HCS 529 Week 1 Past, Present and Future of Facility Design Example

From the 1970 Surgicenter to Joint Replacement Without an Overnight Stay: Two Trends Reshaping Surgical Facility Design and What They Mean for a Suburban Surgery Center Project

[Student Name]

University of Phoenix

HCS/529: Contemporary Health Care Facility Design

Week 1 Assignment

[Instructor Name]

[Date]

The health system, county and project are composites written for a model paper; national data and research come from the sources listed.

The board of a composite three-hospital nonprofit health system in a growing suburban county has asked its planning team a question: should the system add four operating rooms to its main hospital, which is landlocked and busy, or convert a vacant 34,000-square-foot warehouse near the interstate into a freestanding ambulatory surgery center? The answer depends partly on money and partly on trends that have reshaped surgical buildings for half a century. This paper examines two of those trends, the move of surgery out of the hospital and the rise of evidence-based design, and what each means for the project.

Trend One: Surgery Leaves the Hospital

The Past

For most of the twentieth century, surgery meant a hospital stay. Operating rooms were designed as part of inpatient buildings, near intensive care and inpatient beds, with patients arriving the night before. In 1970, two anesthesiologists opened a freestanding surgery center in Phoenix that let patients arrive, have a procedure and go home the same day. Medicare began paying such centers in 1982, and as anesthesia and minimally invasive techniques improved, the list of procedures that could safely be done without an overnight stay grew steadily.

The Present

By 2010, national survey data counted 28.6 million ambulatory surgery visits to hospitals and freestanding centers, during which 48.3 million procedures were performed, most commonly colonoscopies, cataract surgery and spinal injections; only 2% of visits ended in a hospital admission (Hall et al., 2017). Growth has continued. In 2024, about 6,400 surgery centers treated 3.4 million traditional Medicare patients, and the number of centers grew more than 2% a year between 2019 and 2024. Total knee and hip replacements, once inpatient operations, rose 27.6% and 28.7% in these centers in 2024 alone, and Medicare's payment rates for most services were 46% lower than in hospital outpatient departments (Medicare Payment Advisory Commission, 2026). The operation that once required a week in a hospital bed now often ends with the patient home for dinner.

What It Means for Design

A surgery center is not a small hospital. Its design centers on flow: a patient checks in, changes, is prepared, has surgery, recovers and leaves within hours, often escorted by a family member. Space shifts from inpatient rooms to preoperative and recovery bays, which must be numerous enough that operating rooms are never waiting. Short procedures mean rapid room turnover, so sterile processing, supply storage and staff circulation must be close to the operating rooms. Joint replacement adds requirements the first centers never had: rooms large enough for orthopedic equipment and imaging, space for physical therapy before discharge and in some cases extended recovery for patients who stay longer.

Trend Two: Evidence-Based Design

The Past

For decades, hospitals were designed mainly around efficiency, codes and the preferences of physicians and architects. In 1984, a study of 46 patients recovering from gallbladder surgery in a Pennsylvania hospital found that the 23 whose windows looked onto trees had shorter postoperative stays, fewer negative comments in nurses' notes and took fewer strong pain medicines than 23 matched patients whose windows faced a brick wall (Ulrich, 1984). The study was small, but it suggested that the physical environment could affect recovery.

The Present

A later review of the research literature identified hundreds of studies linking design features to outcomes, including evidence that single-patient rooms reduce infections, that noise control improves sleep and reduces stress, that daylight and nature views reduce pain and that layout and standardization affect staff walking and errors (Ulrich et al., 2008). Evidence-based design is now common in planning, and design teams increasingly measure outcomes after a building opens.

What It Means for Design

For the surgery center, evidence-based design suggests private preoperative and recovery bays with solid walls rather than curtains where possible, daylight in recovery and staff areas, quiet materials, handwashing sinks in view of every bay, standardized operating room layouts so staff find equipment in the same place in every room and short, direct routes between operating rooms and sterile processing.

Why Not Add Rooms to the Hospital?

The alternative the board raised deserves a fair answer. Adding four operating rooms to the main hospital would keep surgery near intensive care and blood bank services, which matters for sicker patients. But the hospital's surgical floor was designed in 1988 around inpatient flow: patients arrive by elevator from inpatient units, preoperative space is a shared curtained area and the sterile processing department is a floor below. Expansion would mean building over a loading dock and relocating the kitchen, at a cost the facilities director estimated at nearly twice the per-room cost of the conversion. Healthy outpatients would also share elevators, parking and waiting areas with emergency and inpatient traffic, which the trend toward convenient outpatient care argues against. The hospital's rooms would be better used for complex cases that need its support services.

The Limits of the Trend

Not every patient belongs in a surgery center. Patients with serious heart or lung disease, poorly controlled diabetes or severe obesity may need hospital-level backup, and centers select patients carefully for that reason. The design must therefore include a clear, practiced route for transferring a patient who deteriorates, an agreement with the nearest hospital and space to stabilize a patient while the ambulance arrives. Evidence-based design also has limits: many studies are small or observational, and features that improved outcomes in inpatient units may matter less in a building where patients stay a few hours. The planning team should treat research as a guide to priorities rather than a guarantee.

Where the Trends Are Heading

Both trends will continue. More complex procedures, including spine surgery and some cardiac procedures, are moving to outpatient settings, which will require larger operating rooms, imaging and possibly overnight recovery. Design research is extending to operating rooms themselves, where traffic, door openings and layout affect infection risk and efficiency. Sustainability, with lower energy use and flexible spaces that can be converted as procedures change, is becoming part of design briefs.

Implications for the Project

The two trends favor the warehouse conversion. A freestanding center can be designed from the start around outpatient flow rather than fitting it into an inpatient building, and a large open structure allows standardized room layouts. The design brief should include operating rooms sized for joint replacement, enough preoperative and recovery bays for rapid turnover, evidence-based features in patient and staff areas and flexibility for procedures not yet performed outside hospitals.

Conclusion

Surgery's move out of the hospital, from a single center in 1970 to thousands today performing joint replacements, has created a new building type designed around same-day flow. Evidence-based design, from a study of window views to a large body of research, has changed how that building should be planned. Together they give the health system a reason to build a purpose-designed surgery center and a set of principles for designing it.

References

Hall, M. J., Schwartzman, A., Zhang, J., & Liu, X. (2017). Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010 (National Health Statistics Reports No. 102). National Center for Health Statistics. https://www.cdc.gov/nchs/data/nhsr/nhsr102.pdf

Medicare Payment Advisory Commission. (2026). Ambulatory surgical center services: Status report. In Report to the Congress: Medicare payment policy (pp. 325-342). https://www.medpac.gov/wp-content/uploads/2026/03/Mar26_Ch11_MedPAC_Report_To_Congress_SEC.pdf

Ulrich, R. S. (1984). View through a window may influence recovery from surgery. Science, 224(4647), 420-421. https://doi.org/10.1126/science.6143402

Ulrich, R. S., Zimring, C., Zhu, X., DuBose, J., Seo, H.-B., Choi, Y.-S., Quan, X., & Joseph, A. (2008). A review of the research literature on evidence-based healthcare design. HERD: Health Environments Research & Design Journal, 1(3), 61-125. https://doi.org/10.1177/193758670800100306