Healthcare Design’s 2026 Architecture/Engineering/Construction Survey
- Renovation work continued to comprise the majority of activity in 2025, according to responding A/E/C firms.
- In total, survey respondents reported 2,915 project contracts signed in 2025 at a combined value (construction cost excluding land) of $21 billion.
- Supporting population health/improving access to care moved into the top three list of common client goals for healthcare projects in 2025.
Healthcare organizations are continuing to move projects forward despite a difficult financial landscape defined by declining reimbursements, rising construction costs, and ongoing funding uncertainty.
According to respondents to Healthcare Design’s 2026 A/E/C Survey, project activity remains steady, though many organizations are pursuing smaller-scale efforts. Renovations continue to dominate the work, while client priorities are also evolving—expanding beyond revenue growth to include population health and improved access to care.
Together, these shifts suggest healthcare systems are balancing financial pressures with a growing focus on expanding care access and supporting community health.
What challenges does healthcare design face?
Healthcare organizations are continuing to move projects forward despite a difficult financial landscape defined by declining reimbursements, rising construction costs, and ongoing funding uncertainty.
According to respondents to Healthcare Design’s 2026 A/E/C Survey, project activity remains steady, though many organizations are pursuing smaller-scale efforts.
Renovations continue to dominate the work, while client priorities are also evolving—with supporting population health and improving access to care noted as one of the top client goals, joining revenue growth as a primary driver. Together, these shifts suggest healthcare systems are working to balance immediate financial pressures with a growing commitment to expanding care access and supporting community health.
The biennial survey was conducted online in January and February and open to any U.S. architecture, engineering, and construction (A/E/C) firm that completed at least one healthcare project in the prior year. All financial and business data reported is from 2025.
Of the responding companies, healthcare represents 59 percent of the participating firms’ overall business; 57 percent of respondents reported healthcare as their primary business segment (60 percent or more of their business).
(To view the corresponding charts for this article, go here. You can also read the article in HCD’s April digital edition.)
2026 Healthcare Design Survey By the Numbers
Looking at 2025, participating firms reported a total of 1,814 projects completed. When considering if that was more, fewer, or about the same as the year before, 46 percent of firms said they completed about the same number of projects, followed by 39 percent that reported more. Fifteen percent of respondents said it was fewer.
Comparatively, in the 2024 A/E/C survey, which assessed healthcare business in 2023, total completed projects reported was 2,583, as 39 percent of firms said they completed more projects, 35 percent said the same, and 26 percent of participants reported fewer projects than the prior year.
Furthermore, this year’s firms reported a total of 3,183 requests for proposals (RFPs) in 2025, which the majority of respondents (56 percent) said was about the same. Meanwhile, 28 percent said they saw more RFPs and 16 percent said fewer.
The total is down slightly from the 2024 survey, which reported 3,254 RFPs; however, at that time, 50 percent of firms said they had received more proposal requests in 2023 compared to 2022.
How many healthcare project contracts were signed in 2025?
A similar picture was painted by respondents when asked about the number of healthcare project contracts their firms signed in 2025. Here, 35 percent of respondents said that number was about the same year over year, while 35 percent said it was higher. Thirty percent reported fewer contracts signed in 2025 than the year prior.
In total, firms reported 2,915 contracts signed last year at a combined value (construction cost excluding land) of $21 billion. Breaking that down by services provided, participants reported 75 percent of the business was architecture, 19 percent engineering, and 6 percent construction. In the 2024 survey, respondents reported fewer new contracts signed (2,350) but at a higher combined value of $27.7 billion.
As for total healthcare revenue, responding A/E/C firms represent a reported $3.4 billion of revenue in 2025. Of that, 77 percent was for architecture services, 17 percent engineering, and 6 percent construction. As the year closed, a reported 3,821 projects remained in progress, with 1,683 scheduled for completion in 2026.
Shifts in healthcare construction workload and facility priorities
In 2025, renovation work continued to comprise the majority of activity in the industry, with 65 percent of projects completed last year renovations versus 35 percent new construction.
