Hurricanes, pandemics and robotic surgical arms are driving fundamental changes in healthcare design.

Hospital and medical projects represent some of the nation's most disruptive changes in architecture, Dan Thomas and Julie Frazier at Perkins & Will said during a presentation last week at the American Institute of Architects' yearly conference in Washington, D.C. The changes were already underway when the coronavirus hit in 2020, but the pandemic contributed to healthcare property owners’ urgency, they said.

“As a result of the pandemic, we’ve seen it change dramatically,” said Thomas, a principal in the Dallas office of Perkins & Will. “We went from ‘How can we expand our facilities over five or 10 or 20 years?’ to ‘How can we change overnight?’”

Hospitals had to scramble to rearrange the layouts of their facilities, including waiting rooms and examination rooms, to treat coronavirus patients, Thomas said. Hospitals also had to devise ways to lock down facilities for patient security, and many converted routine patient wings into isolation wings.

Perkins & Will is creating designs for new and renovated facilities that will make it easier for hospitals to make these changes in the event of another public health crisis.

“As patient volumes change, the facility changes to serve the type of patients” that are being admitted to the hospital, depending on patients’ specific needs, Thomas said.

Perkins & Will has created designs reflecting these changes for both for-profit and nonprofit hospital owners. Those clients include the Cleveland Clinic in Ohio; HCA Healthcare; Kaiser Permanente; Parkland Memorial Hospital in Dallas; Tenet Healthcare and the University of Oklahoma Medical Center in Oklahoma City, Thomas said.

Hospitals need higher ceilings, fewer columns and more open-floor space to create more operating rooms and fit large robotic surgical arms, Thomas said. At HCA’s Texas Orthopedic Hospital in Houston, Perkins & Will expanded the size of a waiting room by installing a prefabricated air diffuser system in the ceiling, opening up floor space that had held the previous air diffuser. That allowed the hospital to convert the waiting room into an operating room.

The increasing frequency and severity of hurricanes and other natural disasters have led hospitals located in vulnerable areas to beef up facilities, said Frazier, a principal and director of healthcare planning at Perkins & Will.

Christus Health’s Spohn Hospital Shoreline in Corpus Christi, Texas, is located on the Gulf of Mexico coast but is the region’s only Level 2 trauma center. It’s also located near one of the largest concentrations of oil and gas facilities in the United States, making Corpus Christi a potential target for terrorists, Frazier said.

“They could be impacted by just about everything — sea levels rising, storm surge, hurricanes, bioterrorism, disease outbreak, cyberattacks, you name it,” she said.

Perkins & Will designed several ways the hospital can convert spaces to respond to public health emergencies. It created isolation rooms on every floor, redesigned an ambulance bay so it could be converted into an outdoor holding area during a public health crisis and reconfigured rooms to allow for conversion to overflow areas.

Hospital architects are also trying to create easily accessible outdoor spaces for nurses to recover, Frazier said. Nurses were subjected to extreme emotional and physical stress during the pandemic but lacked places for respite. That led to an uptick in nurses quitting their jobs.

“It used to be that the nurses’ staff lounge was a small, dark room in the middle of the hospital,” Frazier said. “They had endless feelings of hopelessness for months and months. I can't tell you how many times I heard stories during COVID where everybody's masked up all the time and all a nurse wants to do is have a place to step outside and just take off the mask and have a breath of fresh air.”

Designers are also looking at ways to make the experience of visiting a hospital or doctor’s office less stressful for the patient, Thomas said. To address the phenomenon of “white coat syndrome” where a patient’s blood pressure spikes when walking into a waiting room and passing the nurses’ station, architects are segregating the patients’ area from the space where nurses and doctors are working.

“You go to get an exam and your heart rate spikes up because you walk in and you’re seeing the white coat and you get nervous,” he said.

“This also helps the staff because they aren’t having to worry about crossing in front of the patient in the hallway,” Thomas said.