When it comes to the playbook for architects who specialize in designing healthcare facilities, COVID-19 came like a wrecking ball. The years-long migration to fewer private offices and more collaborative workspaces? The friendly trend of checking patients in without a desk? The vast multispecialty clinics, with common areas meant for lingering? Gone, gone and gone.

“We’ve spent so much time over the last decade making waiting rooms cozier, like living rooms,” says Jennifer Arbuckle, a Vermont-based partner in E4H Architecture, which specializes in healthcare offices and facilities. “Now we’re trying to make them more spread out.”

HVAC issues are top of mind also, as are square-footage conundrums. But each question —Should patients wait in their cars? What about those who can’t come in alone, like a mom with three kids in tow? What services work in a drive-through? — “cascades into so many other questions,” she says. “Right now, everyone is trying to figure it out.”

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Despite the question marks, experts seem sure that even if a vaccine brings a return to normalcy within months, this pandemic is driving long-lasting design changes.

Making room for technology

“The transition to telehealth is the most massive change,” says Sheila F. Cahnman, president of JumpGarden Consulting, a healthcare planning and design firm based in Wilmette, Illinois. While that shift had long been underway, the pandemic vaulted adoption rates years ahead of schedule.

Doctors like it. Patients like it. “And as long as insurance companies and Medicare continue to cover it, it’s going to be a permanent part of their practice,” she says.

That calls for plenty of small, well-lit offices where providers can offer telehealth in privacy. And because many patients won’t have the required technology or broadband at their homes, healthcare facilities will need to make video-equipped rooms available to patients when they come into their offices.

Those will gobble up the square footage now used as open areas, designed to promote more teamwork between doctors, nurse practitioners and other providers. “I’ve been doing this for 25 years, and we’ve spent the last 10 or 15 years urging practitioners to share space and collaborate more,” says Arbuckle. “This [division of space] is a new direction.”

Doctors’ homes are now part of the equation too, as many want to continue working from home more. “That brings up all the same issues and considerations that face other remote workers,” she says. “Do the doctors have the right secure technology at home? Enough broadband? Do they have young kids, which makes it hard to concentrate?”

And all tech questions intensify the ongoing effort to develop solutions for balancing the demand for more screen time from doctors without dehumanizing patients. “About two-thirds of most visits are spent talking,” says Cahnman, who is also a board trustee for the American College of Healthcare Architects. “How can you design offices that are tech-friendly yet make patients feel heard?”

Underscoring every technology is heightened security. More telemedicine means more potential leaks, just as the Federal Bureau of Investigation (FBI) issues increased warnings about ransomware attacks.

Solving real-estate riddles

For years, smaller practices have been affiliating with larger health systems, with mega ambulatory centers. These bigger facilities attract a higher volume of patients than a small practice, offering patient-friendly conveniences like plenty of parking and on-site labs and imaging centers.

But higher patient volume means a greater risk of infections, and patients are staying away. That means lower revenues for the facilities.

“I don’t think these large centers are going away,” says Arbuckle. For one thing, they’re space savers. Because many functions, like restrooms and administrative office spaces for things like copiers, can be shared, providers in these larger facilities can save about 500 square feet per provider, as compared with smaller practices. “And patients love them because they’re a one-stop shop. But they are going to need many modifications.”

Facilities that flex

COVID-19 has shown healthcare executives that even the most massive bureaucratic organizations can move fast when they need to, making them more open to quick changes. Among these? Traditional exam tables that look more like seats but quickly convert to flat surfaces (in case of disease surge) and deeper reception desks to create more distance. Drive-through options, such as those used for COVID-19 testing, will continue, and so will sensor technology, making everything from sinks to doors to light switches completely hands-free.

In a survey of its members shortly after the pandemic began, the American College of Healthcare Architects found that more than 60% of members said they’d been asked to create more bed space. And more than 70% believe that designing for mass patient surges will be an important design element for hospitals.

That’s true for medical offices, too. More offices will have “soft” spaces, especially in multifunction areas, that can quickly be converted to exam rooms, offices or “hoteling” space.

“Adaptability means designing rooms, usually of similar size, that can have many uses,” Cahnman says. “That was a trend before, and COVID has accelerated it.”