As part of Healthcare Design magazine’s 25th anniversary, we invited industry leaders to reflect on some of the key milestones that have shaped modern healthcare facilities. Here, Wayne Barger, vice president, federal market leader, SmithGroup, and Craig Passey, vice president, director of health, SmithGroup, talk about the importance of the shift to all-private patient room in healthcare.
(Image credit: Courtesy of SmithGroup)
Over the past 25 years, few shifts in healthcare design have been as transformative—or enduring—as the move to all-private patient rooms. What began as a gradual evolution driven by clinical research and patient advocacy has become a defining feature of modern hospital design. Today, private rooms are not just a design preference, they are a reflection of how far healthcare has come in prioritizing safety, dignity, and personalized care.
Once considered a luxury, private rooms are now widely recognized as both a clinical and operational necessity. This change, which gained momentum in the early 2000s, rendered much of the existing infrastructure obsolete and drove an astonishing number of bed tower additions and full replacement hospitals across the country. According to the Federal Reserve database, healthcare construction spending surged from approximately $25 billion in 2000 to nearly $70 billion today; the only significant slowdown in the last 25 years occurred after the 2008 financial crisis.
How did policy shifts change approaches in patient room models?
(Headshot credit: Courtesy of SmithGroup)
If we were to isolate one primary driver of this sizeable capital spend, it would be the virtually complete transition of the inpatient environment to an all-private room model—and complementary innovations in nursing unit design. How did we arrive at this point, and what were the key milestones along the way?
Following the Hill-Burton era (1946-1975)—ushered in by the Hospital Survey and Construction Act of 1946, a state grant program which funded a wave of non-profit hospital construction nationwide—the semiprivate patient room was the de facto standard of hospital planning. This was an upgrade from the large multi-bed wards typical of pre-WWII hospital designs.
This post-war construction boom created a massive inventory of healthcare infrastructure designed under this semiprivate room model. As that inventory aged into the 1970s and ’80s, evidence-based research began to coalesce around the benefits of private patient rooms. Today, those advantages are well-known and thoroughly ingrained in the best practices of healthcare design:
- Increased patient privacy
- Improved infection control (later playing a pivotal role in the pandemic response)
- Reduction in noise levels, supporting rest and recovery
- Elimination of logistical challenges in pairing patients by gender, disease type, and acuity
- Accommodation for family zones and overnight rooming-in
- Greater flexibility to accommodate larger care teams, especially in academic and team-based care models
- Alignment with evolving consumer preferences for comfort and autonomy
- Reduced errors and improved patient outcomes
Several early adopters helped validate the model. By 2019, the Mayo Clinic had converted 91 percent of its 1,296 beds to private rooms, while Johns Hopkins had renovated its facilities to achieve 96 percent private occupancy—100 percent when excluding psychiatric patients.
These and other early groundbreakers helped normalize the concept and provided valuable data on operational efficiencies, patient outcomes, and staff satisfaction, reinforcing the case for private rooms as a clinical and strategic advantage.
Movement to private patient rooms
Beginning in the mid-1980s and extending into the early 1990s, many projects still incorporated a significant number of semiprivate rooms into the patient bed mix. While private medical/surgical rooms were becoming more common, the ideal of an “all-private bed” hospital was still about a decade away and was not required by design guidelines or codes.
In many instances at that time, transitioning to private rooms simply involved removing the second bed from a semiprivate room and reconfiguring the space around one patient. In renovation projects, this approach often left issues in place, such as compromised floor-to-floor heights and inadequate MEP systems.
In new construction, designers were able to reconceptualize the private room, incorporating dedicated zones for the patient, staff and family; more equipment floor space; and added flexibility to adapt to higher or lower acuity needs. The longer travel distances required for staff to attend the same number of patients also led to the decentralized nurses’ station. These became the design innovations that defined the modern patient room.
Of course, this shift would not have happened without an eye toward the bottom line. Although many all-private construction projects resulted in the same or even a reduced number of total beds, the return on investment has been proven. A 2021 study in the Cambridge University Press identified a $70,000 net social benefit of a private versus a semiprivate bed, even after accounting for the increased construction and staffing cost of private rooms.
Best practice to patient room design standard
The private room movement reached a milestone at the beginning of the 21st century, gaining recognition in the 2001 Guidelines for Design and Construction of Hospitals—a foundational document for healthcare facility design, originally published by the American Institute of Architects and now maintained by the Facilities Guidelines Institute (FGI). These guidelines, widely referenced by architects and regulators, affirmed the importance of privacy and comfort in patient outcomes.
The 2001 edition noted: “More or all private rooms may be desirable to achieve effective infection control, to improve the environment of care, or to increase the percentage of occupancy.”
In 2006, FGI officially codified the recommendation, stating: “In new construction, the maximum number of beds per room shall be one unless the functional program demonstrates the necessity of a two-bed arrangement. Approval of a two-bed arrangement shall be obtained from the licensing authority.”
Patient rooms designed to support personalized, dignified care
As architects, it’s fascinating to watch how building typologies evolve—how one model becomes obsolete, and another rises to meet changing needs. It’s playing out today as single-use office towers and malls give way to mixed-use developments that better reflect how people live and work.
A similar shift occurred in the world of sports: the cookie-cutter, dual-use stadiums of the 1960s and ’70s—shared by football and baseball teams—were eventually replaced by purpose-built venues tailored to each sport’s unique requirements. While sharing a facility was cost-efficient, it compromised the experience for both players and fans.
The same principle applies to healthcare design. Semiprivate patient rooms may have once been the norm, but they were never ideal for delivering personalized, dignified care.
Like those outdated stadiums, they forced a compromise—on privacy, infection control, patient comfort, and a host of other considerations. The move to all-private rooms reflects a deeper understanding of what patients need and deserve: environments purpose-built for healing, not just efficiency.
Evidence-based room design standards
As the healthcare industry navigates the current era of financial constraint and policy-driven cost reductions, it’s essential to recognize the hard-won progress represented by the all-private patient room model. This shift wasn’t merely aesthetic—it was a response to evolving clinical standards, consumer expectations, and demographic realities.
While reimbursement pressures may tempt systems to scale back, the evidence supporting private rooms as a driver of better outcomes, operational efficiency, and patient satisfaction remains strong.
The challenge ahead is to preserve and build upon this foundation, ensuring that future healthcare environments continue to reflect the values of safety, dignity, and human-centered care—even in the face of economic headwinds.
Wayne Barger is vice president, federal market leader, at SmithGroup (Dallas) and can be reached at [email protected]. Craig Passey is vice president, director of health, at SmithGroup (Phoenix) and can be reached at [email protected].
For more design trend insights from Healthcare Design’s 25th anniversary issue, go here.
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Credit: Courtesy of SmithGroup]]
