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.

 

Images

01-Cancer Care Trends

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

City of Hope’s Hope Plaza kinetic-façade parking garage and outpatient building. Photo: Tom Bonner, Courtesy CO Architects

 

05-Cancer Care Trends

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

UCSD Koman Family Outpatient Pavilion’s modular floor plan design. Photo: Tom Bonner, Courtesy CO Architects

By Dylan Bui, PE, Principal, Salas O’Brien

 

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.

By Bill Ledger, AIA, ACHA, NCARB, EDAC, LEED AP, LSSGB

 

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

Partner, Healthcare Market Leader, Senior Healthcare Architect

“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…

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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.

Many of you may already know Marc Schweitzer—a respected healthcare architect whose work has helped shape more thoughtful, patient-centered environments across our industry. As a recipient of the Planetree Lifetime Achievement Award, Marc has spent his career advancing healthcare design in ways that truly impact people’s lives.

Today, Marc is facing a very personal challenge. He is living with kidney failure caused by Polycystic Kidney Disease and is currently undergoing daily dialysis while awaiting a transplant. A living kidney donor would not only improve his quality of life, but give him the opportunity to continue contributing to the field he cares so deeply about—and to spend more time with his family and community.

Like so many in healthcare, Marc has dedicated his career to improving outcomes for others. Now, he needs our help.

Even if donation is not something you can consider, simply sharing his story can make a meaningful difference. You never know who might be able to step forward.

To learn more, get involved, or help spread the word, please visit: marcneedsakidney.com

Sometimes the most impactful thing we can design is connection—let’s come together to support one of our own.

By Jessica Detweiler, AIA, ACHA, NCARB

At OhioHealth Hardin Memorial Hospital, leaders were looking for a practical way to strengthen access to MRI services for their community.

Like many rural hospitals, they needed a solution that could support consistent imaging availability while remaining mindful of budget realities and patient demand.

For a period of time, the hospital relied on a mobile MRI trailer that visited the campus once or twice each week. While it provided an important service, availability was limited to the days the unit was on site, and patients had to step outside the building for their appointments. Hospital leadership began exploring options that could create a more permanent, convenient experience for patients while still fitting the scale and resources of the facility.

That’s where the idea of a prefabricated MRI suite came in.

Why a Prefabricated Unit Made Sense

For a smaller rural hospital, prefabrication can be an appealing option. Instead of constructing a full addition, the MRI room is manufactured off-site and then delivered to the hospital campus. The hospital still builds the foundation and makes the connection to the existing building, but the clinical space itself arrives mostly complete.

From a cost standpoint, that approach can be significantly more affordable than a traditional addition. It can also shorten the construction timeline.

For Hardin Hospital, it offered a way to move from a temporary mobile solution to a permanent MRI environment that was connected directly to the hospital.

Navigating New Territory

One of the most interesting parts of this project was learning how Ohio handles prefabricated healthcare units. These units fall under the industrialized unit code, which is different from the standard building code, so there’s a unique process for getting approval.

It was a great opportunity to dive into the process and figure out how everything fits together.

Working with a manufacturer who had already successfully completed a unit in Ohio made the approval process more predictable. It also showed just how valuable working with a team familiar with local requirements can be.

Prefabricated Doesn’t Mean “No Design”

Even though the MRI room itself is manufactured off-site, careful design and coordination are still key to a successful installation.

A big part of our role was reviewing the manufacturer’s design and making sure it actually worked with the hospital it was being attached to. Things like construction type and fire ratings still matter because once the unit is connected, it’s considered part of the hospital.

The connection points are really where the project succeeds or fails. We had to look carefully at how the door between the hospital and the unit worked, how utilities would connect, and how the foundation would support the unit’s platform.

The foundation in particular is crucial because the MRI suite sits on a raised platform. That meant recessing portions of the foundation and making sure the unit could be properly supported once it arrived on site.

Location also played a role. The unit connected near an existing exit corridor, so we had to maintain life safety clearances while still creating a functional pathway for patients and staff.

A Better Experience for Patients

The biggest change for patients is actually pretty simple.

Before this project, patients receiving MRI services had to leave the building and walk outside to the mobile trailer. Now the MRI suite is directly connected to the hospital. Patients stay in a conditioned environment with proper air quality and temperature control the entire time.

