond the traditional hospital campus. Lower-acuity, higher-volume services are often strong candidates to move into community-based settings, improving convenience for patients while allowing hospitals to focus on more complex inpatient and procedural care. Decanting can be an effective right-siting strategy, but it should be driven by clinical appropriateness and long-term system goals rather than simply the availability of real estate.
Referral patterns provide another way to evaluate how a new facility fits within the broader health system. While demographics identify where potential patients live, referral patterns reveal whether those patients are likely to enter your health system or seek care elsewhere. Examining where physicians are referring patients today and whether those referrals remain within the health system or leave for competing providers can uncover opportunities to strengthen physician relationships, reduce volume leakage and improve patient access before a project ever moves forward.
Planning teams should also be cautious about assuming that favorable demographics alone will support a new service line. A market may appear to be an ideal location for an ambulatory surgery center, for example, but still lack the physician alignment or referral network needed to sustain procedural volumes.
A primary care clinic may generate relatively modest direct revenue while creating significant downstream value through imaging, specialty care, procedures and inpatient services across the health system. Evaluating the service mix requires understanding not only how an individual facility will perform, but also how it contributes to the organization’s broader continuum of care.
Lens 3: Development
A promising market and a service mix that strengthens the health system don’t automatically make a site the right choice. The final question is whether the right facility can be successfully built and operated there. Even the strongest strategic plan can be undermined if the property itself can’t support the intended program.
Different types of care have different requirements. Consumer-oriented services, such as primary care, urgent care and imaging, depend heavily on convenience. Patients are typically willing to travel only 15 minutes or less for routine care, making visibility, accessibility and proximity important considerations. Higher-acuity services, including surgery and specialty care, are often more referral-driven, allowing patients to travel farther when the clinical need warrants it. Those differences should shape not only the services offered, but also how a site is evaluated.
Some of the most important questions aren’t always obvious during an initial site review. Will patients be able to access the facility easily? Is there adequate parking? Can utilities support the planned level of clinical care? Is there room for future expansion? Answering those questions during site selection helps teams avoid costly surprises later in design and construction.
Other challenges may remain hidden until due diligence is underway. Steep topography can significantly increase grading costs, while poor soil conditions may require expensive foundation systems. Wetlands, streams, easements and stormwater requirements can all affect where a building can be placed and how the site functions, and utility limitations may require costly infrastructure improvements before construction can even begin. Individually, these issues may seem minor. Together, they can fundamentally change a project’s feasibility.
One recent community hospital planning effort illustrates why early site evaluation is so important. An initial conceptual site plan appeared workable, but a closer review identified streams crossing the property, significant tree preservation requirements, steep grades, variable soil conditions and utility limitations. Rather than moving forward with the original concept, the planning team adjusted the building location and site strategy to improve circulation, minimize environmental impacts and better accommodate long-term operations. Addressing those challenges during planning helped avoid more significant issues during design and construction.
Site feasibility is also about planning beyond opening day. A property may support today’s program but leave little room for future growth. Evaluating usable acreage, circulation, parking and infrastructure capacity early helps ensure a facility can adapt as patient volumes, services and community needs evolve.
The Right Site Requires the Right Balance
The real challenge isn’t evaluating opportunity, integration and development potential independently. It’s determining what to do when they point in different directions.
A market may demonstrate strong demand, but the proposed service may not align with how patients access care. A well-planned clinical program may meet a genuine community need, yet the site itself may introduce constraints that affect long-term feasibility. When one lens falls out of alignment, planning teams should pause to understand why before moving forward. Ideally, each lens reinforces the others, providing confidence that the project is positioned for long-term success.
That evaluation requires input from multiple perspectives. Clinical leaders determine the most appropriate care setting. Strategy leaders evaluate market opportunities and long-term organizational goals. Operational leaders assess whether a facility will function effectively day to day. Architects, engineers and facilities professionals evaluate whether a site can realistically support the intended program, while planning partners contribute lessons learned from similar projects and an objective perspective.
Healthcare organizations will continue facing pressure to expand access, improve patient experience and invest capital wisely. Those realities make right-siting more important than ever.
By evaluating these three lenses together, organizations can make more confident decisions that position facilities to serve patients and communities for years to come.
After all, the most successful projects don’t begin with a property. They begin by having a clear strategy.
About The Author
Heather Hayes, MHA, is a senior advisor with McMillan Pazdan Smith Advisors, helping healthcare organizations make smarter capital investments through data-driven decision-making and community-aligned strategy. From market assessments to service distribution planning, MPS Advisors works at the intersection of design and strategy to help clients right-size facilities, align operations with future demand, and bring stakeholder priorities into focus. Learn more at mcmillanpazdansmith.com
I’m still coming down from the energy of Charlotte.
