At their most basic level, healthcare buildings are places people go to regain and/or maintain their health. Patients visit ambulatory care facilities for physician’s visits or medical tests, hospitals for more serious interventions, and rehabilitation or long-term care facilities for the road to recovery. At this basic level, the relationship is mostly transactional and the buildings that house those transactions tend to be singular unto themselves.

As designers, we often have the intention to design and build healthcare facilities that offer more than their functionalities; still, most projects fail to emerge as vital community hubs. To truly elevate our healthcare buildings and establish them within our communities, it’s time to start thinking of them as “fourth places.” Closely related to the concept of “third places,” or spaces between home and work where we may spend time connected with other individuals (for example, in a library or coffee shop), fourth places support gathering but also a sense of inclusiveness where strangers from all backgrounds and viewpoints can come together for informal social interactions in public or semi-public spaces.

As a visual person, I used to see the ideal healthcare system as a hub-and-spoke model, with the hospital being the hub and the spokes being all of the ambulatory buildings and services that emanated out of the hospital into the community. Over the last few years, that image in my mind has morphed to be more of an intricate spider web that overlays a community, with amplified relationships between buildings through increased connections and services. As the lines between healthcare, education, retail, and hospitality blur more and more, the types of buildings providing services that improve public health expands. The web that weaves them all together is considerably more complicated but also significantly stronger because of the many levels of connectivity.

This blurring is occurring because building types might serve multiple functions with the common purpose of improving and contributing to community health. For example, hospitals could become destinations for more than medical reasons if public parks are incorporated into their design. Gyms could be connected to hospitals, not only as places to exercise and socialize but for rehabilitation, while hospital restaurants might provide a gathering place for nutrition and education. In this fourth-place approach to design, the lines that previously differentiated these types of settings begin to disappear thanks to connection and common purpose.

We’ve already seen this occur in other sectors, such as grocery stores that sell clothing and housewares, farmers markets set up in transit hubs, and airports with shops that rival retail malls. This blurring of singular functionality is happening at a quicker and quicker pace in our communities. Though healthcare is traditionally conservative and slow to change—and the idea of hospitals serving community needs in a variety of ways is not new—it’s also still not the norm. As we start to think about designing the next generation of healthcare facilities to serve our communities for at least the next 50 years, it’s time we work to ensure they actually do.

Debra Levin is president and CEO of The Center for Health Design. She can be reached at