The Importance of Predesign in Healthcare Construction

The difference between life or death for your patients often hangs on the health of your medical facility. Imagine a small, critical access medical facility that is vital to its community. The facility serves not only the residents of its community, but also individuals from a surrounding radius of many miles.

As a physician, your patients rely on this medical facility, whether they have a health crisis or routine medical need. Imagine that this same facility has become unable to adequately serve regional residents due to its age, size, or any number of other factors. Facility leaders know it needs improvements, but the range of possibilities feel overwhelming.

A range of questions loom:

  1. How can space be made for the medical technology that patients and physicians now require?
  2. How can the facility’s layout make it easier for patients and their families to find what they need?
  3. How can it be made more efficient for staff–especially at those times of day (or night) where only a handful of medical professionals must run the entire facility?

Critical First Step

Predesign is the critical first step in the process of solving these and a host of other design challenges. It can be difficult to navigate this process; collaboration with a skilled architect or medical facility planner is crucial. Here’s the nutshell on what predesign is and how it will get you what you need:

Predesign 101

At its core, the purpose of the predesign phase of any building project is to consider the big-picture for long-term. A skilled architect uses a common-sense approach to facilitate the process of pooling stakeholders’ knowledge and experience, achieving a balance between meeting today’s needs and developing a vision for the future. Stakeholders include physicians, facility managers, nurses, caregivers, specialty departments, patients, and families. The needs of each facility are unique, as is the vision for the future. Predesign is vital because it will deliver a design that provides a longer return on investment, improved medical care, and more successful recruitment and retention of medical staff.

The typical individual is not fully aware of all that is considered for a building plan. There are a number of important questions an architect asks to guide healthcare leaders through the predesign phase.

Leaders must begin to think about answering the why, who, what, where, when, and how of a building project. Some of these questions include, but are not limited to:

  • Why is the project being considered?
  • What are the needs of each department to best serve patients?
  • What is the desired outcome today and in the decades to come?
  • During construction, what considerations will need to be made and who will be in charge?
  • Where will the necessary resources and finances come from?
  • How do the needs align with the budget?
  • How can the facility be designed to provide the most options for future adaptability?
  • Who are the stakeholders?
  • What are the responsibilities of the building owner and operator in a building project?

Predesign Studies

There is no clear-cut process for the predesign phase. Depending on the specific project, it usually begins with one of several studies. These studies can change or overlap as more information is gathered:


The first study we will examine is called a program study. The basic goal of a program study is to examine how a facility is used, including work processes, procedures and flow. Departmental organization is considered, as are the details of patient care—what currently works well and what could work better? The basic question to answer with a program study is, “How is the medical staff doing what they do now and what would improve it?” Developing this baseline knowledge is the foundation of a successful project.


A facility study is also a common component of predesign. This study focuses on the physical building itself. Considerations include the building’s current general condition, its age, the building systems, the building enclosure, the building finishes, and its ability to adapt to rapidly changing technologies and processes. Original construction documents as well as past additions or renovations are examined. Staff are consulted regarding how the building meets their needs and how it does not. In short, the facility study is meant to determine an answer for the question, “How does the facility work now, what is its condition and how could it be improved?”


A third study is called a visioning study. This study takes a bird’s eye view of the facility and includes considering questions such as:

  • What do we need the facility to accomplish?
  • What is our vision for the future?
  • What are the opportunities?

It takes a great deal of experience and skill to facilitate this study, including having a finger on the pulse of medical advances in both care and technology. Every building project must consider the future. Too often, medical facilities have been designed, renovated, or added on to for a purpose or particular technology that is too specific and short-sighted to remain effective as that purpose or technology becomes obsolete. A visioning study is part of the process to design a facility that is highly adaptable, eliminating the potential need for further major building projects and to remain on the cutting edge of both technology and patient care.

Predesign Opportunities

Once one or more of these studies are complete, the predesign process addresses several questions to gain a clearer vision of the opportunities and challenges presented by the project. These questions include:

  • Should we re-use, renovate, and/or add on to what we have?
  • Should we build a new facility entirely?
    • What property or assets do we own or could we buy to use for this
  • What factors must be considered to make these decisions?
    • Up-front financial costs including:
      • Purchasing land.
      • Purchasing existing building(s)
      • Renovating or adding onto existing buildings.
    • How will the medical facility continue to operate during the building project?
      • Where can operations continue?
      • Can the project be phased to facilitate operation?
    • Long-term financial costs including:
      • Cost to operate and maintain each design option.
      • HR costs to staff each design option.
      • Any available tax rebates, subsidies, etc. related to each design option.
    • Long-term flexibility provided by each design option:
    • Healthcare delivery technology changes rapidly; effective hospital design must include great flexibility for future changes to the way spaces are used.
    • Security is an increasingly important priority for all hospitals:
      • How can we integrate security options and measures into each design?
    • Civic Benefits
      • This is an especially important consideration in cases of government-owned hospitals, and/or where the location of civic assets impact local populations in particular ways.

The Master Plan

Once there is a solid view of the facility and its needs, and once the above questions are answered, the predesign can serve the facility in completing a single project, or the information gathered could be used to develop a master plan. The master plan is a long-term strategy for meeting the needs of the facility. Often, due to budget constraints, or when an area of the facility is currently adequate but will become obsolete or in need of repair in the future, those items will be included in the master plan. The length of time a master plan covers will vary for each facility, lasting one year, or a decade.

Healthcare Menagerie

There is a menagerie of healthcare facilities and predesign is equally important for non-hospital facilities as well. Surgical centers, physical therapy centers, family practice and specialty clinics, short and long-term care facilities, nursing homes, recovery centers, and a myriad of others must also place great value on predesign during building and renovation projects. Each type of healthcare facility brings its own unique needs, requirements, and desires to both improve patient care and remain fiscally responsible.

Critical Condition

If your organization is considering a building project, it’s important that you work with a skilled architect who can help you walk through the predesign process. With 40+ years’ experience specializing in healthcare construction, Engan Associates Architects we’re here for you!

Call 320-235-0860  to connect with our healthcare architects.

Adapted from an article originally published in Minnesota Physician, June 2018.

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