After months of planning, the Symposium flies by in three very full days. And now that I’ve had a minute to breathe, I keep coming back to the same thing: the people made this one special.
Our Advisory Board’s AI keynote was definitely a highlight. Instead of simply talking about what AI could mean for healthcare facilities, they showed us, exploring how it can impact a project from planning and design through construction and operations. Watching our own Advisory Board tackle something so new and complex together was exactly what the Symposium is about: different perspectives, honest conversations and learning from one another.
I also loved seeing our Emerging Leaders making their voices heard. They weren’t just there to listen. They were asking questions, sharing ideas and becoming part of the conversations shaping our industry. Seeing that next generation connect with longtime industry leaders was pretty incredible.
And there was no shortage of networking. Everywhere I looked, people were talking, reconnecting, making introductions and exchanging ideas. I’ve always believed some of the best Symposium moments happen in the hallways, over coffee or during an unexpected conversation, and Charlotte proved that once again.
I’m also incredibly proud that our community came together through the raffle to support Hospitality House of Charlotte and give something back to the city that welcomed us.
To everyone who joined us in Charlotte, thank you. You didn’t just attend, you participated, shared and helped create the energy that makes this community so special.
I’m leaving Charlotte incredibly grateful, very proud and already excited about what we’ll create together next.
By Gina Chang, AIA, EDAC Principal, CO Architects, Los Angeles
Two million Americans will be diagnosed with cancer this year—about 5,800 people a day. The number keeps climbing, although not because the disease is getting more common: we are living longer, and we are finding it earlier.
The risk of dying has declined by a third since 1991. For most, cancer is becoming something closer to a chronic condition, and people are coming back for years: for surveillance, for maintenance therapy, for survivorship. The disease is also shifting. It still falls hardest on older adults, but colorectal cancer is now the leading cause of cancer death among adults under fifty, with rates climbing 3% a year. Breast cancer is rising in women under 50. Nobody can yet say what is causing younger people to have cancer.
Architects are not solving the cancer crisis. Our clients are, with clinical care, research, and therapies that did not exist when their current buildings opened. What we do as healthcare architects is make our clients’ mission buildable and flexible. We design not just for the technology, which changes faster than any building can, but for the whole person who walks in: their capacity to heal, to sustain a longer fight, and to go on living well with a disease they may carry for years.
Every organization tackles cancer differently. Our job is to listen hard, find their unique approach, and equip them. We think about the design of cancer centers through a journey from far to near, across four scales. Our recently completed work tells this story: Hope Plaza at City of Hope, the Chao Family Comprehensive Cancer Center at University of California, Irvine, the Koman Family Outpatient Pavilion at University of California, San Diego, and other projects along the way.
XL — WHERE IS IT?
We rarely choose the site. We read it.
Every cancer center starts as a strategic decision. A health system identifies a regional need, a gap in access, a population it is not reaching, and it selects a site. We are often not in that room. What we can do is read the selected site—for what it offers, and for what the building might give back.
The Chao Family Comprehensive Cancer Center and Ambulatory Care Center sits on greenfield land at the new UCI Health – Irvine campus, a specialty medical center organized around oncology, neurology, and orthopedics, plus an emergency department so that the facility also serves the local community.
Strategically, UCI Health – Irvine extends the university’s reach into a growing part of Southern California. Physically, it sits at the edge of the San Joaquin Marsh, a natural preserve and wildlife sanctuary threaded with trails that connect back to the academic campus—a connection that matters to clinicians, researchers, and students who move between the two on foot or on a bike, through a wetland.
The Marsh is the muse.
Patients arrive from busy six-lane Jamboree Road, and the approach delivers them a straight-shot view to greenery and water. The intent is that blood pressures begin to drop in the car, and keep lowering as people walk into the building.
Every patient room has a view. An infusion terrace overlooks the marsh, putting the breeze and the changing light into the treatment itself. The flora and fauna shift through the year, and the biodiversity and seasonal variation are what the biophilic research actually measures. The marsh is also an argument for the first all-electric hospital in the nation. When the case for planetary health is sitting outside every window, a building that burns fossil fuel is hard to defend. And the exchange runs both ways, as water from the facility is treated and returned to the marsh, guided by UCI’s biologists.
Opened mid-2024, the UCI Health Chao Family Comprehensive Cancer Center has received positive reviews. Our client, UCI Health, its patients, and the industry celebrate the building, which was recognized by Becker’s Hospital Review as housing one of the nation’s top cancer programs.
Hope Plaza at City of Hope’s suburban Los Angeles site sits in a very different condition, an established campus that has been growing for more than a century, where the new building slots into an existing fabric and connects to its neighbors by bridge. Strategically it is a consolidation—a hub that gathers outpatient services into a single destination, so a patient has one stop.