For a rural hospital, that’s a meaningful improvement. It creates a more comfortable experience and allows the hospital to provide imaging services in a setting that meets full hospital standards.

What We Learned

Looking back, there are a few key things that stand out from this project.

First, it’s important to work with a manufacturer who has already installed units in your state and understands the approval process. That alone can save a significant amount of time and frustration.

Second, even though the unit is prefabricated, you still need to approach the project the same way you would a traditional addition. Fire ratings, building codes, and connection details all need to align with the existing hospital.

And finally, the success of a project like this really comes down to coordination—between the hospital, the manufacturer, the design team, and the state approval authorities.

A Potential Model for Rural Healthcare

Despite some challenges along the way, the concept behind the project is still promising. For hospitals that can’t justify the cost of a traditional addition, prefabricated imaging suites offer a way to bring permanent services to their communities.

As codes continue to evolve, solutions like this may become more common—especially in rural settings where access to care is critical.

The key is understanding that while the unit itself may be manufactured elsewhere, integrating it into a hospital environment still requires careful design, coordination, and planning.

 

Designing effective healthcare spaces requires thoughtful planning, coordination, and attention to every detail. Our team partners with hospitals to create solutions that balance clinical needs, regulatory requirements, budgets, and patient experience. Contact us to see how we can support your next project.

 

Author

Jessica Detweiler, AIA, ACHA, NCARB, Healthcare Architect

Jessica is a board-certified healthcare architect with over 15 years of design experience. Her commitment to creating functional, efficient, and patient-centered spaces through well-coordinated drawings has led to a multitude of successful projects and clients. Her experience includes a broad range of project types with Parkview Health, Parkview Physician Group, Van Wert Health, and Franciscan…

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Written by Jeff Cichonski and Jim Norton

Connecticut Children’s Hospital Patient Tower | Hartford, Connecticut

Hospitals are often judged by what happens inside their walls – but the systems behind those walls determine whether care is possible at all. For Connecticut Children’s, the only hospital in the state dedicated exclusively to pediatric care, the need to expand was not simply a matter of growth. It was a matter of resilience.

Like many hospitals across the country, Connecticut Children’s was facing aging infrastructure. Its existing facility – nearly 30 years old – was operating with systems at or beyond capacity, limited redundancy, and equipment approaching the end of its useful life. Renovation options were increasingly constrained, and the hospital was running out of ways to modernize critical services while continuing to care for patients.

At the same time, demand for pediatric care was growing. Families across Connecticut were traveling long distances to access specialized services that the hospital aspired to provide closer to home. The organization’s vision was clear: expand access to advanced pediatric care, consolidate services, and create a modern, healing environment that could support patients, families, and clinicians – today and for decades to come.

The result is a new eight-story patient tower in downtown Hartford, designed to nearly double the hospital’s size and significantly expand clinical capacity, including much-needed NICU beds and critical care services. Behind the scenes, however, the project represents something even more transformative: a fundamental rethinking of how hospital infrastructure can be designed for uninterrupted care, adaptability, and long-term resilience.

Salas O’Brien served as the mechanical, electrical, plumbing, fire protection, medical gas, and technology engineer for the project, partnering closely with Connecticut Children’s, CannonDesign, DPR Construction, and design-assist trade partners to deliver a facility where no single system failure can compromise patient care.

Designing for zero downtime

From the outset, reliability was the project’s north star.

In the existing facility, a single failure could take out core services and directly impact patients. That reality shaped the new tower’s approach: full redundancy across all critical systems.

Power, air handling, medical gas, and life-safety systems were engineered so that maintenance, equipment failure, or external events would not interrupt operations. Electrically, the tower is fed by two new utility services connected to double-ended switchgear, creating a robust primary backbone. Emergency power is supported by N+1 generation and fully automated controls that allow generators to engage seamlessly during outages.

In a dense urban environment like downtown Hartford – where flooding risk, utility coordination, and limited site access add complexity – critical infrastructure required careful placement and protection. Emergency generators were elevated to mitigate flood risk, and utility upgrades were coordinated directly with city agencies to create reliability on a scale.

For a hospital, power consistency is not optional; it is fundamental to life safety.

Mechanical Systems Built for Resilience and Efficiency

The mechanical systems were designed with the same philosophy: no single point of failure, paired with long-term efficiency and adaptability.

