Revenue-generating spaces within healthcare facilities, such as patient, operating, and imaging rooms, get a lot of attention on projects. But back-of-house rooms are just as critical, said speakers at the 2023 Healthcare Design Conference + Expo, Nov. 4-7 in New Orleans, during the session “Small But Mighty – Neglected Rooms That Will Make or Break Your Hospital Design.”

The session was presented by Randy Geise, senior healthcare facility planner at Cleveland Clinic (Cleveland), Jennifer Storey, senior principal at Stantec Architecture (Cleveland), and Michael Zambo, principal at Bostwick Design Partnership (Cleveland).

“When the business plan for a project is created, it’s based on the number of patient rooms, operating rooms, and imaging rooms, for example, because these spaces can only be utilized by one patient at a time, so it can be charged directly to the patient, their insurance, or Medicare for reimbursement,” Geise said. “The use of the spaces that support these rooms do not get directly charged.”

Support rooms include clean and soiled utility rooms, medication rooms, environmental services closets, equipment rooms, nourishment, and break rooms. If these are undersized, you may need multiple rooms to achieve optimal results.  When they are not located near nursing desks or patient bedrooms, they create increased travel distance for staff who are already walking a lot in the day for their work and spending more time traveling to or looking for supplies rather than providing direct patient care.

Along with this, if key elements of these rooms such as shelving, technology, work counters, and equipment storage space with readily available electrical outlets, are not discussed early in the planning and design process, the infrastructure to support these elements may be more costly to the project to add later, according to the speakers.

“Thinking of these support spaces early in programming and schematic design is crucial to the success of the caregivers and their ability to provide world-class care to their patients,” said Geise. “Without the proper design and flow into and out of these spaces, the caregivers are not able to effectively do their jobs and provide care for their patients.”

For example, the speakers said environmental services (EVS) equipment rooms are often too small to hold the necessary number of carts required to support patient rooms. On one project, the EVS staff had to keep carts in the basement, adding extra time to wait for elevators and travel between floors to get the equipment, making staff less efficient with their time throughout the day.

The speakers also noted that in many cases they found soiled utility rooms on nursing units with an extensive amount of cabinetry that never gets utilized. “Reducing this to just a work counter provides much needed floor space under the counter that can be effective to store other needed equipment while reducing costs to save the project budget for things that will bring value to the patients,” Geise said.

Another time-saving solution for staff is combining clean supply and medication rooms, Storey said. “We regularly design support cores with clean supply and medication zones all in one to allow a caregiver one swipe access,” he said.

To successfully implement this approach, Storey said a quiet zone should be incorporated into the space so that the caregiver isn’t distracted while dispensing medications.

Overall, Zambo says elevating the importance of these spaces in planning and design can help make operational outcomes as successful as possible. “Early planning and forethought will greatly improve the environments the clinical and support staff must navigate to provide the best patient care,” Zambo said.

For more session reviews from the 2023 HCD Conference + Expo in New Orleans, visit