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.

Chris McQuillan is the global healthcare practice leader at B+H Architects (Toronto). Here, he shares his thoughts on the COVID-19 crisis, the mobilization of healthcare, and planning for future fights against unknown viral threats.

  1. Resilience must stretch beyond hospitals

Our ability to successfully handle our next health-related crisis will depend in large part on the adaptable designs of buildings not principally designed for healthcare needs. The pressures of COVID-19 suggest that we need to design more flexibility, adaptability, and resilience into the built environment. Think polyvalent function—how can our sports stadiums, hotels, and similar structures be designed to allow them to be easily repurposed to handle health-related needs? How do we adapt public space to allow for more outdoor functions or more ways to access buildings to limit contact with others? More than any previous crisis, this pandemic has mandated the need to re-examine different types of buildings under a new lens.

  1. We cannot solve a problem that we cannot measure, or manage

With few exceptions in the response to COVID-19, we’ve failed to test (an infrastructure and human resources problem) and to isolate (a behavioral problem), leading to hundreds of thousands of avoidable cases, deaths, and deep economic impacts. We should be looking to invest in more distributed basic-to-intermediate care centers on a community level that would also house relevant diagnostics, permitting ease of localization in the population. We should apply infection management and control principles to key places of assembly such as schools, shopping malls, and restaurants to manage the level of contact.

  1. Shortcomings in flexibility, not fundamental design

Like the acute care system itself, our hospitals are designed to treat individuals, not cohorts, and individual “episodes” not longitudinal events. The wholesale suspension of elective treatment in response to COVID-19 has served to “block” access to ongoing care for patients. One clear design lesson is that we need to be able to compartmentalize and support diverse routes into and out of our healthcare facilities so that they can continue to operate different zones (non-infected, status undetermined, infected) across multiple service lines in parallel. The unstated problem today is the impact of the backlog of nine months (and growing) of suspended and curtailed care for all issues beyond the pandemic.

  1. Accelerating acceptance of virtual medicine

The COVID-19 pandemic has accelerated both the development and (arguably more importantly) the acceptance of remote care. Diagnostics can be performed anywhere, outpatient procedures have become the norm, and patient data is collected and relayed electronically. Wearable medical tech, online health apps, and emerging services allow anytime, anyplace virtual access to the primary healthcare system and the possibility of all-time data gathering. These new tools will change what we do in the “physical” space of healthcare. Routine primary-care encounters will continue, but they too may be “touched by tech.” For example, in Guangxi, China, a service called “Ping A Good Doctor” has created a kiosk exam space (similar to a photo booth) that combines artificial intelligence, which runs an initial screening and on-board diagnostics, with a telemedicine event with a human caregiver. These kiosks also come equipped with a pharmacy vending machine that can fill-out basic prescriptions.

  1. Expanding our idea of health

More than any recent event, COVID-19 reinforces that the notion that health rests with the person and is not strictly found in a hospital. Indeed, COVID-19 should not lead to a sector-wide shift in hospital design. We need to address the root causes, transmission paths, and testing gaps in our public health system (inclusive of new or adapted building types) as the primary vehicle to shield the acute care system. As can be seen in the more severe outbreaks, the disease will quickly overwhelm limited hospital space, equipment, and caregivers. What must be addressed are the vulnerabilities and inflexibility of our built environment outside of hospitals so that we can live, work, socialize, and be healthy in body and mind. Apart from changes in how we interface with the healthcare system, this will lead to infection control principles and practices moving into day-to-day life (think of the ubiquitous hand hygiene stations that have been created as a simple example) and a shift in the milieu of care out of hospitals into a safer, more efficient, and more responsive place closer to home.

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