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.

Victoria Nichols, a partner at ZGF Architects’ Seattle office, leads the firm’s national healthcare practice. Here she shares her thoughts on remote work, impacts to frontline staff, and leveraging acuity adaptability to address future flexibility.

     1. Engaging users in new ways

Work hasn’t stopped in the last 18 months; in fact, we’re busier than ever. So are our clients. Remote work has enabled us to engage them in new ways. For example, pre-COVID-19, a hallmark of the design approach was to invite staff, patients, and family groups to design sessions using cardboard mock-ups to get their real-time feedback on a new space. When the pandemic hit, our firm quickly shifted to virtual tools such as Microsoft Teams, Zoom, and WebEx, to maintain that level of engagement and help them address the challenges they’re facing. We’re also testing new approaches to get at the same answers, whether it’s presenting draft solutions and using virtual walk-through’s of concepts for users to react to, or relying more heavily on consolidated feedback from patient and family advisory groups. But how effective are these tools, and what might be getting lost by not hearing from as many individual voices and standing in the mock-up spaces together? The jury is still out.

  1. Shaping the whole-person experience

Healthcare doesn’t begin at the front door of a hospital or clinic or end when a patient leaves. What happens before and after care can be as impactful as the time a patient spends receiving care. Perhaps a family has to take three buses to get to the medical campus. Maybe they’re reluctant to seek care in the first place. The design team can’t solve some of these challenges, but if we know what we’re up against—through direct feedback from patients, staff, and families—we can use design to help break down barriers, making our spaces feel safer, more welcoming, and easier to navigate. Even providing a transition space in a lobby can help patients catch their breath and shift gears mentally before proceeding to an appointment.


  1. Distributing care off campus

During the latest COVID-19 surge, fewer elective procedures are being cancelled or postponed compared to last spring. Patients still don’t want to risk exposure by going to the hospital if they don’t need to. This begs the question: What care needs to happen at the hospital, and what can be done in community clinics where most patients live, or even at home? Similarly, a lot of primary care takes place at academic medical centers because it’s convenient for providers. Looking ahead, we have an opportunity to help our clients reconsider the best care setting for the patient and not continue to expand already large, imposing campuses.


  1. Prioritizing the staff experience

For years, our clients have cited staff retention and recruitment as their most acute challenge. Eighteen months into the pandemic, the strain of caring for patients continues to take a toll. And yet, while most hospitals have requirements to provide lactation and wellness rooms for staff, all too often, we hear stories about how staff break rooms are being absorbed for other uses, such as for meetings, report outs, conference room, or training. It becomes “the everything room.” It’s never been more important to help staff recharge and care for themselves by rebalancing the distribution of space for staff respite, clinical support, and direct patient care. We must take the time to understand the needs of staff, offer choice in the built environment, and not assume the status quo is acceptable going forward.

  1. Flexibility of space and infrastructure

With clinical space at an all-time premium, especially during the pandemic, many hospitals have resorted to converting  waiting areas, conference rooms, and support spaces to make room for high-acuity patients. Some facilities are literally running out of oxygen, which puts a strain on their entire medical gas infrastructure. Acuity adaptability has once again become a trending discussion topic—the idea of designing every patient room to accommodate the highest-level acuity and scaling the use of these rooms down as needed. But this level of care also comes with the largest and most expensive footprint. The big challenge designers face is to find a happy medium between being prepared for the worst—such as a long-term surge—without overbuilding and while still being good stewards of our clients’ resources.

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