Hope Plaza sits at the end of the main campus arrival down Hope Drive. Its front yard is the Ted Schwartz Family Hope and Healing Park, a fountain that adds water sounds, and an award-winning parking structure whose kinetic façade ripples and gives visual character to wind. City of Hope has a long tradition of gardens as a way to calm patients and welcome the surrounding community, with events and traditions that keep that culture alive.
The building takes its cue from the oldest gift of the site: the San Gabriel Mountains, and the clean, arid air moving off them that originally made this the site of a tuberculosis sanatorium. The north face is fully glazed, giving the longest views to the longest visits—infusion. The clinic floors get exterior views too, deliberately for staff with long days.
L — WHAT IS IT MADE OF?
Identity in front, flexibility behind.
A cancer center has to be a place with a name. A breast center, a lung center is somewhere a multidisciplinary team sits around a disease, and that place’s name lets a frightened person know they are in the right room.
But designing around named centers can restrict growth, change of use, and full utilization in a field this unpredictable. At UCSD, COO Brendan Kremer described what he wanted as the Disneyland concept: everything the guest sees is curated and particular, everything behind is a machine that can work for any specialty. Identity onstage, flexibility offstage. This conversation led us into our first clinic module study at that level of rigor, and has shaped every cancer center we have designed for the past decade.
Design the module to work for any name on the door.
Every cancer clinic needs roughly the same program pieces: exam, infusion, treatment, and multidisciplinary team space. The Koman Family Outpatient Pavilion at UCSD Health organizes its clinic from front to back—onstage to offstage, which keeps the two flows separate and allows the clinics to expand and contract from side to side based on the day’s needs.
Chao at UCI Health uses a different approach, a two-door exam room. The patient enters from the public corridor, the care team from the back, off a large, shared bullpen with direct access to each room. Physicians, nurses, residents, and students work in one space together without the worry of patients overhearing private clinical conversations. This academic model is less flexible than Koman’s front-to-back arrangement but offers something else—a teaching floor where the whole team, students included, is in one room. That was the priority for UCI Health.
Then organize the models in the way the organization works.
Hope Plaza’s clinics sit on a large floor plate, which is efficient to build and punishing to walk. Dividing the floor into four quadrants around a central elevator core shortened the distance from elevator to exam room—which matters here, for a patient population that overwhelmingly has mobility challenges. Treatment rooms sit between adjacent quadrants, so two specialties can share a bank.
At Koman, the client wanted centers of excellence on a single floor: part clinic, part infusion, part imaging. That is less flexible than an arrangement built to change constantly, and it was the right trade. Placing all these program parts on the same level made each center feel comprehensive with clear identity. They are still built from modules. A tenant can change and keep clinic and infusion side by side, or clinic can be converted to infusion without much trouble, because the rooms are a standard size and the pods are a twelve-room arrangement.
Infusion deserves its own attention, because it is where the change is fastest. Straightforward chemotherapy is moving outward—to community clinics, to unlicensed sites, in some cases to the home. What stays at the academic center is the complexity: cell and gene therapy, theranostics with their shielding requirements, patients immunocompromised enough to need an enclosed room with a dedicated toilet.
That argues against a single floor of identical bays. It argues for a suite with variety built in—open bays, enclosed rooms, rooms with dedicated toilets, rooms with lead lining—arranged so that whatever is not needed for its highest purpose today can absorb overflow from something else. Variety is what makes it flexible.
M — HOW DO YOU MOVE THROUGH IT?
Design the flows, then test them.
Healthcare is defined by movement. In cancer we refer to the patient journey, which starts long before patients enter a building. Within the building, they go through entry, diagnostics, a waiting room, a clinic, and sometimes a longer stay in a patient room or an infusion chair. We must pay a good amount of attention to the paths between these spaces, because often this is where the damage happens: getting lost, getting tired from too many steps, or errors in transport or delivery.
Our approach is, before a plan is fixed, we simulate it with movement. Our in-house-built tools have advanced each project, and now incorporate AI to mimic random human behavior, simulating real usage of the building. We map flows on the plan and run them over and over to see where the problems pop up.
Here we follow three paths.
The patient. Koman is a one-stop shop, which means it holds the whole cancer journey and the paths inside. Follow a woman coming in for breast surgery. She reports to her center’s front door, and the staff take her from there—into treatment for a needle localization, then through back-of-house elevators to surgery, then out a discrete exit for post-surgical discharge. At every one of those transfers, she is handed off in a vulnerable state. When that many people have to touch a patient, the path has to be considered as carefully as the rooms are.
The cells. Chao made a newer demand. In cell and gene therapy, the cells come from the patient, go to the lab to be processed, and are returned to the patient in a different department. That is a chain of custody with a clock on it. Modeling that cell’s route is what argued for keeping it entirely inside the building: fewer handoffs, fewer opportunities for error, less time lost, and quality control that never leaves anyone’s sight. The clean-room labs are embedded in the clinical building, so the cells never leave. Of equal importance, the physician and the researcher are in the same building, treating the same patient, as a person and not a sample.