Rather than relying on traditional high-temperature steam, the tower operates entirely on low-temperature hot water. Salas O’Brien engineered a new boiler plant and a chiller plant with year-round heat recovery, creating a system that is more efficient today and better aligned with the hospital’s future decarbonization goals.

Heat recovery chillers capture waste heat from cooling operations and reuse it for heating, allowing the building to heat and cool simultaneously while maintaining the precise environmental conditions required in pediatric and neonatal care. High-efficiency gas boilers with fuel-oil backup provide reliability without sacrificing performance, while operating temperatures remain compatible with future electrification strategies.

Water efficiency was also integrated into the system design. A condensate recovery system captures water from air-handling units and reuses it as cooling-tower makeup, supplying approximately 60 percent of demand in a high-use clinical environment.

Air Systems Built for Infection Control and Adaptability

In pediatric care, air quality and infection control are inseparable from patient safety.

The clinical space within the patient tower is served by three custom air-handling units, each capable of maintaining operations even if one unit is unavailable. Fully redundant air-handling systems support critical spaces, including C-section and fetal surgery operating rooms, infant resuscitation areas, and the sterile compounding pharmacy suite.

Patient rooms were designed to adapt as conditions change. In the event of an airborne infectious outbreak, acuity-adaptable rooms can automatically switch to full exhaust mode with some relatively simple control modifications, supporting isolation protocols without invasive renovations or operational disruption.

Medical gas systems were also engineered to support surge ventilator demand, allowing rooms to accommodate additional equipment during emergencies. The building was intentionally designed with a pandemic response mode, capable of supporting more patients, more ventilators, and higher-acuity care when it matters most.

Solving Complex Challenges in a Constrained Urban Site

Delivering this level of redundancy on a landlocked urban site required creative problem-solving.

One major challenge was locating the bulk oxygen system within tight spatial and code constraints. Through close coordination with fire marshals, city officials, and civil engineers, the team developed a compliant solution for the new tower that can backfeed the existing hospital, strengthening resilience across the entire campus.

Plumbing design required equal precision. Below-grade kitchen operations required pumped grease waste systems to reach street-level interceptors – another example of adapting infrastructure to site realities without compromising safety or performance.

Structural coordination was equally demanding. The new tower connects directly to the existing hospital, requiring alignment with floor-to-floor heights never intended for modern hospital systems. Early coordination and extensive prefabrication enabled major beam penetrations to be designed with large ductwork and piping in mind, reducing field conflicts and maintaining the overall construction schedule.

Delivering at Speed Without Compromising Quality

Time was a defining pressure.

Patient demand already exceeded capacity, with beds placed in temporary locations throughout the existing facility. Compounding the challenge, the project was launched amid post-pandemic supply-chain disruptions, with lead times for major electrical equipment stretching beyond 100 weeks.

To maintain momentum, Salas O’Brien worked closely with DPR Construction and trade partners to identify long-lead equipment early and release it before design documents were complete. This approach required rigorous risk assessment and clear communication, but it allowed procurement to move forward without sacrificing performance or reliability.

Releasing equipment mid-design is rarely comfortable for engineers. It succeeded here because risks were shared, decisions were aligned, and the team moved forward together.

Collaboration as a Design Strategy

That collaborative mindset defined the project.

Rather than a traditional top-down delivery model, the team adopted design-assist, bringing trade partners into the process early. Engineers, contractors, architects, clinicians, and facilities staff worked together in a “big room” environment, sometimes with dozens of stakeholders collaborating in real time.

Connecticut Children’s intentionally included voices from across the organization, from infection control teams to frontline nurses. While this approach added complexity, it made sure decisions reflected real operational needs.

Salas O’Brien’s long-standing relationship with the hospital strengthened this collaboration. Beginning with a mechanical and electrical infrastructure study in 2018, the firm brought institutional knowledge that helped define clear goals for redundancy, serviceability, and future readiness from day one.

A Healing Environment for Children and Families

While much of the project’s complexity lies behind walls and ceilings, its impact is deeply human.

The new tower reshapes the hospital’s presence in downtown Hartford, creating a welcoming main entrance on Washington Street with improved valet access, clearer wayfinding, and a more intuitive arrival experience. Inside, themed environments, natural light, and thoughtful finishes help reduce anxiety for children and families alike.

