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When the coronavirus outbreak hit the U.S. earlier this year, health care providers had to move quickly to alter their operational practices to prevent the spread of COVID-19 while adapting spaces to accommodate a massive influx of patients.

Now, with months’ worth of perspective, architects and health care providers are looking at how medical spaces can be designed to allow maximum operational efficiency and prevent the spread of infectious diseases.

Over the past decade, Ebola, SARS and H1N1 (swine flu) pandemics spurred an evolution of health care design, said Ali Sadri, director of planning, design and construction with Legacy Health. But the arrival of COVID-19 was a wake-up call that accelerated discussions about functional programming, and the relationship between building occupants and their physical environment.

鈥淢ost of our providers started paying more attention to environment of care in general,鈥� Sadri said. 鈥淲hat do they need to be more effective and efficient, and care for their patients better so that space would not become an obstacle for them?鈥�

One major step involves removal of some patients from buildings altogether. While business owners, school officials and others weigh strategies for returning to in-person operations, the health care industry is doing the opposite by adopting new methods for keeping some patients off-site.

鈥淲e’re going to rely a lot more on care within your own home, because that’s where you’re safest,鈥� said Erin Couch, the Portland-based architectural standards and design director for Providence St. Joseph Health.

Health care providers in recent months have increasingly relied on 鈥渢elehealth鈥� as a means of seeing patients while reducing the number of people in their buildings. Rather than coming to a hospital or clinic for preventive care appointments, patients connect with providers via video conferencing or over the phone, minimizing the risk of virus exposure for both staff and other patients.

Couch, who works within Providence’s Real Estate Strategy and Operations pillar, sets design standards across a seven-state system that includes 51 hospitals, over 1,000 clinics and 100,000 caregivers. Moving forward, she is going to recommend that Providence convert a quarter of its existing examination rooms to telehealth rooms.

Monty Hill, a Mackenzie design director and associate principal whose specialties include health care design, said his firm anticipates telehealth remaining prevalent after the pandemic, due in large part to changes in how providers are compensated.

鈥淪ome of the things that we use as cues for changes in health care are Medicare and what the government is willing to reimburse,鈥� he said.

The Centers for Medicare & Medicaid Services in April announced a temporary expansion of telehealth benefits for Medicare patients, allowing hospitals to bill the system for services rendered remotely. A bill introduced to the U.S. House of Representatives on July 16 would make the expansion permanent, as would a bill introduced to the U.S. Senate on July 20 by Sen. Ron Wyden.

Designers and providers are also giving considerable thought to the flexibility of spaces. For years, the nature of health care building design was to create silos of specialties. While a shift in thinking was taking place before the pandemic, providers are increasingly looking at creating universal rooms.

Solvei Neiger, a ZGF Architects partner who specializes in health care spaces, says an ongoing consideration among her clients is the design of nursing units, including those in emergency departments, to allow for compartmentalization of spaces and creation of flexible groupings of rooms for cluster care.

Clients are planning lobbies with some of the infrastructure necessary to convert them to triage space, Neiger said. Rooms are being rethought as well.

鈥淢aybe it’s an exam room one day, a triage room or treatment room another day,鈥� she said. 鈥淏eing able to not have barriers allows for different types of uses to happen, which gives them maximum flexibility.鈥�

Especially important will be a shift toward rooms that can be adapted to intensive care units in the event of a surge, Hill said. With COVID-19, demand exceeded supply for ICU rooms, which differ from typical rooms because of their life-sustaining equipment available, level of monitoring for the nursing staff, and either positive or negative air pressure.

鈥淚 think we’re going to see government rules change to have a plan in order to deal with any major catastrophe,鈥� Hill said, 鈥渘ot just for coronavirus, but any future virus that we may need to be prepared for.鈥�

Also on the horizon is a shift away from using return air to a 100 percent outside air system in all areas in order to reduce the likelihood of contagions spreading through a building’s HVAC system. The Emanuel West core-and-shell project nearing completion in North Portland will not use recirculated air, Sadri said. Energy models show that the full outside air system offers better control of the environment without wasting energy.

鈥淲e can actually capture more energy from our exhaust than reintroducing that air back into the building,鈥� Sadri said. 鈥淎nd, of course, fresh air and not recycled air is what everybody in infections control is advising. You will see single-pass air become much more common.鈥�

Providence is also considering a move to a 100 percent outside air system, and is using simpler ways to keep contaminants out of the air. According to Couch, they have already turned off all hand blowers in restrooms, and are considering a return to use of toilet lids.

Reducing surface contamination is an equally important consideration. Touchless devices will also become even more commonplace than they already are, as will handwashing sinks. Some materials like carpet may be completely eschewed for surfaces that are more conducive to disinfection. Cove base flooring and countertop backsplashes, already common in many areas, could become even more prevalent in any areas that patients go.

鈥淚t really just eliminates any place for a virus to hide,鈥� Hill said. 鈥淭he cleanability of surfaces is going to increase.鈥�

Waiting rooms are likely to shrink to allow for improved social distancing among patients and visitors. Large groups of chairs will give way to small clusters or individual seating. Modern communications technology makes it possible for medical staff to be in full contact with patients and to stay updated without being on hospital grounds.

Also, after the widespread shortage of personal protective equipment that caught many hospitals off-guard early in the COVID-19 pandemic, some may begin storing supplies in bulk in warehouse space.

Designers are also beginning to rethink how providers are typically clustered, such as at nursing stations, in order to allow for greater distancing between medical staff members.

The pandemic has accelerated thinking on how to make medical spaces function as safely and efficiently as possible. For Couch 鈥� busier than she’s ever been with Providence 鈥� it’s a time that has begotten industry-wide ingenuity and a fresh approach to provision of community health care.

鈥淚’m sorry it took a pandemic to do that, but it’s certainly improved the way we do business,鈥� she said. 鈥淲e will look back at 2020 and say, 鈥楾hat’s when it all changed.’鈥