Current Trends

In the 2026 revision cycle, the Facility Guidelines Institute made a major structural change by separating enforceable codes from non-mandatory guidance. However, there are minimal changes that impact the  types, numbers, and sizes of spaces included in the SpaceMed Guide.

BACKGROUND

The Facility Guidelines Institute (FGI) is an independent, not-for-profit organization that provides guidance for the planning, design, and construction of hospitals, outpatient facilities, and residential care facilities. Through a consensus process that includes public input, the FGI documents are updated every four years.

The SpaceMed Guide complements the FGI documents by helping healthcare architects and planners develop the functional program, required prior to application of the FGI documents, and the room-by-room space requirements necessary to begin the design process. Although the FGI documents provide indispensable guidance for the designer on risk assessment, infection prevention, architectural details, surfaces, and built-in furnishings, the SpaceMed Guide specifically addresses the types, numbers, and sizes of spaces.

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Any healthcare organization would be delighted to have a private donor fund a building project. Sometimes, however, the donor has no interest in the organization’s long-range capital investment strategy but wants to construct a building or fund a program that is not even on its radar screen. Most organizations are not in a position to reject such donations, and it is a rare administrator who has the backbone to turn down money rather than compromise the organization’s long-range facility master plan.

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Hospitals and healthcare systems have spent much of the last three years balancing being in a state of emergency readiness while waiting for the next COVID-19 wave and safely delivering routine health services. Many of the challenges that existed before — a shrinking workforce, an aging infrastructure, and narrow operating margins — have worsened during the pandemic. At the onset of the global pandemic, faced with rising COVID admissions, many hospitals canceled elective procedures and redeployed patient care space in new ways to meet the rising demand for beds and new infection control measures. At the same time, U.S. adults delayed or avoided medical care due to their coronavirus-related concerns causing non-COVID admissions to plummet. Starting the third year of the global pandemic, staffing shortages due to burnout were at an all-time high as hospitals still struggled with COVID-19 admissions while treating higher-acuity patients. Hospitals and health systems continue to face increasing costs for labor, drugs, personal protective equipment (PPE), and other medical supplies needed to care for higher-acuity patients.

According to the American Hospital Association (AHA), America’s hospitals are experiencing unprecedented financial losses — 2022 was the most financially difficult year for hospitals and health systems since the start of the pandemic, leaving over half of hospitals operating at a financial loss at the end of 2022, and with negative operating margins continuing into 2023. As a result, healthcare organizations are rethinking their capital investments while existing facilities are being retooled, expanded, and underutilized simultaneously. In this post, you can read about some of the current issues in healthcare facility planning — fluctuating utilization and forecasting challenges, shortage of nurses, new safety protocols, rapid growth in telemedicine, advances in telecommunications technology, and integration of imaging into most medical specialties.

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The term “flexibility” has become somewhat overused today. It is repeated as a mantra among healthcare planners and design architects. By definition it means “adaptable” or “adjustable to change.” In reality, achieving flexibility often requires that physicians and department managers and staff relinquish absolute control over their space and equipment for the greater good of the organization. However, with fluctuating workloads, rapidly changing technology, staff shortages and high turnover, and limited access to capital in today’s dynamic healthcare environment, planning flexible space is no longer an option.

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