The staff. At Harbor-UCLA, the staff had a preconceived idea that consolidating many separate buildings into one new outpatient building would mean more walking. As an aging and short-staffed population, it was a reasonable concern.
We had the staff measure their existing steps on their Apple watches and compare it against the modeled distances in the new-building plan. The conversation stopped being about anxiety and became about numbers. Once we proved that the difference in steps was minimal, the conversation focused on how to further reduce steps within the building through strategic placement of supply and med rooms.
What simulation made possible. The simulation method made a truly innovative idea a reality. UCI Health’s surgical director, Mara Rosalsky, wanted inpatient and outpatient surgery combined into one integrated system, not just connected by bridges. This would result in a floorplate of 160,000 square feet (about the size of three football fields) and require a complex orchestra of movement, resulting in a very high-performing surgical department. At that scale, operating rooms and pre-/post-op bays could be grouped in a flexible and efficient way to maximize utilization, particularly of the surgeons. A surgeon is among the scarcest resources in medicine, and a design that would allow surgeons to do inpatient and outpatient procedures in the same day greatly increases their flexibility in scheduling.
Sterile processing gains even more. Instrument sterility is a matter of obvious consequence. A single large, well-stocked department can hold a standard that several small ones cannot.
The same is true of supply. Surgery is urgent work, and in-the-moment waste is a reasonable trade—but it accumulates, and a just-in-time-picking process around a central supply room reduces incredible waste.
Simulated over many iterations and many months of modeled operation, the plan paid off in a number: the operating rooms opened at 76% utilization, measure in the health system’s own EHR records. That is close to ideal—high enough to be efficient, with enough slack left for emergencies and last-minute add-ons. It also started operating profitably immediately, funding the next operational improvement.
S — WHAT DOES IT FEEL LIKE?
Giving choice back
A cancer diagnosis takes away control from a person. They become forced participants, and this layered further with anxiety. At the smaller scale, a space can hand back some choice where it’s noticed, when people take a minute to pause.
At Chao, an infusion patient can stay at her bay, go to the family lounge to be around people, or take her treatment outside on the terrace. That is a real choice, made differently on a hard day than an easy one, and it costs the patient nothing. The building makes choice and variety part of its design.
At Hope Plaza, the choice sits in the garden, in a collection of different spaces—shaded or open, solitary or social, near art or away. Waiting is the largest untreated interval in a cancer patient’s day, and a garden with variety turns that interval into positive distraction. It works on all people. Dr. Stephen Forman, Director of T-Cell Therapeutics at City of Hope, wrote to tell me he often goes there to reflect after a long day.
At the University of Arizona’s Peter and Paula Fasseas Cancer Center, the little things do the work along the journey. Courtyards are spaced between the clinics and are encountered every so often, not as a single destination that requires a decision and a walk. Instead, daylight and greenery arrive repeatedly, giving eyes and minds a break between high-tech spaces. At Chao, the yoga deck at the marsh edge is the same idea at full scale.
Staff need restorative space too, and they seldom ask for it. A person delivering oncology care spends the day absorbing people’s worst news, and there is nowhere in a clinical corridor to rest that. UCI Health has lavender rooms dedicated for Code Lavender, the emergency response to acute staff distress, away from the nurse stations for immediate decompression. Staff-only floors with dedicated terraces allow for outdoor respite where no one is watching. For staff who walk into stressful situations every day with a supportive smile on their face, the case for healing interventions is critical to life itself—the life being saved, and the lives spent saving it.
Built to Outlast the Medicine by Designing for the Humanity
A cancer center takes years to design and build, then stands for decades. The therapies it houses change several times in that lifetime. It’s not an oversight; no one saw CAR-T coming, and no one knows what will come next. Hence, the building must be designed around the things that don’t change: that people arrive frightened, that movement has to preserve dignity, and that someone who works there for decades can still enjoy showing up to work.
A cancer center needs to flex, because the clinical program will.
It has to flow, because the paths determine the patient experience and the staff experience.
It has to heal, because a person fighting cancer draws from many reservoirs to heal—physical, mental, social, spiritual—and needs to access all of them to gather strength to fight a lifelong relationship with cancer. Cancer care is a marathon.
It has to be a place people want to work, because the scarcest thing in oncology is not technology, space, or brilliant ideas, it’s people.
None of that comes from a template. The answer comes from a process—deep listening to an organization’s mission, deep understanding of what the site has to offer, then testing the answer until it is solid enough to build. Every institution attacks cancer differently. Our job is to find out how, and build the space that makes it happen for years to come.