During construction, a nurse paused to look at the nearly completed tower and shared that what was being built would fundamentally change how she could do her job. The moment captured the project’s purpose more clearly than any technical metric.

Strengthening the Community

Beyond the hospital walls, the project has made a meaningful impact on the Hartford community.

The tower expands the hospital’s campus by approximately 40 percent, consolidating NICU and specialty services that were previously spread across multiple buildings. Families who once traveled out of state can now access advanced pediatric care closer to home.

The hospital partnered with the City of Hartford to improve Washington Street, committed to planting 100 trees in the Frog Hollow neighborhood, and coordinated parking solutions that benefit both hospital staff and local residents. Job fairs held with DPR Construction connected city residents to employment opportunities during and after construction.

Engineering for What Matters Most

At its core, the Connecticut Children’s patient tower demonstrates what’s possible when engineering excellence is aligned with purpose.

From redundant power and adaptable air systems to efficient mechanical design and collaborative delivery, every decision was guided by a single principle: children come first. The result is a facility built not just to operate, but to endure, adapt, and support care through whatever challenges the future brings.

For Salas O’Brien, the project reflects more than technical success. It represents a commitment to partnership, rigor, and designing systems that quietly – but powerfully – enable healing.

Jeff Cichonski is a mechanical engineer with over 25 years of design and management experience. He is known for building long‑term client relationships through responsiveness, clear communication, and a balanced approach to design and project leadership. His work spans hospital expansions, complex renovations, and major infrastructure upgrade projects. Jeff serves as a Principal at Salas O’Brien.

Jim Norton has nearly two decades of design and leadership experience in the healthcare sector, contributing deep technical expertise and a collaborative approach to every project. His work spans master planning, new construction, and highly intricate renovation projects across diverse healthcare environments. Jim leads an MEP studio of 16 design professionals and serves as a Senior Vice President at Salas O’Brien.

Written by Madison Steidley

A Legacy Reimagined, Not Replaced

There is a certain kind of work that rarely asks to be noticed, yet changes everything when it is done well. In healthcare, that work lives in the details most people never think to look for. The way equipment is organized. The way a room allows a nurse to move without hesitation. The way a space supports care quietly and consistently, without demanding attention.

At Paladin Healthcare, this kind of work has always been the point.

Paladin exists at the intersection of infrastructure and intention. It is a company built on the belief that the physical environment of care matters, not as an aesthetic afterthought, but as a functional partner in patient outcomes, staff wellbeing, and long-term operational success. What Paladin builds does not compete with care. It supports it. It creates the conditions for it to happen better.

That belief has shaped everything from the company’s origin story to its culture, its product philosophy, and its role in the healthcare community today.

Paladin Healthcare was founded in 2013 through a generational transition that was less about change and more about evolution. What began as Fairfield Medical Products became Paladin Healthcare, LLC, not to discard the past, but to sharpen it. The passing of leadership from father to son marked the beginning of a new chapter, one rooted in legacy but guided by a future-focused vision of healthcare infrastructure.

From the beginning, Paladin understood that progress in healthcare does not come from reinvention for its own sake. It comes from asking better questions. How do spaces need to function now? How will they need to function later? And how can infrastructure be built to evolve alongside the people who rely on it every day?

That mindset, respectful of history and relentlessly forward-looking, remains embedded in Paladin’s DNA.

More Than a Product Company

At first glance, Paladin may be known for its equipment rail systems. But reducing the company to a product category misses the point entirely. Paladin does not manufacture objects in isolation. It designs systems that think ahead.

The Universal ONE-Rail is a clear example. Built to integrate seamlessly with Modular, AMICO, Hill-Rom, and legacy Fairfield headwalls, the ONE-Rail was designed to solve a problem many healthcare facilities face quietly and expensively: the inability to adapt without rebuilding. Instead of forcing hospitals into costly tear-outs or rigid configurations, Paladin created infrastructure that absorbs change. Equipment can be added, moved, or upgraded without compromising safety, cleanliness, or workflow.

That adaptability is not a technical feature. It is a philosophical one.

Paladin designs for the reality of healthcare, not the idealized version. Departments shift. Technology evolves. Care models change. Infrastructure should not be the thing holding progress back.

