The Mistretta File


  • Health care principal at Perkins&Will.
  • Chief nursing and operating officer at Dignity Health, San Francisco.
  • Senior director of cardiac, critical care, emergency and perioperative services at Dignity Health.
  • Director of cardiovascular services at Scripps Health, San Diego.
  • Oncology services at Penn Medicine, University of Pennsylvania, Philadelphia.


  • President of Nursing Institute for Healthcare Design.
  • Certified change management professional from Prosci.
  • Lean Six Sigma Black Belt.


  • Master of Science in health care administration, San Diego State University.
  • Bachelor of Science in nursing and biology, minor in psychology, West Chester University, West Chester, Pa.

Anthony Mistretta, R.N., MS, current president of the Nursing Institute for Healthcare Design (NIHD), continues to center patient advocacy in his work as a principal at Perkins&Will. This month, he talks with HFM about using his experience in direct patient care to inform the design of the health care physical environment.

How has your previous experience prepared you for your present role at Perkins&Will and as 2023 NIHD president? 

I started my career as a registered nurse clinician in cardiovascular services. During my practice, I began growing into leadership roles, such as charge nurse, and progressing to director for cardiovascular services. After that, I began taking on additional service lines, such as emergency services and critical care services. These roles eventually led to my becoming chief nursing officer and chief operating officer for the entire hospital. I also went back to school to get my master’s in health care administration. 

I am fortunate to have had a career that has been able to evolve and build upon itself. Before coming to Perkins&Will, I served as the operations translator between the design team and all of the clinical staff for a large cardiovascular tower that merged two programs into one facility.

With my experience as a clinician, registered nurse and health care executive, I am able to bring the voice of the patient, clinician and staff to the forefront of the built environment. Having such a deep understanding of the operations and business of the health care ecosystem allows me to be a translator and advocate for not only our Perkins&Will clients but the rest of the design world, as well as a true voice for NIHD.

Before serving as president, you were the marketing chair for NIHD. What initiatives were you able to spearhead? 

The most exciting work I was able to accomplish as marketing chair was recreating the external face of the organization and enhancing our internal operations by launching our new website. I worked closely with our web design consultant and executive director to create a more engaging, modern-day website.

Our original website didn’t have the tools that allowed us to really put our best face forward from a visual standpoint. We began by working on website optimization as a backbone of our website infrastructure. This has given us a higher presence and relevance in Google searches related to clinicians in the design world. 

Our site is also now a lot more interactive. Users can see what the member features are, and the goal here is to entice membership. For instance, we show that we have our book available as a digital copy by chapter, but you must be a member to access it. Another example is that you can always see our current newsletter, but if you want to access our history of newsletters, you have to be a member. We keep our blog public on the website as a place for the latest NIHD and industry news, member spotlights, new partnerships and more.

For current members, we spent a lot of time and attention on creating a robust online community forum. In the past, it was very difficult to post and contribute to it, so it didn’t get a lot of traction. The vision and goal for the community forum was not to change the concept and principle behind it, but to allow an easier interface for our members. With this strategy, we would get more member activity and responses, and archive those, so if anyone wants to go back and look at the conversation around a certain topic, they can.

What is NIHD’s strategy in forming partnerships with other organizations?

Our mission and vision is to raise the presence and importance of clinical expertise in the built environment, and we partner with organizations that see the value in it. NIHD partners with organizations that help us further our mission through the exchange of new knowledge by promoting opportunities for education, research and innovation, while encouraging the mutual growth and development of their organization and NIHD. We have three types of partnerships: industry partners, including manufacturers, vendors, and architecture, engineering and construction firms; academic partners, such as universities with undergraduate or graduate programs for health care and design; and professional partners that are trade groups and 501(c)(6) organizations focused on health care and design.

All of these partnerships allow our audience to be heard in partnership with theirs. It also provides us with the opportunity to collaborate and inform. For example, if a manufacturer or a product developer seeks NIHD’s input on a project they are working on, there’s an exchange within the partnership where the manufacturer is gaining true, real-time clinical expertise and industry knowledge to inform their future decisions and, in return, our voice is being heard.

What are some of the major trends impacting health care design today? 

There are so many trends impacting health care design. I usually advise not focusing too heavily on each specific trend, but on what the trends tell us. There’s no way to truly future-proof, but how do we think about those trends and plan for the environment to be able to adapt through iterations of trends?  

For instance, flexibility is a huge theme. We also have a generation of millennials and xennials coming up that are going to be huge health care consumers. They have expectations of health care that are very different from the current largest consumers of baby boomers and Generation X. We need our built environment to be nimble to respond to those changes but also accommodate today.

I’d like to see our field collaborate on how we plan for and think about these trends, with NIHD being one of the key voices in that discussion. NIHD has such a broad range of membership, both clinical and nonclinical, that within the organization we have members who touch all of these components and are seeing the day-to-day trends being implemented.

What advice would you offer nurses who want to help influence health care design at their facilities? 

First, start by speaking up and volunteering. Express your interest in wanting to be a part of the design process. No project is too small or too big to have your voice present. It may seem intimidating at first that you don’t understand the design lingo or the process; however, that’s not what they need you for. They need you for your clinical and operational expertise, and your understanding of the way to work in spaces.  

My first experience with this was early on in my clinical leadership career. I saw first-hand the value-add we provide. I didn’t know how to read architectural plans. I didn’t know how to measure square footage. I didn’t know what those details meant, and so it was a bit intimidating. But I knew if things didn’t sound right. I knew that if I had to walk from “A” to “B” in the way they were talking about, it was not going to be efficient or practical, and I was going to find three workarounds to avoid doing that during my shift. So, I spoke up not just to offer criticism but a different point of view about how things were being offered. When I did that, everyone in that room turned and listened. From there, we worked collaboratively to rethink the layout and how we were going to operate. 

One of the best gifts you can give to your future colleagues and patients is to help inform the future workspace and care environments for them. Apply the advocacy you provide in your patient care each day to advocate for your clinical expertise in the environments in which they receive care. 

Jamie Morgan is editor of Health Facilities Management.