Working with 'dual-vantage' architects
By bridging the gap between architectural vision and the gritty reality of daily operations, certified architects ensure that the built environment truly supports the mission of care.
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The disconnect between architectural healthcare design and daily hospital operations often stems from a fundamental divergence in focus. When an architect operates from within the walls of a hospital, the primary drivers are immediate and pragmatic. The mission is to complete work safely and efficiently, ensuring the least possible disruption to clinical care while remaining strictly cost-effective.
Conversely, when working within a traditional architectural practice, the lens expands significantly. While efficiency remains vital, there is an elevated responsibility toward complex code compliance, life safety and the foresight required for long-term scalability.
Working with a professional who has learned to speak both languages provides healthcare facilities with more well-rounded solutions to address their most complex challenges. These "dual-vantage" architects understand that a healthcare project is never just a set of construction documents; it is a surgical intervention within a living, breathing facility. They recognize that a hospital is one of the few building types that never truly sleeps, meaning every design choice must account for 24/7 operational continuity.
For the healthcare provider, the most reliable way to identify an architect with this specialized dual-vantage point is to seek out one who is board-certified by the American College of Healthcare Architects (ACHA).
Specialized excellence
Much like board certification in medical specialties, ACHA certification signals to the public that an architect has passed a rigorous peer review of their qualifications and experience. This credential ensures clients that the architect possesses the specialized knowledge and skills necessary to deliver high-quality results within the complex field of healthcare design.
Architects licensed in the United States and countries with reciprocal National Council of Architectural Registration Boards licensure are eligible to apply, but the path to certification is demanding. The examination tests an architect’s knowledge of healthcare-specific codes, regulations, emerging trends, clinical workflows and critical adjacencies. This process is overseen by an independent testing agency to establish a professionally sound and legally defensible standard.
In addition to the exam, each candidate must submit a portfolio for peer review and provide letters of reference from healthcare clients and fellow architects who can attest to their expertise. These professionals carry a vision of transforming healthcare through better-built environments.
Bridging design and operations
ACHA offers the only specialty board certification recognized by the American Institute of Architects (AIA). The American Society for Health Care Engineering also has recognized ACHA certification.
“Successful healthcare construction projects rely on early and sustained involvement from the right experts," states Chad Beebe, AIA, CHFM, CFPS, CBO, FASHE, ASHE's deputy executive director of regulatory affairs. "Engaging an ACHA board-certified architect is a strong starting point, as healthcare architecture is the only architectural specialty formally recognized by the AIA. Healthcare facilities are highly specialized environments. Familiarity with regulations, reimbursement models, technology trends and clinical workflows is essential. In addition to architects and engineers, clinical leaders, facilities teams, information technology and operations staff should be actively involved. Front-line users such as technologists and nurses also are valuable contributors and sometimes underrepresented in early planning discussions.”
By involving an ACHA-certified professional, facilities ensure that their design partner understands the heavy lift required by operations teams. These architects bring varied backgrounds to the table; while all are licensed, many have spent portions of their careers working within health systems as strategic consultants, equipment planners, clinical researchers or even as licensed clinicians.
Through educational sessions and mentorship, they continually expand their skills by learning from fellow certificants about new technology and industry shifts. Many are active in national organizations such as the AIA Academy of Architecture for Health, FGI Health Guidelines Revision Committee and The Center for Health Design. This involvement ensures they are not just following the rules but helping to shape them based on real-world feedback from the field.
Navigating regulations
One of the most significant value-added benefits of an ACHA-certified architect is the ability to navigate the labyrinth of regulatory requirements governing healthcare environments. Hospitals are subject to a staggering array of oversight from the Centers for Medicare & Medicaid Services, organizations like Joint Commission and various state departments of health. A dual-vantage architect understands that these regulations are not merely checkboxes but are deeply tied to patient safety and reimbursement eligibility.
For instance, an architect must understand the nuances of the National Fire Protection Association's NFPA 101®, Life Safety Code®, as it applies to smoke compartments and egress in a high-acuity environment.
An architect who has spent time on the owner's side knows that a failed inspection can result in immediate threats to a facility’s accreditation or its ability to bill for services. By integrating these regulatory requirements into the earliest stages of design, the architect mitigates the risk of costly post-construction retrofits. They act as a bridge between the clinical vision and the rigid demands of the authorities having jurisdiction, ensuring that the final product is both innovative and compliant.
Understanding clinical operations
Clients rightfully expect a healthcare architect to design a safe, friendly environment that meets clinical needs while remaining operationally efficient. All of this must occur while ensuring that infection control and risk assessment processes are strictly met.
Because every healthcare facility has unique internal policies, working closely with a multidisciplinary staff is critical to the success of any project. The architect must understand how the clinical space operates on a granular level, including the complex flows of patients, staff, support services and materials.
