Like almost all industries, design for healthcare is regulated by federal, state, and local codes. But in addition, there are standards that have been established by many groups, societies, and advocates that influence design.

For example ASHRAE publishes volumes on the design of healthcare facilities. The designer, faced with creating a healthcare facility, must wade his/her way through the thousands of regulations, codes, and standards to come up with a suitable design.

In addition, there is heightened pressure to design healthcare facilities at reduced cost and at higher operating efficiencies.

Each state and locality also have their own requirements that are interpreted at the local level by an authority having jurisdiction. This authority, being human, often interprets the regulations differently than the designer, which adds to the challenge.

So, what about all these regulations?

The good
Over the years research has been done that has resulted in regulations that improve patient safety. This has resulted in a set of minimum requirements which have been based on research and practice. These requirements are used by the designer as a starting point for the design of the healthcare facility.

Patient safety is the reason for all of the regulations, codes, standards, etc., and to that end they do serve a good purpose.

The bad
Most all regulations, codes and standards are very prescriptive, meaning that they tell the designer what to do and in many cases how to do it. This method of prescriptive regulation can limit or eliminate the innovation in healthcare design.

Additionally, there are so many regulations, rules, codes, and standards that once they are all found, read, understood, and applied, the design can be extremely complicated and costly. The designer needs a research team to vet out all the regulations before starting the project.

The ugly
With so many regulations, rules, codes, and standards, they sometimes are in direct conflict with one another or in many cases are counterproductive to one another.

Codes and regulations are adopted by federal, state, and local governments, which, by their nature, are slow and cautious to react and change. However, technology is changing at an ever faster rate.

Evidence-based design principles and outcomes dictate that better design is possible, practical, and safer. As the design community attempts to apply new technology and techniques to healthcare design, many are prohibited by regulations that do not prescribe to the new concepts. The better and more innovative way may have to be abandoned to accommodate the regulations.

Maybe it’s time to rethink how we regulate healthcare design into a more performance-based environment, which allows both patient safety and innovation to occur.

Does the good outweigh the bad and the ugly? Probably, but maybe it’s time to search for a better way to regulate healthcare design practices.

John Sauer, PE, LEED AP, is Senior Director Engineering Design at BSA LifeStructures in Indianapolis. John is a strong advocate for sustainability and the use of energy-efficient design in traditionally high-consuming healthcare environments. John has leveraged his knowledge of heating, ventilation, vacuum, air conditioning, steam distribution, energy centers, and piping design to identify cost efficient and sustainable solutions for all types of healthcare facilities. He can be reached at For more information, please visit