What truly differentiates Paladin is not what it builds. It is how and why it builds it. Paladin’s company culture is deeply collaborative and rooted in listening rather than prescribing. The most meaningful innovations at Paladin rarely begin in a conference room. They begin in conversations with nurses, facilities teams, architects, and clinicians who understand the daily pressures of care delivery.

Listening is treated as a professional discipline. It informs design decisions, refines workflows, and shapes long-term strategy. Whether it is a nurse describing wasted motion during a night shift or a facilities manager navigating infection prevention protocols, Paladin takes those insights seriously. They are not anecdotal. They are foundational.

This culture of listening extends internally as well. Paladin is a team-driven organization where experience matters, curiosity is encouraged, and craftsmanship is valued. People are trusted to care deeply about the work they do because the work itself carries weight. When you are designing environments where life-altering moments occur, there is no room for indifference.

Built on Principles, Not Noise

The name Paladin speaks to the company’s moral center. Historically, paladins were protectors defined by loyalty, integrity, and service. That symbolism is not decorative. It is operational.

Paladin Healthcare does not chase trends or flood the market with excess. It does not lead with volume or spectacle. Instead, it operates with a disciplined restraint that reflects a deeper respect for healthcare environments. Every solution must earn its place. Every innovation must serve a purpose grounded in clinical reality.

This principle-driven approach is why Paladin’s presence in the industry is often quiet, but constant. It is why the company is trusted early in the design process, invited into complex projects, and relied upon long after installation. Leadership, in this context, is not about visibility. It is about reliability.

Paladin’s impact on the healthcare community is not abstract. It is measurable, lived, and experienced daily by the people inside the spaces it helps create.

Cleaner floors reduce infection risk. Elevated equipment minimizes clutter and trip hazards. Thoughtful layouts reduce wasted motion and cognitive fatigue. Flexible systems allow teams to respond quickly in moments when seconds matter.

These outcomes may not appear in marketing headlines, but they shape the quality of care in profound ways. They support healthcare workers navigating long shifts and high-pressure decisions. They create environments that feel calmer, safer, and more intuitive for staff and patients alike.

Paladin understands that supporting healthcare workers is one of the most direct ways to support patients. When a space works with the care team instead of against them, confidence grows. Efficiency improves. Burnout is reduced not through slogans, but through design that respects human limits.

Why No One Else Is Doing It Quite Like This

Many companies can manufacture components. Few can think systemically. Fewer still are willing to slow down, listen, and design for longevity in an industry often pressured by speed and cost.

What sets Paladin apart is its refusal to separate infrastructure from responsibility. The company does not see healthcare environments as static builds, but as living systems that must remain resilient over time. That perspective requires foresight, humility, and a willingness to prioritize long-term value over short-term gain.

Paladin’s independence allows it to hold that line. It allows the company to say yes to complexity, yes to collaboration, and yes to doing the work thoroughly, even when it would be easier not to.

As healthcare continues to evolve, Paladin Healthcare remains steady in its mission. Sustainability, adaptability, and human-centered design are not trends to follow, but commitments to uphold. The company will continue to learn from the field, refine its systems, and build infrastructure that supports care without ever overshadowing it.

There is a quiet confidence in knowing your work matters even when it goes unnoticed. That confidence defines Paladin.

Because when a hospital room works the way it should, when everything is exactly where it needs to be, care becomes clearer. Movement becomes easier. Outcomes improve.

And in those moments, Paladin Healthcare has done its job.

By Bill Ledger, AIA, ACHA, NCARB, EDAC, LEED AP, LSSGB Jessica Detweiler, AIA, ACHA, NCARB

 

Healthcare renovations are complex by nature.

They involve aging infrastructure, active patient care environments and regulatory oversight—all at the same time. Projects that perform well rarely do so because construction is easy. They perform well because the groundwork was thorough.

Success in renovation is largely determined before construction documents are complete. Seven principles consistently separate stable projects from reactive ones.

1. Define the Real Problem Before Defining the Solution

Renovations often begin with a stated need: more space, better flow, updated finishes. But the stated need and the actual operational issue are not always the same.

Careful workflow analysis—tracking patient movement, staff circulation, equipment staging, and material flow—often reveals whether the constraint is square footage or process. In some cases, expansion is necessary. In others, targeted reconfiguration or operational adjustments provide greater impact.

Establishing this clarity early prevents oversizing a solution—or underbuilding one.