Author
Gina Chang, AIA, EDAC, Healthcare Architect
Gina Chang is a healthcare principal at Los Angeles-based CO Architects who has successfully led large teams through ambitious project goals. With more than 20 years of experience, Gina understands the complex and unique nature of healthcare projects. She is an advocate for evidence-based design and sees each project as an opportunity to create an environment for healing and wellness. Gina joined CO Architects in 2007 as a medical planner and project coordinator for Palomar Medical Center. She has since held key leadership roles on major healthcare projects, including UCI Health – Irvine and City of Hope’s Hope Plaza. Gina holds a Bachelor of Arts in Architecture from the University of California, Berkeley, and is EDAC certified.
UCI Health – Irvine view from the San Joaquin Marsh. Photo: Tom Bonner, Courtesy CO Architects
02-Cancer Care Trends
UCI Health – Irvine Chao Family Comprehensive Cancer Care Center’s infusion family lounge and Clemons Family terrace. Photo: Tom Bonner, Courtesy CO Architects
03-Cancer Care Trends
UCI Health – Irvine AI-optimized circulation modeling. Courtesy CO Architects
04-Cancer Care Trends
CO Architects / City of Hope Dwarte / Hope Plaza / Photography by Tom Bonner / Inv 7101
City of Hope’s Hope Plaza kinetic-façade parking garage and outpatient building. Photo: Tom Bonner, Courtesy CO Architects
05-Cancer Care Trends
CO Architects / City of Hope Dwarte / Hope Plaza / Photography by Tom Bonner / Inv 7101
City of Hope’s Ted Schwartz Family Hope and Healing Park at Hope Plaza. Photo: Tom Bonner, Courtesy CO Architects
06-Cancer Care Trends
Hope Plaza infusion with San Gabriel Mountains view. Photo: Halkin Mason
07-Cancer Care Trends
CO Architects UCSD OPP Photography by Tom Bonner – Job ID 6341
UCSD Koman Family Outpatient Pavilion’s modular floor plan design. Photo: Tom Bonner, Courtesy CO Architects
Hospitals were once designed around the assumption that utility outages would be rare, localized, and short-lived. That assumption no longer holds.
Today’s healthcare facilities operate in a different environment. Outages last longer. Public Safety Power Shutoff events occur with little warning. Extreme weather, seismic activity, and regional disruptions can affect both electricity and fuel supply. At the same time, hospitals themselves are becoming more dependent on electricity. Clinical technologies consume more power, building systems continue to electrify, and expectations around air quality and emissions are rising.
These pressures are changing how hospitals think about on-site power and how they define resilience.
In most buildings, a power outage is a disruption. In a hospital, it is a clinical event. Every interruption can affect patient care, clinical workflows, environmental controls, digital systems, and life-safety infrastructure. As a result, healthcare organizations are beginning to shift away from viewing on-site power solely as emergency backup and toward treating it as part of a broader continuity strategy.
From backup power to coordinated on-site generation
For hospitals, on-site power has traditionally been framed around emergency backup: the grid fails, generators start, and life-safety systems remain online. That function is non-negotiable.
But the conversation is expanding.
The question is no longer just, “What turns on when the grid goes down?” It is, “How should the hospital produce, store, manage, and prioritize power across normal operations, brief disruptions, and extended events?”
A layered system helps answer that question by assigning different roles to different technologies.
For continuity in the first seconds
At the onset of a disruption, the priority is stability. Battery energy storage or uninterruptible power systems can support voltage and frequency, allowing sensitive clinical equipment, IT systems, and controls to continue operating while the facility transitions away from grid power or moves onto backup sources.
This layer is not about carrying the hospital for hours. It is about making the transition nearly invisible, where even a momentary interruption can affect care, data, controls, or diagnostics.
For code-required emergency response
Emergency generators remain central to hospital resilience. Healthcare codes such as NFPA 110 and CSA Z32 require rapid power restoration to life-safety and critical systems, and generators are designed to meet those timelines.
Diesel remains the most widely accepted option because it is proven, code-recognized, and familiar to facility teams. But it also comes with fuel storage, fuel logistics, emissions, air quality considerations, testing, and maintenance demands.
Natural gas reciprocating generators can start quickly and eliminate the need for on-site diesel storage. They may support longer runtimes where gas services remain available, though they introduce dependency on utility gas infrastructure and carry their own emissions and maintenance requirements.
For longer outages and daily energy strategy
As outages extend, the conversation moves from response to endurance. Fuel cells, combined heat and power, or other steady generation sources can help carry base load, while batteries help absorb short-term changes in demand.
This is where on-site power begins to move beyond backup. These systems may support resilience during an outage, but they can also contribute to normal operations, demand management, energy cost control, and carbon reduction.
Fuel cells can provide quiet, efficient, scalable power with lower local emissions than many combustion-based systems. Natural gas or renewable natural gas units can reduce carbon impact, while hydrogen fuel cells offer a pathway to zero local emissions where low-carbon hydrogen and supporting infrastructure are available.
