Hospitals represent some of the most complex buildings on our planet, monitoring tens of millions of data points, pieces of equipment, and people every day. Examining and tracking all these interconnected and critical parts in real time is a great challenge, especially when delays can be a matter of life and death. In response, many health systems, hospitals, and outpatient centers are developing command centers—akin to air traffic control centers—to meet the need for monitoring, analyzing, and tracking the thousands of pieces of data.

These centers—the so-called “brains” of a facility—take different forms, from a room to a series of rooms, located on- or off-campus depending on scope and space needs. They are equipped with a variety of technologies, powered by artificial intelligence and predictive analytics, to process and display a range of real-time data, from hospital bed availability and patient transfers to equipment tracking and patient monitoring. Housed within these centers is a variety of professionals, including doctors to update care protocols, nurses to monitor patient status and vitals, technicians skilled at telemetry, and aides to monitor patients. Incorporating environmental, patient transport, and material management staff can also ensure efficiencies in bed turnover, patient movement, and supply delivery, helping keep costs in check by increasing overall throughput and occupancy.

This setup allows hospitals to be proactive rather than reactive by helping staff address issues as they arise. For example, staff can receive alerts when backups occur in the imaging room and patients are waiting for services, helping to quickly resolve the flow issue. Centers that monitor the physiology of patients can use the algorithms generated to spot patient changes much faster, allowing clinical staff to intervene and treat the issue sooner and avoid medical complications. Command centers can also help unite previously siloed teams, from inpatient room logistics to procedure schedulers to clinical specialists, and enhance communication among employees, enabling staff to coordinate alerts and more easily track follow-ups through a patient’s electronic medical record. Finally, these spaces can also help boost patient and family satisfaction and provide comfort to loved ones who are reassured knowing there are multiple layers of monitoring and care in place.

Design considerations
When deciding where to locate a hospital command center, it’s important to keep in mind that these facilities don’t require expensive hospital-grade space. This can create flexibility, as both on-site and off-site locations are suitable. For a large hospital network, an off-site command center outside the urban core may help lower costs because it’s less expensive to build and can free up space for clinical care on campus. However, a smaller rural hospital may choose to keep a single-room command center on-site for integrated access and cross-utilization of staff.

Another key issue to consider is the scope and type of command center. Will it serve a single hospital or a whole system? Will the command center include one site or multiple sites with collocation and remote collaboration? Generally, a command center that monitors patient flow would be about 1,500-2,000 square feet, but the overall size depends on the amount of services a hospital plans to incorporate. For example, a command center that intends to include centralized physiological monitoring for a hospital, or for several hospitals, would need at least double or triple the space requirement noted above. Services like remote patient sitters and emergency and disaster response will also require additional square footage. In all respects, command centers should be designed to expand to accommodate future technology and added services, as well.

These variables will also impact the number of staff members who need to be accommodated in the center as well as the size and layout of workstations. For example, while a typical workstation in a medical facility is 6 feet by 8 feet (48 square feet) per person, many other details need to be considered for a command center, such as the number of monitors per station, acoustical or visual privacy, ceiling heights to accommodate large hanging computer screens, and lighting controls that ensure proper screen readability and minimize glare. This means the workstation could be smaller or larger, depending on services and equipment requirements.

Other space needs may need to be accommodated, as well. For example, command centers that incorporate telemedicine capabilities will need private rooms with monitors so the practitioner can have private conversations with patients, much like what occurs in an exam room. Having respite spaces that allow command center staff who work with frequent auditory alarms and visual alerts to get quiet off-screen time is also important to prevent fatigue and burnout. Testing different layout scenarios and building mockups of the physical space to gather feedback from a variety of key stakeholders and decision-makers can help maximize space and lead to more efficient design solutions that work for everyone.

Accounting for costs
The main factors that drive the cost of command centers are construction fees to build the facility, the initial expense of equipment to outfit the center, and then technology upkeep. Selecting an appropriate site for a command center is critical, as the cost to build can hinge on several factors, such as off-site versus on-site locations and urban versus suburban versus rural settings. Backfilling unused, older hospital space with a command center can often be more costly than new construction in non-hospital space due to the difficulties in retrofitting modern technology into old, ill-configured space. Once all the requirements have been established, it’s vital to consider the business case for both options (backfill and new construction) to determine a cost-effective choice that fulfills not only immediate needs but the long-term evolution of the command center.

Additionally, equipment costs, as well as technology maintenance and staff training, need to be considered. Command center designs must support powerful systems that harness the algorithms, predictive analytics, and artificial intelligence that can help command center staff coordinate logistics and monitor patients. Therefore, the command center will need emergency power, highly efficient Wi-Fi technology, its own data center, and integration into the system’s back-up data storage.

What’s next?
As healthcare undergoes a technological revolution, hospital command centers, still in their infancy, are paving the way for other smart innovations. For example, with assistance from a command center, what if every hospital could employ artificial intelligence-driven patient monitoring to assist caregivers to create a customized precision medicine plan that’s tailored to a specific patient, and then adjust it in real time?
Additionally, other technologies could be supported via command centers, such as transport robots that deliver automated medical supplies and patient medications throughout a hospital. Cloud-based remote monitoring could provide closer communication between hospitals and patients across the full treatment timeline—from pre-admission to treatment to recovery and long-term care.

Hospital command centers can improve patient outcomes and experiences, optimize care delivery, and lower operational costs. By designing spaces that host real-time hospital data and machine learning and unite staff across hospital departments, command centers can improve the ability of staff to care for patients, predict and flag medical risks, and streamline patient care.

Teri Oelrich, BSN, MBA, is a partner at NBBJ (Seattle). She can be reached at Donald Bellefeuille is the director of healthcare strategy at NBBJ (Boston). He can be reached at