Anne DiNardo (Emerald)
Healthcare Design’s biennial A/E/C Survey provides an opportunity to take stock of where this industry is and where it’s heading next, getting into the challenges and opportunities on the horizon. Open to any U.S.-based architecture/engineering/construction firm working in healthcare, the report captures a high-level view from companies working in this space.
At first glance, the numbers reported in the 2026 A/E/C Survey, which looks at financial and business data from 2025, suggest a sector holding its own.
For the 2026 edition, respondents reported completing 1,814 projects last year and receiving 3,183 requests for proposals—levels that remain steady year over year. In a climate marked by persistent financial pressures, that stability is noteworthy. Yet a closer look at this year’s survey results reveals a more layered story.
Although the volume of signed contracts increased in 2025—reaching 2,915 compared to the 2,350 reported for 2023 in the previous survey—their overall financial value saw a notable decline. Total combined contract value dropped to $21 billion, down from the $27.7 billion reported in the 2024 survey.
In open-ended responses, participating firms noted a sector in which clients are moving forward on projects, but with guarded steps, smaller investments, or new priorities. Renovation now comprises 65 percent of completed projects, up from 56 percent in the 2024 survey, as many organizations opt to defer substantial capital spending in favor of targeted upgrades and ambulatory projects to meet evolving needs.
Furthermore, 70 percent of recent projects fall between the 5,000–19,999 square foot range—a continued shift toward smaller project sizes that we started to see two years ago.
Notably, responding firms cited canceled or delayed projects as their leading challenge in 2025—identified by 23 percent of respondents, doubling from 13 percent in the 2024 survey. Delays are particularly acute in sectors with urgent needs, such as rural care and behavioral health.
Still, within these constraints, there are signs of progress. Supporting population health and improving access to care has become a top client goal, cited by 22 percent of responding firms in the 2026 survey versus 10 percent in the 2024 edition.
Emerging tools and strategies—including the integration of artificial intelligence, collaborative delivery models, and adaptable building systems—are influencing what it means to design healthcare spaces that serve both present and future needs.
As you dive into HCD’s April issue and the A/E/C survey, I hope you find insights that inform your approach and help strengthen the collective effort to advance healthcare design.
For more insights and charts, read Part 1 of the survey here and Part 2 here.