Combined heat and power can support continuous electric output while also producing useful thermal energy for heating, hot water, or other campus loads. It can improve efficiency and operating economics where hospitals have steady thermal demand, but the benefits depend heavily on load profile, fuel costs, emissions goals, and operating strategy.
For lower-carbon contribution and future firm power
Renewable sources such as solar PV and small wind turbines can reduce purchased electricity and support decarbonization goals where site conditions allow. Their role is usually contributory rather than primary because output depends on weather, available space, interconnection limits, and storage capacity.
The value of a layered strategy is that it gives hospitals more ways to respond. A brief grid disturbance may require only a seamless transition. A multi-hour outage may require load prioritization and fuel management. A prolonged regional disruption may require the hospital to operate more like an independent energy system.
That is why on-site power planning is moving beyond backup. The same systems that protect clinical continuity during an outage can also help hospitals manage daily energy performance, prepare for electrification, and adapt to changing emissions requirements.
Microgrids as an organizing framework
The growing use of multiple power sources has brought increased attention to microgrids. In healthcare, a microgrid is best understood as a control framework rather than a standalone technology.
A microgrid coordinates multiple on-site energy assets so they can operate together, isolate safely from the utility grid when necessary, and prioritize critical hospital operations during disruptions. It does not replace emergency power systems or eliminate the need for generators. Instead, it connects and manages the systems hospitals already rely on while allowing additional technologies to contribute strategically.
Within a healthcare microgrid, generators continue to provide code-required emergency power and extended contingency support. Battery energy storage systems stabilize transitions and maintain power quality for sensitive clinical equipment. Fuel cells and combined heat and power systems deliver steady base generation with reduced reliance on stored fuel. Renewable energy systems contribute supplemental generation where site conditions and climate allow.
The value lies in coordination.
Coordination also opens the door to a benefit beyond resilience: peak shaving and load shifting. As utility power becomes more expensive, on-site generation gives hospitals a way to manage electric bills alongside continuity. This matters especially in markets like California, where rate structures include demand charges tied to peak usage. Running battery systems during the day, when utility power is most expensive, reduces draw from the grid during high-cost windows. Recharging those batteries at night, when rates are lower, shifts consumption to periods with lower charges and helps facilities stay under peak demand thresholds. The same infrastructure that supports clinical continuity during an outage can also reduce operating costs during normal operations.
Regulatory developments are also making this approach more accessible. The introduction of 2023 NFPA 70 (NEC) Article 517.30(B)(4) reflects growing acceptance of healthcare microgrids within compliant emergency power strategies. Unlike previous code cycles, the new provision acknowledges microgrid applications in healthcare environments, where emergency power systems must support distinct life safety, critical, and equipment branches.
Coordination with Authorities Having Jurisdiction remains essential, but the shift signals broader recognition that hospitals can plan beyond a single generation source while maintaining regulatory compliance.
For healthcare organizations, this creates a more flexible path forward. Systems can be expanded in phases, adjusted as technologies mature, and adapted to evolving operational and regulatory requirements without compromising continuity of care.
What effective resilience planning looks like
Healthcare organizations navigating this transition successfully tend to begin with operational priorities rather than equipment selection.
That discipline matters because hospitals are being approached from every direction with potential solutions: generators, batteries, fuel cells, microgrids, renewables, and emerging technologies. Many of these options are valuable. But when teams are under pressure to improve resilience, reduce emissions, manage costs, and keep facilities running, it is easy for the conversation to move too quickly toward a specific technology before the larger operational need is clear.
Effective planning creates room to step back.
It starts by identifying which clinical functions must remain continuously operational, which systems can tolerate brief interruption, and how long the facility must sustain independent operation during a disruption. From there, infrastructure strategies can be phased and aligned with actual needs.
Early coordination is essential. Bringing utilities, engineers, facilities teams, and regulatory authorities into planning discussions early helps preserve flexibility and avoid constraints that become costly to address later.
Many organizations adopt phased implementation strategies. Rather than pursuing large, single-stage overhauls, they build resilience incrementally by modernizing generator infrastructure, adding battery storage, or introducing microgrid controls as part of ongoing capital programs. This approach allows systems to evolve alongside changing regulations, technology, and clinical demand without disrupting patient care.
Financial planning has become part of the resilience conversation as well. Hospitals now evaluate how on-site power investments affect downtime risk, fuel dependency, operational continuity, and future infrastructure costs rather than viewing power systems solely as compliance requirements.
The organizations that navigate this most effectively treat power as clinical infrastructure: systems that directly support continuity of care and require the same long-term planning discipline as any other critical healthcare asset.
Looking ahead
Hospitals operate in an environment defined by uncertainty. Grid conditions, clinical demands, regulatory frameworks, and sustainability goals will continue to evolve. On-site power systems must evolve with them.
