In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

Brandon King is a senior strategic facility advisor at architecture firm BWBR, with offices in St. Paul, Minn., Madison, Wis., and Omaha, Neb., shares his thoughts on unnecessary projects and healthcare worker safety.

  1. Process improvement as primary service

Architects are often expected to facilitate intense Lean 3P (people, process, and place) improvement events at the start of many projects. Incredible time, energy, and expense is put into this effort, but after occupancy, the owner is left to implement processes and help staff adapt to operational changes derived months or years prior. Healthcare architects are uniquely positioned to offer support in the assessment, measurement, tracking, and adjustment of healthcare facility use, and with addressing process inefficiencies at any stage of the building lifecycle. This could mean engaging with clients in existing facilities to assess the actual operational effectiveness of that facility outside of the normal design and construction cycle, or providing access to technologies such as RFID or occupancy trackers in addition to BIM models and construction documents. Healthcare organizations don’t just need help from the architecture, engineering, and construction community when a big project is ready to be awarded—they need expertise long before and after.


  1. Designing for empathy, not just productivity

The current challenging labor market has underscored the immense value of an engaged workforce to a high-functioning organization. This is especially true in healthcare, where frontline workers have dealt with unimaginable conditions over the past 18 months of the COVID-19 pandemic and are facing increasing rates of burnout. Burnout happens for many reasons, but one important one is feeling like one is listening. Now more than ever, it’s vital to balance design efforts that respond to productivity, metrics, and measurement with those that allow for empathy and authenticity. It is humbling to know that the facilities we create can help inspire calm, recuperation, and healing for staff as well as patients. Taking the time to observe workflows and talk to staff about how they feel (and want to feel) in their space before beginning design work can make a real impact on the day-to-day experience of healthcare workers and thus the performance of the overall organization.


  1. Security: As non-negotiable as fire protection

The majority of code-required life safety elements, such as fire sprinklers, egress width requirements, and flame-resistant materials, focus on preventing or slowing fire spread while preserving human life by egress or sheltering in-place. Yet over the last decade, there have been close to 10 times more fatalities in healthcare facilities due to violence than due to fire. Despite this tragic loss of life, security improvements such as well-distributed access controls, security hardened entrances, and securitized emergency departments are often value-engineered out of budgets while parking ramps and other exterior areas are particularly ignored when it comes to security improvements. Advanced technologies like gunshot detection, facial recognition threat detection, and RFID tracking for patients and visitors are showing incredible potential as more active response mechanisms. Ultimately, building codes dictate life safety requirements, so it’s time that the regulatory world recognizes security events as a real threat to life safety by committing resources and research to developing standards and requirements.


  1. Starting strong: Protecting healthcare staff time during facility startup

While healthcare staff may be experts at care delivery and day-to-day operations, they often have little experience or capacity to safely and efficiently transition and stabilize new operations in a facility. Worse, the activation period of the project schedule is often reduced or eliminated to meet an arbitrary (or political) deadline. As project delivery experts, the architect and contractor should plan for and protect the activation time and budget as intensively as they would for any other major phase of the project. This will ensure that the owner can concentrate on patient care and not worry about medical equipment installation, IT/AV, signage, or new supply and support flow adjustments. With healthcare organizations requiring staff to do more with less, many project activation and transition tasks can be offloaded to the architect and contractor to free frontline staff for the vital work only they can do.


  1. An operational problem searching for a facility solution

Healthcare facility projects are expensive and complicated, and even small projects can have disproportionally large costs. While some projects are truly needed due to growth, facility obsolescence, or technological advancement, many others are actually sidestepping around a broken process or a political issue. If an architect’s role is to help clients make good decisions, one way to do that is to understand and address the root cause of a problem—which may not always include a facility project. Sometimes the right solution is to revise a process, adjust communications, or directly address a personnel issue. We must develop the skills to adapt our creative problem-solving methods and have the courage to tell our clients when a facility project may be unnecessary, leading owners through process improvement and change management initiatives before proceeding with expensive facility projects. Not every interaction with a client needs to be addressed with a drawing, especially when the demands on healthcare facilities, budgets, and staff have never been higher.

Want to share your Top 5? Contact Managing Editor Tracey Walker at for submission instructions.