Designing Flexibility into Tomorrow’s Healthcare Infrastructure

How future-flexible planning helps healthcare facilities balance today’s needs with tomorrow’s unknowns.

By Austin B. Delaney, Executive Vice President of Technology Consulting, HBS

Across healthcare design conversations this year — from national conferences to local panels and active projects  — one concern continues to surface: how to balance the spatial resources that support technology infrastructure against viable program space and future technological unknowns.

Ironically, as healthcare facilities become more human-centric, the amount of technology required to enable that experience grows. Across all systems and departments, the digital layers are now integral to delivering comfort, safety, and efficiency.  Yet these systems compete for the same square footage and budget as the care environment itself. So, how do we plan projects that remain nimble as technology evolves without sacrificing the functional needs of care delivery?

It Starts at the Beginning

Just as no healthcare facility should be designed without understanding its programmatic and clinical intent, sizing spaces for technology infrastructure begins with the same principle: purpose. Is the project primarily an outpatient facility requiring comparatively minimal cabling, or a first step toward an inpatient unit with ‘smart room’ capabilities?

Having a clear and early vision for how technology will support operations enables rightsizing its share of resources, namely rack space, conduit sizing, and backbone cable counts. Some parts of the vision will inevitably remain less defined—  such as how a display might be personalized or what the lighting control sequence might be — but even posing those questions enables early infrastructure planning. It establishes that there will be a display, there will be control points, and therefore, there must be pathways and capacity to support them.

Align with the Program

Every square foot allocated to the IT riser, closet, or ceiling plenum competes with direct patient care space. Aligning technology decisions with the operational and clinical programs ensures that infrastructure supports, rather than constrains, functional planning.

Early collaboration across facilities, IT, design, and clinical teams through integrated project team exercises helps identify trade-offs, eliminate redundancies, and ensure that infrastructure investments directly support operational goals. Testing workflows and validating assumptions before construction — whether through simulation, mock-ups, or pilot areas — gives teams confidence that technology spaces are rightsized based on actual use, not theoretical demand. The result is a design that’s practical, adaptable, and ready to evolve as care models and technologies change.

Each project an organization undertakes is different, and so are its infrastructure requirements. The needs of a $2 billion inpatient tower in Manhattan will differ greatly from those of an outpatient MOB in the Midwest. While recognizing these needs, the Facility Guidelines Institute (FGI), which previously recommended a minimum size of 12’ x 16’ for technology spaces, revised its 2022 guidelines to simply “provide space adequate to meet service requirements for the equipment that will be housed there.” In effect, this defers to BICSI and NEC standards, emphasizing a performance-based approach rather than prescriptive dimensions.

As technology infrastructure matures, the next horizon of planning revolves around how emerging intelligence systems will depend on — and stress — these digital foundations.

Design With Flexibility in Mind…

Technology systems evolve continuously throughout a building’s lifespan, often faster than any other discipline. Yet much of that evolution is now virtual and network-based rather than physical. Integrating systems like RTLS and nurse call may require only modest additional cabling but can yield massive operational gains through shared data and analytics.

For organizations earlier in their digital journey, the evolution from perhaps a dozen cables per patient room to nearly thirty may feel overwhelming. At more technologically mature institutions, the increase may be incremental, absorbed by existing rack capacity and well-planned pathways. The key is not overbuilding but ensuring that flexibility exists to accommodate both scenarios.

… But Avoid Overengineering

Not every department requires the same level of technology intensity. Administrative areas, for example, may have lighter data demands than imaging departments or ICUs. Over-engineering across the board can quickly consume capital and space. The smarter path is to apply program-based design logic: size infrastructure according to operational criticality, redundancy requirements, and realistic technology lifecycles.

Right-sizing also means embracing restraint. Restraint ensures scalability aligns with real-world demand rather than hypothetical extremes — striking the balance between readiness and responsibility. It’s easy to add capacity “just in case,” but doing so can create inefficiencies that ripple across budgets, utilities, and maintenance plans. Designing smarter, not always larger, requires strong coordination between healthcare stakeholders, technology planners, and the wider design and consultant team to ensure systems are scalable without being wasteful.

But What About AI?

Artificial intelligence is rapidly redefining how hospitals capture, process, and act on information, but it’s not changing the fundamental principle that infrastructure enables insight. Most health systems still rely on centralized data centers or cloud-based vendor platforms to handle processing, analytics, and storage. What’s evolving is the demand for speed: the speed of data intake, the speed of transfer, and the speed of action.

From a facility perspective, this means designing environments where data moves seamlessly between endpoints — from bedside devices to enterprise servers to cloud platforms — without latency or bottlenecks. Fiber backbone capacity, wireless coverage, and edge-compute readiness all become increasingly critical to how effectively AI can augment care in real time. In the near term, hospitals won’t need to host their own massive AI data centers. But they will need to plan for the infrastructure that allows data to flow among those systems at the pace of clinical decision-making.

The next generation of healthcare facilities will be defined not by the technologies they deploy today, but by how well they’re prepared for those yet to come. Building future-flexibility into the core infrastructure ensures that hospitals remain agile, efficient, and human-centered, no matter what the future holds. The most successful facilities will be those that design for human experience first and let technology quietly enable it.