Emerging technologies, such as microreactors, will also shape this conversation over time. They are not part of near-term healthcare planning, but they point to where resilience is heading: cleaner sources that can deliver firm power to large, energy-intensive campuses.
Layered strategies and microgrid frameworks offer a practical path forward. They build on proven technologies, preserve compliance, and create room for change. Most importantly, they support the fundamental mission of healthcare facilities: delivering continuous care, regardless of conditions outside the building.
In healthcare, resilience is ultimately measured by one outcome: whether care continues uninterrupted when conditions outside the hospital become uncertain.
When people think about designing a new healthcare facility, they often picture floor plans, renderings, and construction schedules.
Those are all important, but the most successful healthcare projects begin long before design. They begin by understanding the people who will use the building.
That was certainly true for Rush Memorial Hospital’s Milroy Clinic. While every community is different, the lessons from this project apply to nearly any rural healthcare organization planning a renovation, replacement facility, or new clinic.
The building wasn’t the starting point. The community was.
Design Should Solve Problems Before They’re Built
Healthcare projects are full of decisions. How large should the building be? How many exam rooms do we need? What should the patient experience look like? Those are important questions, but they shouldn’t come first.
Before any design began for the clinic, Rush Memorial Hospital had already invested time learning about the community they were serving. They understood the local market, recognized the opportunity created by a retiring physician, and saw the importance of maintaining healthcare access for residents who preferred receiving care close to home.
Just as importantly, they spent time listening.
Hospital leadership met with community stakeholders, local businesses, emergency responders, and members of the local Amish community to better understand how people lived, worked, and accessed healthcare.
That research gave us something far more valuable than a programming spreadsheet. It gave us context. As architects, that’s one of the greatest gifts a client can provide.
Every Community Has Its Own Definition of Access
When we talk about improving access to care, it’s easy to focus on distance alone. In reality, access is much more personal.
For some patients, it’s having parking that feels safe and easy to navigate. For others, it’s minimizing the amount of time a family member has to take off work to drive them to an appointment. In Milroy, it also meant recognizing that not every patient arrives by automobile.
Conversations with the local Amish community revealed practical needs we never would have understood by looking at demographics alone. The site needed accommodations for horse-and-buggy transportation, bicycle access, and clinic hours that aligned with the schedules of local business owners.
Those aren’t architectural features someone adds to a checklist. They’re responses to listening.
Human-Centered Design Isn’t a Trend
Human-centered design has become a popular phrase, but at its core, it’s really about one thing: creating environments that support people. That includes patients, families, providers, and staff.
Throughout the Milroy Clinic, every design decision was measured against that objective.
Could patients easily find their way through the building?
Would providers be able to maintain eye contact while documenting patient information?
Did staff have efficient workflows that reduced unnecessary travel?
Would patients feel welcomed instead of intimidated?
These questions shaped everything from the layout of the nurse stations to the organization of exam rooms and circulation paths.
Good healthcare design isn’t about making a building look impressive. It’s about making care easier to deliver.
Small Decisions Have a Big Impact
One of the things I appreciate about healthcare design is that seemingly small decisions often have the greatest impact on the patient experience.
Natural daylight reduces stress.
Clear sightlines improve communication between caregivers.
Larger restrooms make it easier for caregivers to assist patients.
Wider parking spaces improve accessibility long before someone reaches the front door.
None of these decisions dramatically change the project budget. Together, however, they significantly change how people experience the building. That’s where thoughtful design creates lasting value.
Right-Sized Doesn’t Mean Less
Rural healthcare organizations understand budgets better than anyone. Every square foot matters.
Rather than beginning with a standard clinic prototype, we worked with Rush Memorial to create a facility that reflected how their providers actually deliver care and how their community actually uses healthcare.
That’s what we mean by right-sizing.
It’s not simply making a building smaller. It’s ensuring every space has purpose, supports operations, and contributes to a better patient experience.
When every square foot works harder, organizations can invest more strategically in the features that matter most.
The Building Continues Teaching After It Opens
One of the most valuable parts of any project happens after occupancy.
No matter how much planning goes into a building, there’s always something to
learn once patients and staff begin using it every day.
For the Milroy Clinic, those lessons included adding automatic door operators to better support patients with wheelchairs, walkers, strollers, and car seats. The team also discovered that generous storage—which initially seemed impossible to fill—created opportunities to improve inventory organization through better systems rather than additional space.
Even small observations became valuable feedback for future projects. That’s one of the reasons post-occupancy conversations are so important. Good design continues to evolve through experience.
The Best Design Begins with Listening
The Milroy Clinic received recognition by AIA Indiana for its design, but awards were never the goal. The real measure of success is that the community embraced it.
