From robotic operating rooms to outpatient surgery centers, healthcare facilities look very different than they did a generation ago. Breaking Ground sat down with Tami Greene, President of IKM Architecture, to discuss the trends shaping healthcare design today. Drawing on nearly thirty years of experience in the field, Greene shared insights on technology, flexibility, patient experience, and the future of healthcare construction.
Editor’s Note: This interview has been edited for length, clarity, and readability. Responses have been lightly condensed while preserving the speaker’s intent and meaning.
What have been the big changes you've seen over the course of your career with the healthcare design?
Technology is driving many of the decisions we make in design. Some rooms now need to be larger because of the technology they contain, like operating rooms, while other areas, like waiting rooms, are getting smaller. Technology also changes what has to be built. For instance, we no longer have paper records. Everything is electronic medical records (EMR). We don't have to worry about designing the structure to support, and the large footprints of file rooms.
Every space with a patient has a computer on wheels next to it. That was never the case 15 years ago. There’s also a growing focus on connecting patients with home through technology when they're in a patient room for extended periods. Virtual visits and remote monitoring are changing what the architecture looks like.
From a system perspective, we're seeing a lot of care moving off the main hospital campus and going into the communities. Outpatient care centers, medical centers, and surgery centers create convenience for patients and staff. This shift is making room on hospital campuses for larger spaces like robotic operating rooms (ORs) and whatever additional space is needed for the more acute patients who need to remain there.
Are expanded needs from the OR technology, like the larger space for robotic arms, one of the reasons why they have to downsize areas like waiting rooms?
No, these two areas of design are not influencing each other. I think there are simply less people waiting. Today, systems have very good processes for moving patients into rooms more quickly. In the area of OR design and other clinical areas,some codes require more clearances, but those requirements aren’t making waiting rooms smaller. Sometimes it's a process change based on our understanding of how patients are treated. Sometimes it's additional clearances, and sometimes it's making room for equipment, such as what’s required for orthopedic procedures. We're also seeing more hybrid ORs. Some surgeries now require MRI, CT, and X-ray capabilities all in a single room. That requires significantly more space to accommodate image-guided surgical technology. If we have an operating room with robotics, the equipment sits along the wall when it’s not in use. We need dedicated space for that equipment, so operating rooms are becoming larger to accommodate those systems.
It's kind of funny to think from when you started to now, when you're having to adjust for robot arms. Let’s zoom in a little bit, are there any trends that you're seeing in the past 3 to 4 years? Obviously, COVID was like chucking a stick of dynamite into everything. How has that has that reverberated over the past few years?
Flexibility, in particular. Let's say we design a medical-surgical unit. It might need to function as an ICU in the future. It might need to be converted very quickly if we face another public health crisis. That conversion usually involves air changes. We need to ask: Can we quickly set these rooms to negative pressure so we're not pushing air into the corridors and potentially spreading infection?
We've had many conversations about how to make those conversations possible. We are figuring out if we can have an area in the room, perhaps a cabinet or a connection in a certain zone, or where we can bring in equipment to create negative pressure. It really is about creating flexibility for the spaces we design now, so that if another pandemic occurs, we’re ready to respond.
Across the board, we're much more sensitive to infection control. When you walk into a medical office now, you'll see many hands-free devices, whether it's the soap and the paper towel dispensers, or access controls. Patients and staff no longer have to hit a button on the wall. They can simply wave a hand to open a door. This touchless design approach is a result of COVID and is now common in many of the facilities we design.
Interesting. And what about aesthetic wise? Is there more of a focus on making it feel like a home or high-end hotel?
What I am personally seeing from clients is a greater focus on cost-efficiency. There are a number of things in a healthcare build that must be in place for it to meet code. Rooms have minimum size requirements. There are requiredadjacencies. There are certain finishes that have to be installed to prevent infection and flame spread.
There's no compromise on those requirements because they’re there for patient safety. Once we check all of those boxes, aesthetics is something that can sometimes take a backseat. Facilities are still designed with attractive, durable, and cleanable finishes, but items such as decorative light fixtures, sculptures, atriums, and large wall murals may be eliminated to control costs. Sharing space is another big trend to control costs. Timesharing clinical space has become quite common. Multiple specialties may share exam rooms, support spaces, and physician work areas. Rather than providing private offices, facilities often create shared physician spaces. That reduces the overall square footage required and helps control costs.
Almost like coworking for the medical field.
