Since The Center for Health Design’s founding in 1993, we’ve spent a good amount of time monitoring the industry and looking for patterns and trends. Through this exercise, we begin to recognize key drivers that are or will soon be impacting our industry. As we reflect on our work over the past 25 years, there are four issues that stand out.

1. Move toward measurement. Roger Ulrich’s 1984 study “View Through a Window” got the attention of both the industry as well as the mainstream press. People began to understand that the built environment, in this case patient views, impacted health outcomes. In 1985, Press Ganey and Picker Institute offered the industry measurement tools to start quantifying the impact of the built environment. Then in 1986, the book “Design that Cares” by Janet R. Carpman and Myron A. Grant made the case for why researchers should be part of a design team from the start, foreshadowing the evidence-based design process that’s commonplace today.

2. Drive for safety and quality. Two landmark reports from the Institute of Medicine (IOM), “To Err Is Human” and “Crossing the Quality Chasm,” came out in 1999 and 2001, respectively. In “To Err Is Human,” we learned that nearly 100,000 people a year were dying in healthcare environments because of faulty systems, including design, that led to people making mistakes. In “Crossing the Quality Chasm,” IOM outlined six attributes of care that lead to quality: safe, effective, patient-centered, timely, efficient, and equitable. Many of these can be positively impacted by built environment decisions, such as designing noise-mitigating features to both improve the quality of sleep for patients and reduce staff distractions that may lead to medical errors.

3. Focus on the regulatory environment. In 2001, the Facility Guidelines Institute included an “Environment of Care” chapter in its Guidelines for Design and Construction. By 2006, that chapter introduced the single-patient room as a standard and provided the opportunity to focus on all aspects of the built environment that could improve quality and care outcomes. In 2006, CMS implemented the HCAHPS survey as a means to measure patients’ perspectives on hospital care, and the first public reporting of HCAHPS results was in March 2008. Coupled with passage of the Affordable Care Act (ACA) in 2010, these changes fundamentally altered the way healthcare systems are reimbursed, leading to organizations looking at everything that could contribute to the financial bottom line—including the built environment.

4. Growing holistic view of health. As the ACA decentralized care, the industry re-envisioned what a continuum of care might look like through alternative settings like retail clinics and urgent care centers. Simultaneously, aging baby boomers’ expectations surrounding their health shifted and they began to interact with healthcare for more than just treating illness—they’re using it to try to achieve wellness. Also moving beyond a focus on the physical side of health, The Joint Commission released a sentinel event alert in 2016 regarding suicide in all types of healthcare facilities, acknowledging that mental health concerns are found everywhere, not just in settings traditionally dedicated to mental health treatment. This attention on behavioral health is one that’s still of significant interest today.

Looking ahead, what trends and drivers do you see impacting healthcare in the next decade or two? No matter what they may be, we know our industry will work together to respond to them and to continue to improve healthcare environments to produce the best possible outcomes for patients, families, and staff.

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