In the healthcare reform era, systems will have to be more efficient, doing more with less, while at the same time caring for more patients. As a result, we’ll see several trends.

Fewer big projects, more incremental growth. In the last two decades, we’ve seen many new campuses and greenfield projects. With future cost constraints, healthcare systems will be more risk averse and return to the facility master plan.

They’ll employ building strategies that are incremental and seek to maximize their campuses with small and medium scale projects.

Outpatient care facilities will move center stage. As providers are incented to deliver care efficiently in ambulatory settings, ancillary care facilities that were part of a huge campus will move up the priority list and away from the hospital.

Health systems will devote more resources to create a true distribution of providers, with medical office buildings, hospitals without beds, and outpatient clinics in venues more accessible to patients.

This may mean satellite facilities will be woven into heavily trafficked urban settings, suburban retail malls, or that they will stand alone in rural towns. The good news for facility planners is that these new locations often have lower land costs and can afford architects a more creative configuration than when trying to squeeze a facility into an existing footprint.

Existing hospitals will need to be retooled. As outpatients move away from acute care settings, inpatient facilities will find themselves treating very ill patients. The current hospital configuration, with many private rooms for medical/surgical patients, may not lend itself to optimal care for more critical patients.

In many ways, our hospitals are dinosaurs. I foresee a series of renovations or expansions as healthcare systems make these facilities able to accommodate the coming population.

Hospitals may need to add telemetry units, more ICU beds, or upgrade the facility infrastructure to encompass information technologies necessary for clinicians to care for these patients efficiently.

In the near term, emergency departments will proliferate. At HKS, we’re working on a number of ED projects, including freestanding facilities. Healthcare systems have taken a lesson from the experience in Massachusetts: after health coverage expanded, ED visits spiked.

When patients don’t have a historical relationship with a doctor or clinician, they tend to present in the ED. These new or expanded facilities will accommodate the newly insured patients.

How best to respond to these trends? Flexibility. I have long been an advocate of avoiding over-customization. Healthcare systems’ operations drive facility design, but facility planners also must take into account how these operations will change over time.

They’ll need to seek out building designs that can accommodate evolutions in physical plant systems and information technologies.


Even with the uncertainties implicit in the current healthcare reform implementation, we have some clients forging ahead with major building projects. These clients are certainly watching the demographic shift—with numbers of elderly growing nationwide—that will demand more facilities.

We know our current care delivery model is unsustainable, and this creates a challenge for facility planners. To keep pace, facilities now on the drawing board will have to be more efficient and technologically advanced than any others in history. These are challenging times, but also exciting times.

Craig Beale is executive vice president and health care group director for HKS Inc. He can be reached at