Yes, absolutely. There are a lot fewer private offices. Physicians used to have their own offices and would invite patients into those spaces to share private information. Now, we often see large physician workrooms and medical assistant workrooms. They may have a desk, a file drawer, and a shelf that they can put a family photo on, but that’s about it.
Private conversations now take place in shared consult rooms. A patient might move from an exam room to a consult room for a longer conversation in private, but that room could be used by any physician as needed.
Has designing healthcare spaces changed the way you personally think about healthcare?
When I think back to before I started designing for healthcare clients, I thought medical staff and their ability to evaluate my condition to determine the course of treatment and the successful execution was entirely what determined if I recovered from my medical condition.
I never thought the space I was in had anything to do with my health. I was young then, but now I know there are so many details that matter. There are code requirements, infection control needs, coordination of the complex installation of state-of-the-art equipment, such as linear accelerators and MRI systems, shielding requirements, air-pressure considerations, and countless other details. Every single rule that we follow as healthcare designers exists for the health and safety of patients. Every single one of them focuses on how the staff can support and care for these patients.
We track an incredible number of details in healthcare design, but if we don't follow those rules, and the contractors don't follow them during construction, patient safety can be put at risk. Everything we focus on is ultimately helping patients heal. As designers, we are contributing to that healing process, and that’s a meaningful realization.
My closing question for you was going to be ‘what do you enjoy about this?’, but I think you kind of answered it. This isn't an office. This isn't a restaurant. This is something extremely different. And you might not necessarily appreciate the full value of the work that went into making it up to code, but that's a reason why you leave the building in one piece.
Helping create that environment is really what I love most about healthcare design - contributing to the care of others. My father has stage 4 cancer. I was in an interview yesterday for a project to replace a linear accelerator. I found myself thinking that I can't do anything to help my father heal. But being part of a project that brings the most state-of-the-art equipment to a healthcare facility means something because another team did that for the place where my father receives treatment. We’re contributing in that way, and it means something. On a broader level, what I enjoy the most are projects where we have the opportunity and budget to consider the details of an environment.
For instance, designing for women. I've spent time studying how men and women perceive the built environment. We often have different preferences. Women typically process stress through parts of the brain associated with language and communication. Men, generally speaking, process stress through movement and action.
If I were diagnosed with breast cancer, being a female I might want to talk through that diagnosis more. If someone needed to move me from an exam room, I may be moved to another space where I could ask questions and process the information.
I really like thinking about the patient perspective. Sometimes it's based on gender, sometimes it's related to behavioral health needs. It’s about empathy and understanding who the patient is, what their stressors are, and how we can reduce them throughout the patient journey.
How do patients move through the facility? What are the stressors as they're waiting to be seen? What are the stressors as they're being prepped for surgery? Is there anything I can do in the built environment to provide details that reduce that stress? I really enjoy thinking about those questions.
That makes me laugh a little bit because when I get stressed, I go for a walk. My wife's like, what is wrong? Okay, we'll close out with if you had to make a prediction for the next five years, how do you think your industry will evolve?
I think we'll continue to see care distributed into the communities where people live.
More surgeries will be performed in outpatient centers, and we'll continue to see growth in outpatient facilities and ambulatory surgery centers.
Large hospitals will continue to focus on acute care. But routine diagnostics, rehabilitation, and disease management will increasingly happen closer to home, allowing hospitals to focus on their most acute patient’s needs.
Technology will continue to play a major role. I don't know if it will all happen within the next five years, but I think remote monitoring and home-based care will continue to grow.
There aren't as many telemedicine visits as many of us expected after COVID, but healthcare ultimately comes down to patient convenience. If services can safely be provided at home, I think we'll continue to see that shaping healthcare design.
We also can't leave AI out of the conversation.
Earlier this year, I attended the World Health Expo in Dubai, and there was a lot of discussion around AI listening to patient visits, with permission, taking notes, and helping clinicians document care and evaluate treatment options.
Clinicians will still need to review, edit, and approve those notes and treatment plans, but that's clearly where things are heading.
Anytime AI can help us operate more efficiently, whether it's patient flow, monitoring, equipment movement, or material management within a facility, it will likely be considered.
AI will also affect the buildings themselves. We'll need larger electrical rooms, expanded data infrastructure, and stronger cybersecurity measures.
In the future, I believe AI will become a critical building system, just like mechanical, electrical, and plumbing systems are today.
