For the last 16 months, I’ve been working as a healthcare architect in China, focusing on a variety of private health projects.

Several of the factors driving evolution of the healthcare system in China are similar to those in the U.S., including a focus on fiscal sustainability, particularly the impact of an aging population on overall healthcare costs; a shift in disease profile from infectious to non-communicable diseases requiring a shift in healthcare strategy from curative to preventive; and the need to eliminate the disparities between urban and rural care while universally promoting healthy eating and exercise.

In part to meet the demands created by these challenges, the Chinese government has allowed private healthcare providers to enter the market, triggering a construction boom. Beds in private health institutions have increased by 81 percent since 2011, and 22 percent of outpatient visits in China now occur in private hospitals. Aspiring to provide the highest level of healthcare, designers and private providers in China are constantly looking to facilities in the U.S. and Europe as examples, including the healthcare design research coming out of projects there.

The problem is, China is unique. Just as the U.S. is unique. Its healthcare system and culture, history, and demographics all coincide to form a singular set of circumstances. The longer I’m in China, the more evident it becomes that I can’t always, in good conscience, apply evidence-based design principles based on research conducted outside of these circumstances to Chinese hospitals.

For example, in 2015, CADRE, the non-profit research arm of HKS Inc., released its Clinic 20XX report that looked at the differences between American baby boomers’ and Millennials’ expectations, needs, and desires for their clinic environments and experiences. Last June, at the European Healthcare Design Congress in London, Upali Nanda, director of research at HKS Inc., and Jane Ho, healthcare design director at HKS, presented a follow-up report that looked exclusively at the U.K. (soon to be published on the CADRE website).

It was remarkable how many differences were exhibited between these culturally similar countries, making evident that contrasts in healthcare systems alone can result in a great deal of variety regarding what patients want from their healthcare experience and how they see themselves within the system.

It got me thinking, if this is the difference exhibited from a survey of two demographic groups in two countries that share the same language and have overlapping cultural heritage, what would the results be in clinics in other places that are far more different?

Making assumptions between cultures and societies today, in a booming period for healthcare construction in China, could lead to an abundance of facilities that, although well intentioned, don’t serve the local population well and could result in a shorter lifespan of the facility. What is valued, appreciated, and functions well in one country and healthcare system may not replicate in another.

My colleagues and I attempt to develop design strategies that cater to the management practices, regulations, and social norms that exist in China, to achieve outcomes such as improved hygiene, by coupling international research with informal, personal observations. However, we can’t be certain what effect our efforts are having.

New research in different sectors, cultures, and nations can only benefit this industry’s overall body of research and our profession. I’d be excited to see some of the research might of international architecture firms practicing in China being exercised here, lending  experience and resources to enable a broader study of clinic and hospital design in China.

By diversifying the environments and subjects of study, we can establish whether concepts that are understood to work well are transferable to different sociocultural settings or whether they are more specific than we currently realize.

Sophie Crocker, MArch, MSc, EDAC, is a healthcare designer at Robarts Spaces in Shanghai. She can be reached at