Our healthcare system is designed to treat symptoms rather than focus on prevention. Architecture works slightly differently. We have to plan ahead. This is especially true in healthcare design, where the predesign phase is one of the most critical phases in a facility’s project timeline, when programmatic and other assumptions are identified, along with mapping workflows, equipment requirements, and adjacent spaces.

It is at the PreDesign stage of the project that the right people can answer practical questions while the project still has options. Architects who specialize in predesign are underrated specialists who anticipate how a facility will be built and used, long before the permit drawings are submitted to municipalities for approval.

Within reason, many project change orders can be prevented. They are often the result of an issue that has been overlooked or ignored, largely because healthcare design incorporates the needs of a wide range of specialists, from doctors and medical staff to equipment operators and administrators.

At Clover, we believe that change orders don’t appear out of the blue. They’re delayed consequences of early assumptions, missing information, and decisions that were never properly made, documented, or owned by key stakeholders. Because of the inherently long timelines required to build healthcare projects, there is a tendency to accelerate project milestones at the outset by pushing toward producing a set of permit drawings. However, without clarifying important assumptions early on, a room might be designated a “clinic,” whereas in reality it was intended to be an office with a completely different set of code and finish requirements. We can all appreciate that a pediatrician’s examination room is held to a much higher standard than a room intended for administration.

Similarly, issues arise with barrier-free design. Most architects and interior designers are comfortable with the necessary codes and bylaws related to accessibility, but in a healthcare setting, atypical equipment and vendor specifications require special attention at the outset of design. By the time these issues surface in construction, the project’s costs rise, schedules slip, relationships amongst stakeholders become increasingly strained, and the organization pays for late decision-making.

Why clients should care

Evidence-based design indicates that effective healthcare design speeds patient recovery and improves health outcomes, yet healthcare facility design also affects staff mental health outcomes, including stress, fatigue, burnout, job satisfaction, and general well-being. Burnout is linked to medical errors, hospital infections, and higher patient mortality rates. Effective predesign anticipates staff mental health concerns from training to consultation.

Design excellence, a sense of belonging to surroundings, privacy, safety, and wayfinding influence staff satisfaction, stress, and burnout. Patient areas, staff workspaces, break areas, and outdoor spaces also substantially affect mental health outcomes. For example, single-family rooms in NICUs reduce stress and improve satisfaction, while outdoor spaces and gardens decrease burnout. Intangible factors such as natural light, exterior views, sound/noise levels, temperature, and air quality affect stress, fatigue, and well-being.