As a healthcare architect, it’s frustrating to practice research-informed or evidence-based design when so little research exists that truly proves the efficacy of healthcare planning concepts and design practices.

Peer-reviewed academic research in most cases is limited by resources to smaller studies. High-level esoteric analysis is often years away from application to practice or code adoption. Practice-based applied research has limited investment because clients seldom support it monetarily.

Last year, I wrote about the need for further study regarding hand hygiene and the appropriate location of handwashing lavatories in patient care areas. (Read here for the article.)

If I could wave my magic wand, there are three potential research studies for my 2024 wish list that could make a difference in how we plan facilities and perhaps save cost in the process.

3 Research topics for healthcare design

  1. Clinic design

The concept of developing clinical neighborhoods to support primary care medical home clinics,  where provider groups work to meet each patient’s physical and mental health care needs, including prevention and wellness, spawned the idea of dual-sided entry exam rooms around consolidated offstage work areas.

This is helpful for larger medical teams of providers, medical assistants, and ancillary support services to work together, improving communications and shortening travel distances. However, this design has been shown to increase overall clinic square footage approximately 20 percent due to additional circulation requirements.

Some research has studied the efficacy of this concept, focusing mostly on small, community-based primary care clinics.  Should this planning concept apply to specialty clinics or other sites where direct access to larger teams may be less important? Is there measurable improvement to operations, medical outcome, or patient/staff experience that justifies the increase in building footprint and cost?

I’d like to see studies by the VA Health Care or other healthcare systems that have adopted this model to see if this design is truly worth the investment or if other staff co-location designs can meet the same goals.

  1. Patient room showers

Many readers would be surprised to know that the Facility Guidelines Institute (FGI) 2022 Guidelines for Design and Construction of Hospitals does not require a bathing facility (i.e. shower) in every patient room but does allow for a central bathing facility per patient unit.

To my knowledge, there’s never been a study on what type of patients use showers, how often, and when they’re used during their stay. Are shorter lengths of stay and higher patient acuity reducing the need for showers  in every acute care patient room? Would one “spa-like” bathing facility per unit allow for better staff assistance and usage of mobile lifts and reduce the issues of patient’s slipping and water migration?

The reduction in both plumbing and square footage should warrant an in-depth study of the need for showers in every patient room.

  1. Access to natural light

There’s consensus from multiple research sources that access to natural light and views of nature has the power to improve health outcomes and patient and staff satisfaction.

However, in the FGI 2022 Guidelines, the only requirement for outside windows is in patient rooms in patient care units and not in any other area of the hospital. An observation unit per the Centers for Medicare & Medicaid Services (CMS) may house patients for up to 48 hours (though some states are more stringent), but the building codes do not require that  a patient  have access to a window.

In 2016, CMS adopted NFPA 101 2012, which requires windows in patient sleeping rooms, but in the years since I published articles on this subject it has been up to individual jurisdictions to enforce.

It is unconscionable that large areas of our healthcare institutions are without natural light, especially where there are overnight stays.

Can there be research to show how long patients and staff should remain in areas without windows without adverse effects? How far should staff be allowed to work from access to natural light daily?

Research to support healthcare designers

Hopefully these topics will inspire researchers to delve further into subjects that can best address the needs of design practitioners seeking to reduce healthcare facility costs and improve the environment for staff and patients.

Sheila Cahnman, FAIA, FACHA, LEED AP, is president, JumpGarden Consulting LLC and can be reached at