Image courtesy of Heather Livingston

In 2023, Heather Livingston stepped into the role of CEO at the Facility Guidelines Institute (FGI) after serving as its chief operating officer and managing editor of the Guidelines. This month, she discusses other updates in FGI’s leadership and what to expect when the 2026 Guidelines opens for public comment in July.

What does this leadership transition mean for FGI and the future of the organization? 

Prior to becoming CEO, I was managing editor of the Guidelines and FGI’s chief operating officer. In those roles, I focused on managing the Guidelines revision process, improving business and editorial processes and content, and solidifying FGI’s bottom line. As CEO, that role has shifted to protecting FGI’s intellectual property, diversifying our revenue streams, strengthening industry partnerships and clearing roadblocks to success.

As Health Facilities Management readers may know, former CEO Doug Erickson, FASHE, retired at the end of 2023, and he left some large shoes to fill. Doug is a true luminary in the field of health and residential care design, with a wealth of industry knowledge and experience, charisma and leadership. He’s a one-in-a-million leader, and he’s exactly who FGI needed in that role to grow and evolve as an organization over the last 25 years. 

Doug and I began planning his transition to retirement in 2019 in order to ensure FGI would be set up for future success. We have an excellent board of directors, led by Tina Duncan, AIA, ACHA, CBO, director of code and regulations and partner at architecture firm HKS. We also brought on John Williams, a long-time authority having jurisdiction (AHJ) who has served on the Health Guidelines Revision Committee (HGRC) since 2011, as FGI’s new vice president of content and outreach. Guided by the board on strategic matters and supported by our incredibly capable and talented staff, John and I together are leading FGI into its new future. With John’s experience as an architect and AHJ, his role centers on serving as FGI’s technical content expert and industry and government liaison. With my legal, operations and editorial background, my role is focused on leading and protecting the business of FGI. 

How is FGI continuing to meet the needs of the health care design field?  

We’re always curious about what the community needs to better understand and implement our content. When we release the 2026 edition, we will have a new set of companions to the codes that will offer insight to the development process. These handbooks will probe questions we often receive and feature enhanced graphic information on the requirements contained in the FGI codes. Looking into the future, FGI is exploring ways to integrate artificial intelligence (AI) into our platform to ensure accurate and accessible information is available to users.

Standards development organizations (SDOs) such as FGI, the International Code Council, National Fire Protection Association and ASHRAE are facing very serious challenges that threaten our ability to update codes in the future. While AI and other technologies have rapidly changed what’s possible, they’ve also created opportunities for some to appropriate intellectual property without permission or compensation. 

 I can’t speak to the business structure of other SDOs, but FGI is a small nonprofit that has relied solely on sales of the Guidelines to fund future editions. The all-volunteer HGRC contributes thousands of hours every four years to review and update the Guidelines. Without the support of our volunteers — and without sales of the Guidelines — we would not be able to continue updating the codes. 

 Other organizations that offer access to the Guidelines or provide Guidelines content in an altered form may appear to be in partnership with FGI, but they are not. These other organizations contribute nothing to the cost of developing the codes, and they may not have accurate or current information. Health care construction is incredibly expensive, and using incorrect code information can be a costly mistake. FGI is the primary source for the Guidelines and the only authorized publisher and seller of these documents.

In what ways is the Guidelines more accessible and easier to navigate today? 

FGI launched a proprietary subscription platform for the 2022 edition to deliver an enhanced user experience. We’ve learned a lot since rolling out the platform two years ago and have made a ton of improvements. We’ve added options such as IP address authentication to provide easy and secure access and, in response to our most frequent request, incorporated a scrollable and searchable PDF with licensed subscriptions. These features are an important part of our continuing exploration of ways to deliver content as well as value to our subscribers. For example, in January we launched a new podcast on health and residential care design called “Between the Lines with FGI.” In Season One, we explore the topics of functional programming, behavioral health crisis units, electrical receptacles in patient care areas, infection prevention, the importance of Part 1 of the documents (application and project delivery requirements), dining spaces in residential care facilities and more. We hope your readers will give it a listen. 

Where is FGI in the development process for the 2026 Guidelines

I’m happy to report we plan to release the draft 2026 Guidelines for public comment in July. This is the second opportunity for Guidelines users to recommend changes to the 2022 documents. After the proposal period last summer, the HGRC reviewed and voted on submitted proposals. The draft reflects their decisions. At this point in the revision cycle, we ask the public to review the approved changes and submit feedback to help the HGRC determine if the revisions provide the right balance between patient/staff safety and design/construction costs.

What can the health care design field expect to see in the 2026 draft? 

The 2026 draft will feature several new sections, including a behavioral/mental health medical complexity unit, a rural emergency hospital (REH), and a skilled nursing unit in the hospital code. In addition, the critical access hospital chapter will specify it can be applied to renovations under the new REH provider type designated by the Centers for Medicare & Medicaid Services. A specialty infection control exam room has been added to the draft to provide requirements for this room type, which is listed in Table 7.1 of the American National Standards Institute/ASHRAE/American Society for Health Care Engineering Standard 170-2021, Ventilation of Health Care Facilities. This exam room has some features of an airborne infection isolation room without the negative pressure requirement.

The outpatient code likewise introduces requirements for new spaces, including a sleep disorder clinic and a short-term care facility — a simplified version of the long-term stay facility that appeared in the draft 2022 Guidelines.

Significant changes on imaging and procedure room classification will apply to both the hospital and outpatient codes and are the outcome of continued efforts to provide information to help owners make decisions on appropriate room use.

In the residential code, a single-resident room is proposed as the new minimum following the high mortality experienced in residential care communities during the pandemic. These are just some of the topics addressed in the 2026 draft. 

To review the draft of the 2026 FGI Guidelines, readers can visit The public comment period will be open from July through September 2024. To submit comments on the draft, they can log onto

What are some other ways stakeholders can help shape the Guidelines?

FGI is always looking for subject matter experts to assist the HGRC with technical topics. For example, we have an acoustics task group that reviews proposals/comments and makes recommendations to the HGRC based on their expertise and experience. These individuals are not manufacturers of acoustics products; they’re professionals, such as acoustic designers, engineers and researchers. Other topics where the HGRC periodically needs assistance include imaging, pharmacy, rehab and pediatric facilities. 

Our HGRC members will tell you that serving on the revision committee is a substantial time commitment over four years. Becoming a subject matter expert is a great introduction to the revision process and the amazing community that makes it work, with less of a time commitment. We’ll announce in our quarterly e-newsletter, the FGI Bulletin, when the HGRC is accepting applications for the next revision cycle. This typically happens about three months after a new edition has been released. 

Jamie Morgan is senior editor of Health Facilities Management magazine.