2. Align Leadership and User Groups Early in the Process

Leadership establishes strategic goals, financial boundaries, and institutional priorities. User groups understand daily operations and workflow friction. Both perspectives are necessary.

When user input is delayed until later design phases, revisions often occur, sometimes increasing cost and almost always extending schedules.

A more stable process allows leadership to define parameters first, followed by structured engagement with user groups early enough to validate assumptions before design progresses too far.

3. Separate Feasibility from Full Design

Budget challenges frequently stem from premature cost commitments. When financial expectations are set before scope and infrastructure conditions are understood, projects become constrained by incomplete information.

A phased planning approach mitigates this risk by involving architects, engineers, and cost estimators early. With an initial feasibility study, the design team can gather appropriate information, test fit the needs, evaluate workflow and infrastructure, and create a schematic cost estimate based on current market trends and knowledge.

Once the feasibility study is complete, healthcare teams can move confidently forward into a full design effort.

This sequence allows decision-makers to approve projects based on informed data rather than preliminary assumptions.

In healthcare environments, infrastructure—mechanical systems, electrical capacity, medical gases, IT—often drives cost more significantly than visible architectural elements. Evaluating these systems early stabilizes financial planning.

4. Conduct Thorough Existing Condition Assessments

Many healthcare facilities have experienced decades of modifications. In an ideal world, health systems will maintain a record of all of the renovations that have occurred to better inform the next one. Having a systematic approach to documentation and drawing storage is incredibly helpful in planning future work, especially when systems above ceilings and within walls may be nearing end-of-life or may not comply with current codes.

A proactive facility assessment identifies:

• Infrastructure lifecycle status
• Code compliance concerns
• Structural limitations
• Deferred maintenance liabilities

These findings can materially influence renovation strategy. In some cases, the cost of upgrading legacy systems outweighs the benefit of renovating certain spaces, prompting reconsideration of scope or approach.

5. Make Phasing a Core Design Consideration

Healthcare facilities rarely have the option to suspend operations during renovation. Surgical suites, laboratories, emergency departments, and inpatient units must remain functional.

Phasing strategy therefore becomes central—not secondary—to design.

Airflow control, infection prevention measures, egress continuity, and life safety compliance must be maintained throughout construction. Early coordination with construction managers or contractors improves phasing realism and helps ensure building systems remain operational during transitions.

Phasing plans may evolve as field conditions are discovered, but addressing them early reduces disruption and change orders.

6. Engage Regulatory Expertise Early

Healthcare renovations often trigger life safety, occupancy, and code compliance considerations that vary by jurisdiction. Interpretations from Authorities Having Jurisdiction (AHJs) can differ significantly.

Engaging regulatory consultants or initiating early discussions during study or schematic phases allows teams to confirm code strategies before documentation advances. Although not all jurisdictions accommodate early consultation, pursuing clarity early reduces the likelihood of redesign during review or after construction begins.

7. Plan Around Staff Productivity

Construction impacts operations beyond the physical footprint of renovation.

Temporary walls, modified circulation paths, and staging areas can unintentionally disrupt patient transport routes or staff workflows. Without understanding how clinicians and support staff move through a department, construction sequencing can introduce inefficiencies.

Collaborative phasing discussions that include clinical staff, designers, and construction teams allow operational realities to inform construction logistics.

Renovation Success Is Determined Before Construction

Healthcare renovation projects are inherently complex, but they are not inherently unstable. Stability emerges from disciplined planning.

When these seven elements are in place, construction becomes the execution of a well-tested plan rather than continuous adjustment.

By: Jen Worley, RID, EDAC, LSSYB, Interior Design Principal, BSA and Joe Sagen, RA, NCARB, RID, Senior Architect I, Architectural Lead – Indianapolis, BSA

As healthcare systems grapple with workforce burnout and increasing staff turnover, hospital administrators are recognizing that designing for staff wellness is no longer optional, it’s essential. The physical environment has a profound impact on the well-being of those who spend their days delivering care. Beyond creating healing spaces for patients, forward-thinking hospitals are investing in environments that promote the health, connection, and recovery of their own staff.

Designing for staff wellness means looking at the facility through a different lens, one that places equal priority on those who work in it. It involves embedding opportunities for rest, nourishment, collaboration, and restoration within the fabric of a healthcare campus. From daylighting strategies and lounges with views to outdoor access and nourishing food, the elements of design can make a real difference.