Mastering clinical jargon and acronyms is essential to ensure design intent aligns with operational reality. Architects who have worked on the owner’s side often possess insights that go deeper than what is explicitly expressed in a project brief. They understand that when a nurse asks for a specific storage solution, it may be because of a previous near-miss or an inefficiency that caused a delay in patient care.
Understanding the "why" behind a request allows the architect to provide essential risk mitigation. These professionals work to mentor others in the field to understand this broader knowledge base, moving past aesthetics toward a functional empathy for the staff.
Financial stewardship
As healthcare organizations face constant financial pressure, efficiency throughout the design process is a critical aspect of any project. This efficiency impacts the financials of an organization through the management of space, workflow, materials and construction.
A dual-vantage architect can optimize health and safety outcomes while respecting the bottom line. It is vital for an architect to understand the business factors that drive the industry, as every square foot of renovated or new space carries a significant capital and operational cost.
During early planning, the architect should help the facility explore various scenarios. Working with leadership, they might discuss options such as extending hours of operation instead of adding physical space. They may investigate whether certain spaces can serve dual use, such as prep and recovery bays for surgery during the day that transition to emergency department surge areas at night.
These decisions should be backed by cost-benefit scenarios that include potential lost revenue from denials if patients are turned away due to capacity constraints. These aspects of the business have a profound impact on a facility’s long-term financial viability and its ability to serve the community.
Maximizing workflow
Maximizing workflow efficiency impacts healthcare organizations in several ways. Using specialized tools and evidence-based research, healthcare architects can minimize the physical steps a provider takes to perform a task. This reduction in travel distance can help with staff retention — a critical issue in an era of nursing shortages — and reduce the number of staff members needed for certain functions.
However, balancing these efficiencies with materials management can be tricky. Consider the nurse server: while it saves clinical steps during a shift, the labor required for individualized stocking can strain the supply chain and lead to a duplication of supplies. This contrasts with centralized locations that may be more efficient for inventory management but less so for the nurse.
Architects with owner-side experience look at these choices through a holistic lens. They understand that space is a premium and that requiring a facility to stock dozens of different light bulbs or plumbing fixtures increases overhead. Developing design standards that minimize inventory requirements saves both space and money over the life of the building.
Evidence-based design
Beyond simple aesthetics, the dual-vantage architect utilizes evidence-based design to ensure the physical environment contributes to positive clinical outcomes. This involves staying abreast of the latest research regarding how physical space affects healing. For example, the placement of windows to maximize natural light has been shown to reduce the length of stay for certain patients and improve staff alertness.
Similarly, acoustic design that minimizes noise levels can reduce patient stress and lead to better Hospital Consumer Assessment of Healthcare Providers and Systems scores.
Certified architects move beyond subjective claims of better design, focusing instead on measurable outcomes like reduced patient falls or decreased healthcare-associated infections. By aligning these clinical goals with architectural strategy, they provide the facilities manager and executive leadership with a clear return on investment. The building becomes a tool for care rather than just a container for it.
Communication through visualization
Because clinical stakeholders often struggle to interpret 2D blueprints, the architect must bridge the visualization gap through 3D renderings, full-scale mock-ups and mixed-reality simulations.
These tools allow staff to test-drive repetitive spaces — such as patient rooms or exam suites — before they are duplicated across a facility. By running clinical drills in these immersive environments, teams can verify critical details, such as code blue access or the safe placement of sharps containers, while the design is still fluid.
Correcting a layout during a virtual or physical mock-up phase carries a negligible cost compared to a mid-construction change order. This level of proactive foresight is the hallmark of a seasoned professional who understands the high stakes of healthcare infrastructure.
A strategic partnership
Health systems benefit immensely from ensuring their lead designer is board-certified. Hiring an ACHA-certified professional provides peace of mind that the design team is up to date on regulatory trends, benchmarking and the unique business of healthcare.
Just as hospital executives recognize the value of ASHE certifications (such as the Certified Health Care Facility Manager and Certified Health Care Constructor) for their internal teams, they should view the ACHA credential as a standard for their external partners.
Ultimately, the dual-vantage architect serves as more than just a consultant; they are a strategic partner in the long-term success of the facility. By bridging the gap between architectural vision and the gritty reality of daily operations, they ensure that the physical environment truly supports the mission of care. This alignment results in facilities that are safer for patients, more efficient for staff and more sustainable for the organizations that operate them.
Visit the ACHA website to learn more about the ACHA program or to find an ACHA-certified architect.
Ann H. Adams, FAIA, FACHA, EDAC, LEED GA, is principal at Davis Partnership Architects in Denver and the 2024 ACHA president; and Deborah H. Smith, AIA, FACHA, LEED AP BD&C, is associate principal at Flad Architects in Tampa, Fla., and the 2026 ACHA president. They can be reached at ann.adams@davispartnership.com and dsmith@flad.com.