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.

Douglas King is vice president of healthcare for Project Management Advisors Inc., a national real estate advisory firm. Here, he shares his thoughts on creating a national program of alternative care sites, the evolution of modular design, and the future of healthcare and civic partnerships to drive whole-person care.

  1. We need a national database of alternative care and modular health components for emergency response.

COVID-19 showed how a public health emergency can strain hospital capacity and force the conversion of alternate sites, including convention centers, dorms, and hotels, into care facilities. But as the first wave of the virus receded, many of those alternate care centers were packed up and put into storage. A national program could incentivize healthcare institutions to house, maintain, test, and redeploy these components, meaning they’re ready to go when needed, not stored away or waiting to be manufactured. I’m part of the team drafting the new U.S. healthcare standards addressing Emergency Response for the FGI Guidelines, which will provide guidance and design standards for rapid conversion. Having alternative care facilities ready for immediate deployment will save valuable time during an emergency situation, while greater standardization and cooperation between governmental agencies and healthcare providers can help the entire population during the next threat.

  1. Codify design requirements for hospital flexibility, adaption, and expansion.

A compelling piece of the upcoming FGI guidelines on emergency response is giving hospitals more direction to expand the number of ICU-capable spaces and medical/surgical spaces to meet rapidly growing patient populations. Doing so requires a thoughtful, thorough approach to designing HVAC systems that can expand and contract as needs arise to enable converting spaces for higher-acuity patients rather than moving patients off site. The ability to step-down care into less-intensive spaces can help better manage patient surges if it’s thoughtfully designed and constructed.

  1. Embracing modular construction to win the race to market.

Prefabricated components have grown quite sophisticated over the years, from complete mechanical racks to exterior curtain wall assemblies that only need to be set in place on-site. Healthcare developments are going even further to embrace the 3-D potential of modular design and construction, manufacturing entire rooms that can be connected on-site. This shift has major design implications, as it reduces design variation, but it also requires costs to be incurred early in the project to facilitate manufacturing. Our project management organization recently joined a consortium of firms developing 3-D modular ambulatory care centers in the U.S., and we’ll be keeping a close eye on progress to determine how the process can be deployed in other markets and building types.

  1. Population health management is changing the nature of healthcare design.

Through changes in Centers for Medicare & Medicaid Services reimbursement models, healthcare systems are charged with taking ownership of their services and producing positive outcomes for their patients. Yet 80 percent of what affects health outcomes—behaviors, social and economic factors, and the physical environment—happens outside the healthcare setting. Hospitals need to think of themselves as more than bricks and mortar, which will have a significant impact on how they conceptualize and design their space. We’re already seeing an extension of the healthcare setting into retail and neighborhood environments and many cities are trying to address the same factors that influence health outcomes to create livable or healthy places to live. Creating healthcare and civic partnerships can drive new development in the years ahead to treat the whole person, resulting in healthier communities and addressing healthcare disparities.

  1. FQHCs are expanding healthcare access.

Federally Qualified Healthcare Centers (FQHC) serve a patient population that lives largely below the poverty line. They’re a center for innovation in how they treat individuals with thoughtful, creative care. When the pandemic forced these clinics to stop seeing patients, many quickly shifted to phone-based virtual medicine, recognizing that many patients didn’t have access to a computer at home. This is an example of the changing face of healthcare and how patient services must extend beyond the walls of the hospital and healthcare system, which will ultimately affect design. Others, like Heartland Health Centers, a FQHC in Chicago, have partnerships with local public schools to place clinics in the schools, which engages families and promotes family health. Partnerships like these need to be expanded and promoted across the U.S., with the design community having a role to play in creating these healing spaces.

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