Natural Light: A Fundamental Wellness Tool

Numerous studies and WELL Building concepts affirm what caregivers already know intuitively: exposure to natural light boosts mood, reduces stress, and helps regulate circadian rhythms. For healthcare staff who may work 12-hour shifts or rotating schedules, consistent access to daylight is critical in supporting alertness and psychological well-being.

For years, hospital layouts have placed patient rooms along exterior windows, pushing staff spaces to the interior. Today’s designs are rethinking that approach. For instance, projects that incorporate light wells allow daylight to penetrate interior corridors, giving staff exposure to light even in the heart of a building. Likewise, some facilities are deliberately positioning nurse stations and break areas near windows or using glass walls to bring light deep into core staff zones.

Elongated nurse stations are used to open corridors, improving both visibility and the flow of natural light. This subtle shift in design not only supports wellness but enhances safety and team communication, especially during off-peak hours when staff may feel more isolated.

Importantly, these daylight strategies are being applied in both inpatient and outpatient settings, reinforcing a consistent message that staff wellness matters, no matter where care is delivered.

Respite Spaces That Feel Like a True Break

While every hospital has staff lounges, too often they are tucked away, windowless, and functionally sterile, more utility room than sanctuary. Designing for staff wellness demands more. Respite spaces should provide a visual and emotional contrast to the clinical environment, offering caregivers a chance to genuinely disconnect, even for a few moments.

At a recently completed facility, the look and feel of the staff lounge was intentionally designed to be softer and more residential. Warm tones, natural materials, and comfortable seating signal to staff that this is a space for restoration. These intentional visual cues help staff transition mentally, allowing a true break from the high-acuity zones where they work.

BSA took this concept further in a sports medicine clinic, offering framed views of the mountains from staff break rooms. This access to nature, even if it’s just through a window, helps reduce cognitive fatigue and provides a moment of calm in the midst of a demanding day. Where possible, staff should also have access to outdoor areas. The adjacent gym and café outdoor space allow staff to step outside, get fresh air, and return to being re-energized.

Encouraging Healthy Lifestyles

Supporting staff wellness extends beyond the shift. By integrating healthy lifestyle amenities into hospital design, administrators can encourage long-term staff resilience and retention.

The above-mentioned sports medicine clinic provides a dedicated gym, offering an on-site fitness option for employees before or after hours. Locker rooms and showers make this easy to access and discreet. When wellness is built into the environment, it becomes more accessible, more realistic, and more widely used.

Likewise, the provision of healthy food, available quickly and close to break areas, makes a tangible difference for caregivers working within the constraints of short break times. Food lockers, like those piloted locally at a hospital here in Indiana, allow for scheduled delivery of nutritious meals, reducing the time spent traveling to and from the cafeteria. Staff can eat better, faster, and with more intention, which supports both physical health and morale.

Designing for Connection and Collaboration

Wellness is not only physical, but also social. Hospital environments that promote collaboration, reduce isolation, and encourage team-based care contribute to staff satisfaction and engagement.

One key way this is being achieved is through wider-than-code corridors. At an orthopedic hospital, for example, the corridors were designed intentionally to allow for impromptu staff interaction and informal huddles. These spaces are not just for transport; they become dynamic areas for teamwork and human connection.

Shared lounges and break spaces can also be used to promote cross-pollination between departments. When different care teams intersect in these areas, it fosters a broader sense of community and opens the door for interdisciplinary collaboration.

Flexible care team stations can use modular furniture that can be easily reconfigured to suit team size, workflow, or even mood. This kind of adaptability in design gives staff more control over their environment, another contributor to wellness and professional satisfaction.

Designing with Intention

Designing for staff wellness is not about adding luxury; it’s about removing barriers to well-being. When architects and hospital leaders work together with intention, it’s possible to create spaces that nurture those who care for others.

Strategic shifts, such as placing a window by a break room or widening a corridor, can transform how staff experience their day. More strategic moves, like embedding daylight into core zones, adding gyms or healthy food lockers, or designing shared collaboration areas, can redefine what a hospital means to its workforce.

The message is clear: the healing environment must include the healers themselves. By investing in environments that support staff well-being, hospitals are investing in quality of care, workforce stability, and long-term organizational health.