This illustrates a continued increase in renovations from the 2024 survey, when renovations represented 56 percent of work completed, while 44 percent of work was new construction.
Specifically, hospitals comprised 58 percent of projects completed, up slightly from 51 percent in 2024, while outpatient work was 31 percent (compared to 36 percent in 2024). Skilled nursing/rehabilitation represented 8 percent of project work, and infrastructure only 3 percent.
Completed projects continued to skew smaller, with 70 percent reported between 5,000-19,999 square feet. The next largest size range was 20,000-49,999 square feet, at 12 percent, followed by 50,000-99,999 square feet at 6 percent.
The results closely mirror the 2024 survey, when 66 percent of respondents reported projects in the smallest range, compared with 15 percent and 9 percent in the second and third largest ranges, respectively. Meanwhile, 45 percent of firms said project sizes in 2025 were about the same as those built in 2024, 30 percent reported they were larger, and 25 percent smaller.
Healthcare project values are changing
For project values, results nearly mirrored those shared in the previous survey, tilting on the lower end of the scale. Of completed projects in 2025, 27 percent fell in the range of $1 million to $9.9 million range, 26 percent between $500,000 and $999,999, and 25 percent were valued less than $500,000. A combined 22 percent accounted for the remaining values of $10 million and above.
Conversely in 2024, 36 percent of projects completed were in the $1 million to $9.9 million range; next, 22 percent were valued at less than $500,000, 13 percent between $500,000 and $999,999, and a combined 29 percent at $10 million and above.
When asked how project values compared year over year (2025 to 2024), 55 percent of firms said they were about the same, 30 percent said they were higher, and 15 percent reported lower. In the previous survey, 43 percent of firms reported higher values, 36 percent about the same, and 21 percent lower.
Top 3 client needs for healthcare facility projects
To assess the drivers behind recent project work, responding firms were also asked to identify the most common client goals and needs. The top three needs identified included: expansion of/addition to an existing facility (32 percent), renovation/modernization of space (27 percent), and growth of outpatient sites (22 percent).
Those same three needs accounted for the top three choices in the 2024 survey, as well. When asked to consider all the needs for healthcare projects in 2025 and to rank them in order, respondents additionally chose renovation work with addition, repurposing space for new use, replacement of outdated buildings, and consolidation of existing facilities/services.
Growing revenue, supporting population health rank as top healthcare client goals
Next, respondents identified the most common client goals for healthcare projects in 2025. Here, firms identified two primary goals: growing revenue (32 percent) and supporting population health/improving access to care (22 percent). The next closest goal was achieving future flexibility/adaptability at 18 percent.
While these results follow a similar pattern in 2024, a notable change is that supporting population health/improving access to care moved into the top three, overtaking the goal of addressing aging building stock.
In the 2024 survey, addressing aging building stock was chosen by 17 percent of firms and supporting population health/improving access to care by 10 percent. When ranking all options for the 2026 survey, firms indicated other primary goals included improving patient experience/satisfaction, adding service lines/specialties, addressing aging building stock, and improving staff experience/satisfaction.
Obstacles A/E/C firms face in 2026
To capture A/E/C firms’ own challenges, responding firms were also asked to consider the biggest obstacles they faced.
Those rankings for the 2026 survey illustrate another industry shift with canceled or delayed projects rising to the top of the list (26 percent), followed by construction costs escalation/labor shortages (18 percent), and decrease in number of projects (14 percent).
Comparatively, in the 2024 survey, construction cost escalation/labor shortage was the biggest challenge at 30 percent, followed by talent acquisition at 24 percent, and canceled/delayed projects at 13 percent.
When all the possible options were ranked, other top vote getters were clients unable to fund projects, more competition, talent acquisition, and pressure to lower fees.
Check back next week for Part 2 of HCD‘s 2026 A/E/C Survey results.
Anne DiNardo is editor-in-chief of Healthcare Design and can be reached at [email protected].
