The Pandemic Resilient Hospital: How Design Can Help Facilities Stay Operational and Safe

Download Full Report

As the SARS-CoV-2 pandemic continues to stress our health care system, it is hitting our hospitals especially hard. HKS collaborated with Arup, a top international engineering firm, to share actionable strategies for how hospital systems, large and small, can implement resilience strategies to support and maintain operations during a pandemic.

The Challenge

The COVID-19 virus has killed more than 2 million globally, over 400,000 in the United States, and sent many more into hospital care. This pandemic has brought with it the unintended consequence of deferring an estimated 4 in 10 people from seeking care, temporarily shuttering surgery centers, and causing many hospitals — already with narrow margins — to implement wide layoffs, furloughs, or even shut down in some cases. The American Hospital Association estimates lost revenue has cost America’s hospitals an average of $50.7 billion per month.

Infectious diseases are increasingly likely to arise and become more widespread in the future due to climate migration and the growing spread of zoonotic diseases, and the environments of care must be a part of the solution.

Creating facilities that are able to maintain operations during a pandemic is essential. Facilities need to be safe and demonstrate safety to foster public trust and a return to care. Without this, there will continue to be a monumental impact on our health care delivery system and patients seeking care for conditions like heart disease, cancer, diabetes, or a knee replacement.

Creating facilities that are able to maintain operations during a pandemic is essential.

The Approach

The Principles for Pandemic-Resilient Healthcare Design are intended to serve as a guide for hospital executives, facility directors, and planners as they design and renovate spaces to address the current pandemic and increase resilience for the future.

This guide was created by an interdisciplinary team of architects, engineers, clinicians, and medical planners from HKS, a top global architecture firm, and Arup, a top international engineering firm. Interviews with frontline clinical, administrative, and executive staff informed the design strategies with an understanding that no one strategy or modification is a panacea; each facility needs unique approaches based on its foundational infrastructure.

We address design for long-range airborne infectious diseases and leverage synergies between infectious disease care and overall healthcare priorities, with the goal of creating a flexible and resilient hospital campus.

“Given the hard truth that we will see more pandemics in our future, it is more important than ever to create facilities that are flexible and resilient for what might come,” said Bill Scrantom, Americas Healthcare Leader at Arup. “Our collaboration with HKS has resulted in a report that offers core considerations, rather than prescriptive solutions, that address the unique needs and design of each hospital when planning for future pandemics.”

Hospitals come in many forms. To help facilitate the design principles outlined previously and provide tangible design strategies, we chose one theoretical case study and take it from campus and system, building, unit, and room level. Below, we take these seven principles and simplify them into three overarching themes of design for flexibility, safety and cleanliness, and human well-being.

Each of the strategies provided are being applied throughout the nation in some form, and the final pages of the report include five examples from across the nation on how health care facilities have responded and how they are planning differently for the future.

Designing for Flexibility

Continuity of operations and care is critical to our health care system and patient health. Designing for flexibility, from acuity to isolation level, and using multipurpose or flex spaces will be essential in healthcare design going forward.


  • Designated surge spaces for testing, triage, and care should incorporate necessary medical gas, telecommunication, and critical power to support the surge conditions but be used for standard-care purposes.
  • Assess the medical gas, telecommunication, and electrical infrastructure risers and lateral mains to ensure designated surge areas can accommodate for the additional ventilators and other medical equipment.
  • The Orlando Regional Medical Center has a designated flex pod in their emergency department (ED) that serves for urgent care when in normal mode and can flip to pandemic mode at the flip of a button. This has been used throughout the current pandemic and has been reported to greatly increase staff comfort and safety.
  • Pop up temporary walls or fit in plexiglass dividers to create separations that feel built-in but are flexible and easy to add or remove.
  • Create an infrastructure system that can be modified in the future while limiting the needs to shutdown specific areas. 

Designing for Well-being

Pandemic care is extremely stressful on staff, patients, and families. Hospitals can designate areas to serve as spaces for respite, recovery, and wellbeing.

  • Proximity and visibility between staff can foster teamwork and coordination of care. Unit designs that support this, can support wellbeing.
  • Support the wellbeing of patients through virtual interaction with loved ones on monitors and screens in the patient room.
  • Plan for locations of respite for staff both within the units and outside where they can safely relax. Consider UVC lighting in these staff respite, doffing areas, elevator lobbies and elevator cabs to contain and eradicate the contaminants.
  • Many facilities found themselves needing to house staff who could not safely go home. Facilities that had partnerships with local hotels, or alternate temporary housing were able to better serve their staff.
  • Dedicate a flex space that is able to transition to a safe on-site staff respite for smaller breaks.

Designing for Safety and Cleanliness

One of the primary paths of travel tends to be from the ED, where patients are first assessed and discharged or admitted to the inpatient units. Wherever possible, treat the contagion source directly and shrink the containment zone to minimize risk to the bedside caregivers, reduce possibility of migration, and effectively address the contagion.

Buildings and units that have a shorter and more direct path of travel from the ED warrant greater consideration for designated infectious disease care. Interventions at the facility level must also consider the role of ventilation, power and plumbing as part of any solution to address infection control and pandemic response.


  • Hospital air distribution systems play an essential role in protecting frontline essential workers and isolating them from the standard, non-infectious hospital operations. Risk-based, quantifiable targets should be established for the indoor air quality with the goal of reducing the contaminated particulate concentration and increasing the dilution percentage at the patient, room, and building levels.
  • The majority of hospital clients that were interviewed established at least one dedicated unit for COVID-positive patients. Many projects currently in design have modified their plans above mandated minimums to increase their future operational flexibility. This includes an increased percentage of isolation rooms, and/ or universal design rooms that can quickly shift from acute to critical care.
  • Install a campus-wide Real-Time Locating System (RTLS) to contact trace patients and staff and quickly identify and monitor exposure risks. RTLS technology can also assist in patient flow optimization, nurse call automation, and equipment tracking.
  • To limit the number of times staff members have to go into patient rooms, and thus use often-scarce PPE, many hospitals have passed the cords under the door or through a wall to provide access to regular-use equipment like IV pumps without entering. In this instance, there needs to be clear visibility to the patient from outside the room.
  • Because operating rooms (ORs) are central to operational solvency, hospitals have paid special attention to the perioperative spaces by creating designated ORs with anterooms for COVID-19 positive patients separated from the rest of the surgical areas. For perioperative spaces, some new build facilities have decided to eliminate all open bay prep and recovery spaces, in favor of a three-walled solution, while increasing the number of four-walled isolation bays.

Key Takeaways from the Report:

  • Continuity of operations and care is critical to our healthcare system and the health of patients, and the design of our healthcare facilities can help support this.
  • Designing for flexibility, from acuity to isolation level, or the use of multipurpose or flex spaces is essential in healthcare design going forward.
  • Interventions at the facility level must consider the role of ventilation, power and plumbing as a part of any solution to address infection control and pandemic response.

If you are a health care system or provider in need of assistance with planning or renovating, please contact HKS Principal and Global Health Practice Leader Jason Schroer, AIA, ACHA, LEED AP at [email protected].

Access the full report below.