Vince Avallone (Courtesy of SmithGroup, Copyright 2024 Rebecca Wilkowsk)
In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what has their attention and share their ideas on the subject.
Vince Avallone is national director of medical planning at SmithGroup (San Francisco).
Here, Avallone shares his thoughts on how the built environment can help to mitigate labor shortages in healthcare, address staff security, and balance personalized care with precision medicine.
1. Healthcare facilities that support staff well-being and efficiency
The industry can’t keep planning healthcare facilities as if staffing will bounce back to what it used to be, or as if there’s an easy solution to ongoing clinician shortages. Training pipelines constrained by faculty shortages, burnout, and accelerated attrition increasingly shape how care is delivered.
Beyond organizational strategies, the physical environment plays a meaningful role in staff well-being and efficiency. Access to daylight and views, ergonomic workstations, quiet spaces, and efficient layouts help minimize fatigue and errors while reducing travel distances, wasted time, and frustration. Dedicated indoor and outdoor respite areas support decompression during long shifts.
From a planning standpoint, this places greater emphasis on rightsizing work areas, reducing redundant support spaces, and prioritizing adjacencies that streamline workflows. Decentralized work zones, flexible team rooms, and acuity-adaptable spaces allow fewer staff to safely support evolving care models.
2. Designing for staff safety in healthcare facilities
Staff safety is a serious issue that’s no longer limited to urban centers or traditionally high-risk areas such as emergency departments. Confrontational social interactions, behavioral health issues, and violence increasingly affect everyday operations and staff retention.
Several states are advancing workplace violence legislation including California, which was the first to pass laws that directly elevate the role of the built environment in enhancing safety. For example, weapon detection screening is now required at key hospital entrances, influencing layouts, entry sequencing, security staffing, and the arrival experience.
Safety planning and design strategies include securing offstage staff and service circulation, restricting access to nursing units, integrating staff communication systems, and implementing destination elevator operations, where passengers are directed to preassigned elevators rather than given access to all floors.
As safety concerns grow, layered approaches are increasingly required, combining policy, technology, access controls, staffing, and life safety planning.
3. Reducing patient and visitor stress in care environments
Patients and visitors consistently tell us that navigating the health system as well as healthcare facilities is a significant source of stress. Architectural planning plays a critical role in reducing this friction.
For example, the arrival experience should include clear site planning, visible entrances, and legible massing to establish intuitive wayfinding long before the signage is encountered.
Inside, materiality, scale, spatial hierarchy, and visual cues guide movement and reduce reliance on technology alone. Daylit public circulation both orients and lowers anxiety.
While tools such as digital navigation and geofenced check-in can enhance the journey, they cannot replace fundamental design clarity nor the need for human interaction.
4. Designing to integrate care and research services
Care delivery is becoming condition-specific and increasingly tied to research or advanced therapies. While “bench to bedside” is not new, the physical integration of inpatient, outpatient, and research functions is evolving, and healthcare buildings need to keep pace.
Facilities are increasingly housing research alongside inpatient and outpatient care, often organized around specialty service lines such as oncology, neuroscience, or cardiovascular care.
These environments support genomic-based diagnostics, clinical research and trials, data science, and AI-enabled workflows that shift care from population-based to individualized models.
As a result, these environments require a higher degree of customization—spaces that can be reconfigured over time, infrastructure that can accommodate evolving technologies, and planning frameworks that support both clinical care and research workflows.
At academic medical centers, this shift is particularly evident as specialty clinics are pulled out of the typical medical office building setting, requiring highly tailored environments designed to support translational models of care.
5. Early disaster planning for healthcare design
Facilities must be ready for a wide range of scenarios, from mass casualty events and pandemics to climate‑driven disasters and infrastructure failures. While the emergency department remains a focal point, system-wide reliance depends on intelligent site planning, convertible units, redundant building systems, and clear emergency circulation that’s embedded in the building itself rather than left to operations to bridge the gap.
Getting every future scenario right is unrealistic. What matters more is whether the environments we plan give health systems room to adjust when things change—which they always do.
Want to share your Top 5? Contact Senior Editor Robert McCune at [email protected] for submission instructions.
