Healthcare Design’s 2024 Architecture/Engineering/Construction Survey

To read Part 1 of Healthcare Design’s A/E/C Survey report, go here.

Healthcare Design’s biennial A/E/C Survey provides a design and construction outlook on the healthcare design sector. The survey is open to any U.S. architecture/engineering or construction firm that completed at least one healthcare project in the year prior.

In addition to shedding light on business and financial data, the survey asks firms to provide open-ended responses to capture the opportunities and challenges of healthcare design today.

And while the picture painted is a complex one, at its center is a healthcare system burdened by an economic climate that’s greatly influencing when and how investments in the built environment are made.

“As [healthcare] organizations balance the need for innovative and human-centered facilities with financial realities, projects may be put on hold, canceled, or evolve significantly from the initial scope,” said Lauren Lazarescu, director of healthcare program development, Flad Architects (Tampa, Fla.). “This creates challenges in planning and staffing architectural projects; however, it presents an important opportunity and fundamental responsibility to strategically assess where and how care should occur, right-size facilities, and ensure the highest and best use across the healthcare system.”

HDR, Leo A Daly: What healthcare projects are seeing growth?

One glimpse of what that’s meant in terms of the specific projects being delivered was shared by Hank Adams, global director of health at HDR (Dallas).

“Healthcare systems continue to invest in replacement of aging infrastructure, ambulatory care strategies, and specialty care facilities including cancer, pediatrics, and behavioral health, creating abundant opportunities for firms and a steady stream of both small- and large-scale healthcare projects in the pipeline.”

Several responding firms noted that the primary way health systems are responding to rising inflation and slimming profit margins is consolidation. This is affecting the healthcare design landscape in numerous ways, including creating a backlog of projects as well as reducing the overall number of clients.

“As systems merge, the decision-making matrix for hiring design professionals often changes, leading to the challenge of making new connections, but also the opportunity to work with new systems as these new relationships are forged,” said Joshua Theodore, vice president and global health practice leader at Leo A Daly (Dallas).

EwingCole, AE Works, GBBN discuss financial impact of repurposed, prefabricated healthcare projects

At a project level, financial realities are pushing solutions that address needs for reduced cost and speed to market, respondents shared. “Hospitals are looking at how to stretch their limited dollars further by completing more projects that repurpose existing space instead of constructing new space,” said Jason Fierko, principal, director of healthcare at EwingCole (Philadelphia).

Several tactics were shared for how systems are pursuing project savings, too—for example, through prefabrication and modular building solutions that provide high-value time savings and quicker deployment, said Jeanmarie Zimmerman, healthcare planning and strategy leader at AE Works (Pittsburgh).

Michael Lied, principal of GBBN Architects (Cincinnati) similarly noted on-site prefabrication (or industrialized construction) as a promising solution, given its increased speed to market, decreased construction waste, better labor utilization, and lowered costs.

“The problem is that to meet patient demand and address aging facilities, [systems] have to build today; but doing so risks getting caught in challenging market fluctuations associated with increased construction costs, supply chain issues, and a diminishing labor market” Lied said. “Given this environment, firms must collaborate to bring creative solutions to healthcare systems.”

CO Architects, Flad, Page, SmithGroup talk technology, AI’s role in healthcare design

Financial uncertainty aside, respondents are also considering the evolving healthcare program and integrative technologies that must be addressed in projects, as well. Thomas Chessum, principal of CO Architects (Los Angeles) noted that more clients are pursuing projects with a diversity of functions.

“Projects are increasingly integrating specialty research, including laboratories, into the clinical care environment. Educational or training environments are also finding their way into the clinical platform,” he said.

On the technology front, not only designing spaces for integration of today’s platforms but enabling them to flex in the future is a critical opportunity, added Flad’s Lazarescu.

At Page, Tushar Gupta, healthcare market sector leader, said the Houston-based firm is “hastening to understand the challenges and opportunities presented by the exponential growth of artificial intelligence (AI)-assisted technologies.”

From digital twins to robotics to simulation training spaces, Gupta said it’s critical to understand how the adoption of such technologies will impact design. “Instead of architecture being just a repository for advanced technology, future hospitals will become the technological framework in which platforms can plug and play. Healthcare spaces, then, need to be designed for radical flexibility,” he said.

Wayne Barger, vice president, director of health at SmithGroup (Dallas), echoed that sentiment. “I don’t think we can overstate AI’s impact on healthcare. It will transform the way that healthcare facilities operate and have a significant downstream effect on facilities, from workflow to infrastructure,” he said. “My prediction is it means more facility needs rather than less.”

Firm face staffing challenges

And while opportunities don’t run short, respondents also recognized the challenge of having appropriate staffing to respond to them.

As recruitment and retention remains top of mind, the current remote or hybrid work environment is stressing firms’ ability to provide proper mentorship, training, and collaborative experience necessary to excel in this field, one respondent noted.

HDR’s Adams added, however, that healthcare design is in a good position to attract the talent required.

“Overall, there is very high demand for experienced healthcare design talent throughout our industry, which bodes well for emerging talent,” he said.

Jennifer Kovacs Silvis is brand director of Healthcare Design. She can be reached at

To read “2024 Healthcare Design A/E/C Survey Results: Part 1,” go here.