Patients felt comfortable walking through the doors. Providers gained a workplace designed around how they deliver care. Staff benefited from efficient workflows. Community members saw their input reflected throughout the finished facility.
None of that happened because of architecture alone. It happened because design was informed by listening.
As architects, we can design beautiful buildings. But when we understand the people those buildings are meant to serve, we create environments that improve care, strengthen communities, and continue delivering value long after construction is complete.
That’s where the best healthcare design begins.
Great healthcare design starts with listening. If you’re ready to create a facility that reflects your community’s needs, supports your caregivers, and delivers lasting value, connect with our team to discuss your vision.
Author
Bill Ledger, AIA, ACHA, NCARB, EDAC, LEED AP, LSSGB
“The work we do helps caregivers be at their best—for their patients’ best.” Bill is Design Collaborative’s Healthcare Market and Studio Leader. He was one of the first architects in the state of Indiana to be board-certified in healthcare architecture by the American College of Healthcare Architects (ACHA). He is a recognized thought leader in…
It’s hard to believe we’re already talking about Symposium season again.
Every year around this time, the excitement starts to build, but this year feels a little different. Registration for Charlotte has been incredible, and we’re seeing more people signed up at this point than ever before.
That’s exciting for our team, of course, but what I love most is what it says about our community.
Healthcare facilities professionals are busier than ever. There are projects to manage, budgets to balance, deadlines to hit, and new challenges around every corner. The fact that so many of you are making time to come together in Charlotte tells me that learning, sharing ideas, and connecting with peers is still incredibly important.
One of the things I’ve always loved about the Symposium is that it’s not just about the sessions or the exhibit floor. It’s about the conversations that happen in between. Sometimes the best idea you’ll take home isn’t from a presentation. It’s from a chat with someone over coffee, a chance meeting in the hallway, or a conversation with an exhibitor who understands exactly what you’re trying to solve.
As attendance continues to grow, those opportunities grow, too.
We’re putting the final touches on what I know will be a fantastic event. You’ll find industry-leading education, innovative products and solutions, and plenty of chances to connect with people who truly understand the challenges and opportunities shaping healthcare facilities today.
And let’s be honest, there is something energizing about being in a room full of people who are all working toward the same goal: creating better healthcare environments for patients, caregivers, and communities.
If you’re already registered, thank you. We can’t wait to welcome you to Charlotte.
If you’re still thinking about it, I’d encourage you to join us. The momentum around this year’s event has been amazing, and it’s shaping up to be one of our biggest and best Symposiums yet.
I can’t wait to see so many familiar faces, meet plenty of new ones, and spend a few days learning together this September.
By Jamie Raymond RID, EDAC, LEED AP Partner, Four Point Design, Indianapolis
As the saying goes, a picture is worth a thousand words. While artificial intelligence tools can generate graphics in a matter of seconds, designers continue to appreciate the time, effort, and craft that goes into quality photographs of the built environment. The following are four factors design and construction firms should consider when engaging photographers to capture images of their healthcare projects.
Purpose
At Four Point Design, an interior design firm based out of Indianapolis and doing work around the country, we’re committed to quality photography to tell the stories of the spaces we design. While we regularly take out our phones and snap photos for documentation during the design and construction process, professional photography is a must. Whether we’re doing a case study or interviewing for a similar potential project, we need images that capture the essence of the interior environments, their purpose, and how they support the owner’s needs.
People
There was a time when architectural photography rarely included people. However, in recent years, the team has seen a shift, with more firms including the human element in their imagery.
While this takes a bit more coordination, it’s a change we’ve embraced, because as interior designers, we’re creating spaces for people. By incorporating people into our project photography, we activate the space, show its scale, and demonstrate how the environment will be used in real life. For example, during a recent photo shoot for IU Health Fishers in Indiana, designed with architecture firms HKS and MSKTD, we included moms-to-be for the women’s health services photographs and IU Health team members in the caregiver areas.
Process
Getting great photos requires an intentional, thoughtful, and respectful process.
We meet with our design partners to talk about the project’s goals and key components and generate a list of angles. We start at the front door and consider the patient journey as they move through the space. From showing the overall flow to zooming into details, we consider how we’re telling that story.
While we have the privilege to design the spaces, we are still guests in our owner’s facilities. A critical part of the process is planning and coordinating with the facility owner so that—on photo shoot day—the team is sensitive to any existing operations happening in the building.
Placement
From the angle of a chair to which desktop items are shown and how they are situated, details matter and affect what becomes the focus of an image. Taking care of the placement of items before the photo is taken results in less editing later.
We appreciate working with photographers who invite us to—quite literally!—look through the lens to make sure the scene is on point and supports the healthcare organization’s strong brand and the design team’s high standards.
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Bill Ledger, AIA, ACHA, NCARB, EDAC, LEED AP, LSSGB
