Kenneth N. Cates, president of the Facility Guidelines Institute's Board of Directors

Image courtesy of the Facility Guidelines Institute

Kenneth N. Cates, president of the Facility Guidelines Institute’s (FGI’s) Board of Directors, has been involved with the organization for more than 20 years. This month, he talks to Health Facilities Management about FGI’s structure, health care design that responds to emergency conditions and FGI’s 2022 Guidelines.

The FGI Board of Directors is a diverse group of professionals. What is the thinking behind engaging such a wide range of professional experience?

It is imperative that our board membership be multidisciplinary so it reflects the wide range of designers, clinical users, facility managers, administrators, authorities having jurisdiction and experts in business who use our products. As president of FGI, it is my job to infuse creative, forward-thinking energy into the board’s activities, and enlisting board members with new points of view is a great way to do this. Over the past few years, we have introduced a number of new board members to stay fresh as an organization. For example, with the emphasis on patient and staff safety in the design of health and residential care buildings, we have three physicians on our board to help us keep our eyes on the clinical aspects of delivering care.

Your three guidelines — Guidelines for Design and Construction of Hospitals; Guidelines for Design and Construction of Outpatient Facilities; and Guidelines for Design and Construction of Residential Health, Care, and Support Facilities — are being revised. When do you expect the next editions to be published?

We are currently putting the final touches on the content for the three fundamental Guidelines documents, which will go into production in the fall and be released in January 2022. 

Can you discuss FGI’s work over the past year on new guidance and guidelines that address planning and design considerations for emergency events?

While FGI has always been interested in resiliency and emergency preparedness, the COVID-19 pandemic brought us an influx of requests for practical guidance on setting up temporary facilities and adapting existing facilities for use during the pandemic. In response, the FGI board formed a committee to take a critical look at existing Guidelines requirements and recommendations on emergency preparedness, determine best practices, and establish a new minimum standard on emergency preparedness and response for health and residential care facilities. 

The Emergency Conditions Committee (ECC), led by FGI CEO Doug Erickson and COO Heather Livingston, was a collaboration of 130 volunteers representing disciplines in health care, residential care and facility design. Subcommittees considered risk assessments, surge capacity, alternate care sites, modular facilities, operational considerations, resiliency, renovation and future facility design, small and/or rural health care facilities, and residential care facilities. We knew that applying our rigorous process to this topic would yield credible, long-lasting guidance.

The ECC identified temporary and long-term solutions for design and operation of health and residential care facilities, informed by lessons learned from previous local and national emergencies as well as practices being implemented in the field. The resulting white paper is intended to help organizations respond to emergency events and plan mitigation strategies for the future. Also developed were draft guidelines for emergency conditions in health and residential care facilities, which I believe will ultimately be recognized and used as an industry standard. Guidance for Designing Health and Residential Care Facilities that Respond and Adapt to Emergency Conditions, which includes both guidance and the draft guidelines, can be downloaded at

The draft Guidelines for Emergency Conditions in Health and Residential Care Facilities, which was available for public comment earlier this year, has an anticipated release date of January 2022. How will this be coordinated with the 2022 Guidelines series?

After seriously considering how to deliver this new set of guidelines, we decided to issue the 2022 Emergency Conditions Guidelines as a supplemental offering. Because the requirements are new as of 2021, FGI leadership determined that trying to force the new standards into the 2022 Guidelines would be premature and could jeopardize state and federal adoption. So, for 2022, the Emergency Conditions Guidelines will be published separately with the hope that states will adopt it when they adopt the other 2022 Guidelines documents. The plan is for the emergency conditions content to be incorporated into the Guidelines for the 2026 edition.

How are FGI and the Guidelines documents addressing assertions that code-writing organizations should take a fresh look at legacy codes that may not address resiliency, mission-critical functions and the cost of building a replacement health care facility?

FGI relies heavily on the Health Guidelines Revision Committee (HGRC), our committee of 136 experts who work in the health and residential care arenas. This multidisciplinary group seriously debates Guidelines requirements and makes every attempt to ensure the minimum requirements for design of health care facilities provide value without jeopardizing the therapeutic environment, patient safety or staff efficiency. Readers of the Guidelines should remember that FGI has no hidden agenda and no reason for escalating requirements beyond the fundamentals. More importantly, our standards are produced with opportunities for public participation, which is a critical component of our mission.

How do you respond to critics who say the Guidelines documents are based on “gold-plated” best practices?

Ensuring that the Guidelines are minimum requirements is a key focus of the HGRC. Advised by the FGI Benefit-Cost Committee, the experts on the HGRC are entrusted with examining new and existing requirements in light of FGI’s basic credo that the Guidelines remain fundamental (minimum) design standards.

However, when someone brings this criticism to me, I try to have a dialogue to better understand their point of view. In almost every discussion with critics over the years, I have found the biggest reason for their opinion is that they don’t realize what a rigorous process we use. 

I welcome them to learn more and, if available, to attend an HGRC meeting to experience the discussion, challenges and debate on almost every aspect of the Guidelines content.

FGI has a full-blown project to provide professionals in the health care field with information that goes beyond the fundamental Guidelines documents. Can you discuss this?

What we call “Beyond Fundamentals” are typically white papers and checklists that provide enhanced direction on a topic minimally covered in the Guidelines; a recent example is the second edition of Patient Handling and Mobility Assessments. Beyond Fundamentals projects currently in development will address behavioral health crisis units, extended-stay facilities, and patient and provider checklists for telemedicine. 

We often hear from Guidelines users that this type of information is very helpful. FGI has structured our business model to provide these resources as value-added downloads to support users as they apply the documents and engage in new facility design issues. 

FGI Board of Directors

Members of the Facility Guidelines Institute (FGI) Board of Directors assisted with the answers in this interview. The board members are:

  • Kenneth N. Cates (president), SASHE, CHC, Northstar Management Inc., St. Louis.
  • Dana E. Swenson (treasurer), PE, MBA, ExecHFM, Andover, N.H.
  • Kurt A. Rockstroh (immediate past president), KR Consult, FAIA, FACHA, Gold Canyon, Ariz.
  • Diana C. Anderson, MD, ACHA, ABIM, Dochitect, Boston.
  • Julie Benezet, MSc, Business Growth Consulting LLC, Ashland, Ore.
  • Tina Duncan, AIA, ACHA, CBO, HKS Inc., Dallas.
  • Douglas S. Erickson, FASHE, CHFM, HFDP, CHC, Facility Guidelines Institute, St. Louis.
  • James R. (Skip) Gregory, NCARB, Health Facility Consulting, Tallahassee, Fla.
  • Neil A. Halpern, MD, MCCM, FACP, FCCP, Memorial Sloan Kettering Cancer Center, New York City.
  • David M. Shapiro, MD, Tallahassee, Fla.
  • Walter Vernon, PE, LEED AP, EDAC, FASHE, Mazzetti, San Francisco.