Hospital Building Designs and Plans

The United States is currently in the midst of an unprecedented health care building boom, with a projected $180 billion investment in new hospital construction expected in the next five years. A similar trend is being observed internationally. The key drivers for this boom in the United States include aging facilities (built in the 1950s and 1960s) that no longer support efficient and safe care delivery; advances in treating childhood diseases; rapidly emerging technologies that fundamentally change care delivery processes; and the growing importance of patient- and family-centered care. Most importantly, the heightened focus on improving patient, environmental, and workforce safety and quality has increased the need to create optimal physical environments.

A growing body of research shows that there is a strong link between the design of health care settings and outcomes experienced by patients, staff, and families. There is mounting recognition that risks and hazards of health care–associated injury and harm are a result of problems with the design of systems of care rather than poor performance by providers. Furthermore, there is substantial evidence that the design of hospital physical environments contributes to medical errors, increased rates of infection and injuries from falls, staff injury, slow patient recovery, and high nurse turnover. The wider costs of lost working time, disability, and economic consequences are greater still.

Well-designed, supportive health care environments can not only prevent harm and injury but also provide psychological support and aid the healing process. It has now become imperative to rethink facility design as a critical element in bringing about change in the way health care is provided and experienced in health care settings. 

This approach reflects a significant change in the way design practitioners, health care planners, and health care administrators undertake health care facility design. By linking health care building design strategies with key desired outcomes such as reduced health care–associated infections, reduced falls, increased energy savings, increased patient satisfaction, and increased market share, the discussion at the design table is no longer about the first costs of health care facility design or about meeting immediate facility space needs but about the role of the physical environment in supporting the mission of the organization in providing high quality care. This is a positive trend that will affect the quality of health care facilities being built in the years to come.

In today’s reimbursement climate, where hospitals will increasingly be compensated for performance, it has become evident that the business-case discussion must be about the potential long-term savings from cost avoidance due to a reduction in avoidable adverse events that represent huge costs to both the health care organization and the patients and families who receive care. By linking the design of the physical environment with an organization’s patient safety andquality improvement agenda, processes such as evidence-based design are providing a common language of communication for architects, clinicians, and facility administrators.

Although some of these phases can overlap, they are usually implemented sequentially. The phases provide a framework for the building process; however, some degree of variation is common on almost every building project.