For more than 45 years, Joseph G. Sprague, FAIA, FACHA, FHFI, has promoted design excellence within the healthcare industry for a multitude of project types. As a director of health facilities, principal, and senior vice president at HKS Inc., Sprague serves as technical adviser on numerous projects. He oversees project execution, while providing substantive input in the areas of functional and space planning, master planning, and facility design.

Prior to joining HKS in 1984, he was director of design and construction for the American Hospital Association (AHA). While at the AHA, Sprague managed the nationally recognized Health Facility Codes and Standards Programs.

Without a doubt, Sprague’s industry involvement and influence has been significant. A fellow in the American Institute of Architects (AIA), American College of Healthcare Architects (ACHA), and Health Facility Institute, he is past president of the AIA Academy of Architecture for Health and chairman emeritus of the Health Guidelines Revision Committee for several cycles of the Guidelines for Design and Construction of Hospitals and Health Care Facilities. In addition, he is president of the Facility Guidelines Institute and former president of ACHA.

Acknowledged by many for his achievements, Sprague was The Center for Health Design’s 2008 Changemaker Award winner and also received the Commitment Award from the Facility Guidelines Institute for his achievements as the chairman of the Health Guidelines Revision Committee.

He has been recognized by this publication as one of the top 20 people making a difference in the healthcare design industry and is a member of HEALTHCARE DESIGN’s editorial advisory board. He was also presented with the ACHA Lifetime Achievement Award for his contributions to the profession as a leader in the practice of healthcare architecture.

A few years ago, Sprague, along with HKS Chairman Emeritus Ron Skaggs, FAIA, FACHA, established an endowed chair in health facilities design at Texas A&M University College of Architecture. His work has been widely published, and he is a frequent consultant, faculty speaker, and lecturer on healthcare facility planning, design, and construction.

I sat down with Sprague in his award-filled Dallas office to talk about his life, career, contributions to the field, and thoughts on the direction of the healthcare design industry.


Sara O. Marberry: You began your career in the military. What led you to that?

Joe G. Sprague: I went to undergraduate school at Auburn University and graduated with a Bachelor of Architecture, which is a five-year professional degree. I had two years of ROTC (Reserve Officer’s Training Corps) and decided that I really didn’t want to spend a lot of time involved in the military, so I dropped out. Then, the war in Vietnam escalated.

The U.S. Army medical department was offering direct commissions into the surgeon general’s office and there was a position at the U.S. Army Health Facility Planning Agency. I was very happy to be able to be given a direct commission as a second lieutenant in the Medical Service Corps.

Marberry: How did that experience influence the rest of your career?

Sprague: Going into the Army as an architect, working in Washington, D.C., in the Surgeon General’s office was like a graduate degree program. I was put into the role of learning how the Army designs hospitals and met some of the brightest thought leaders imaginable. My first assignment was to program the new Walter Reed Army Medical Center.

Now, 30-plus years later, HKS has designed the latest Walter Reed Medical Center in Bethesda, Md., renamed the Walter Reed National Military Medical Center.

Marberry: Did you come out of undergraduate school with an interest in healthcare design?

Sprague: There was no specialty program at Auburn that would give students any exposure to healthcare design. While I was on active duty, I learned about a healthcare design graduate program at Texas A&M University’s College of Architecture, which is where I went from the Army. Like today, the program was designed around real projects. The faculty took students to sites and client meetings.

Marberry: And from there, you went to the American Hospital Association?

Sprague: Yes. As director of design and construction, I advised our 7,000 hospital members on issues about design and planning. When they had questions, they would call me. We conducted educational programs around the country.

I was also responsible for working with the AIA to produce the Architecture for Health Exhibit at the AHA’s annual conference. And I managed the AHA’s National Codes and Standards program, which involved the National Fire Protection Association, some 50 committees from the Life Safety Code, the hospital committee, and all of the ventilation and medical gas committees.

At the time were three model building codes (BOCA, SSBC, UBC) that governed what could be done in hospital design. Building officials were over-regulating hospital construction because they thought hospitals were unsafe buildings.

Our role was to influence building officials so they would not put in things that hampered care. And that’s one of the things that led me to become involved in developing the facility guidelines as a representative of the AHA. Back then, they were called the Public Health Service Minimum Requirements, which were written primarily as a government document.

That all changed during the Reagan administration, which decided to do away with regulating the requirements for minimum standards of construction, renovation, and equipment of hospitals and medical facilities.

Marberry: So the U.S. government no longer wanted responsibility for developing the guidelines?

Sprague: Yes—it no longer wanted to publish guidelines, nor the health facilities series, which were documents that showed how to plan a nursing unit, pharmacy, food service, surgery, intensive care/critical care, etc. There was all this good information that needed to live somewhere and keep getting revised. It ended up with the AIA and now the Facility Guidelines Institute and was renamed the Guidelines for the Design and Construction of Health Care Facilities.

Marberry: How long have you been involved in the guidelines revisions?

Sprague: Since 1974, when I joined the AHA. I’m still involved in guidelines work, helping with revisions for the 2014 edition. I’ve been involved in 10 editions of the guidelines through the very first ones up to the current revision.

Marberry: What’s next for the guidelines?

Sprague: We’re going to have two volumes in 2014—Residential Care will be separate from Inpatient and Outpatient Care. We’re looking at all kinds of ideas that will elevate and enhance the mission of the Facility Guidelines Institute, including the transition of our board with new people, new members, and new leaders.

We’re looking at approaching the Centers for Medicare & Medicaid Services to get direct involvement on the guidelines because they have not participated as much as they should have.

There’s a lot of
need out there for guidance. Many think we should do a best practice document, which would put into place not only minimums but concepts that elevate what would be minimally safe from a patient-focused standpoint. We may become involved in educational programs. We’re looking at handbooks, white papers, and workshops.

Marberry: What advice would you give to students or young professionals who want to get into healthcare design?

Sprague: It’s a great, great time to be in healthcare. The challenges are huge. Enhancing the human experience in an environment that is so focused on patient safety, and yet to still be able to bring value to the client in the process, is a huge challenge for the design team.

Students interested in healthcare design should spend their time learning as much as they can about healthcare and maybe not so much about architecture or interior design, because there are issues that healthcare designers face that other designers haven’t even thought about.

Every time there’s been a new regulation in Washington, we’ve heard, “It’s going to stop construction. No more bricks and mortar. Architects are going to be out of work. What are we going to do?” But what happens is that it backs up and then the floodgates open up. Demographics, technology, and access to care are changing how care is delivered.

So I see it as a very positive, bright future. I hope that design professionals can use the knowledge we have not only about architecture and design, but about the forces driving change for our clients so we can better serve them.

Healthcare is a necessity and it’s somewhat immune to the economy. The availability of capital is key, but healthcare is always a priority in the community. That’s what got me interested in healthcare architecture. It’s not just about buildings and design. It’s about making a difference in peoples’ lives, which is a greater calling.

That’s part of the reason why I’m so positive about healthcare design. I encourage the aspiring young student who’s interested in architecture and health to look at it from that perspective.

Sara O. Marberry is the author/editor of three books on healthcare design and writes and speaks frequently about industry trends and evidence-based design.