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Ready for Anything: What It Really Takes to Design a Resilient Hospital Today

By Jessica Detweiler, AIA, ACHA, NCARB

July 31, 2025
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Attending the recent Summer Leadership Summit in Denver, which was co-hosted by the AIA Academy of Architecture for Health and the American College of Healthcare Architects, has made me reflect on what it truly means to design for resilience in healthcare.

It’s a word that’s tossed around frequently. But resilience isn’t just about bouncing back from the next storm, flood, or pandemic. It’s about designing healthcare environments that can bend without breaking and support not just patient recovery, but community recovery, too.

At the summit, a wide range of presenters and thought leaders made something very clear: Resilient design is no longer optional. It’s mission-critical.
Pediatric unit nurses station.
Pediatric unit nurses station.

What Is Community Resilience, Really?

Community resilience is more than a buzzword—it’s a measurable process. Researchers at the summit described it as the ability of individuals and communities to prepare for, absorb, recover from, and adapt to adverse events, all while improving systems and reducing future risks.

For healthcare facilities, that resilience is twofold:

  1. The ability to continue daily operations during disruptions.
  2. The capacity to support the broader community in crisis.

And that second role—being a community anchor—is where healthcare design can have an outsized impact.

The Rising Risk Landscape

Here’s the reality we’re designing for: Natural disasters have increased by a factor of five over the past 50 years, according to the World Meteorological Organization (WMO). We’re not just talking hurricanes. The US is also seeing dramatic rises in wildfires, heat waves, floods, and extreme winter storms. At the same time, many healthcare systems are serving communities that are already vulnerable economically, socially, and in terms of healthcare access.

For example, hospitals in rural, low-income, or minority communities often treat higher volumes of patients who rely on emergency departments for care, especially those without insurance. These facilities already operate under strain, and during disasters, they’re expected to do even more.

Designing for Resilience

One of the strongest takeaways from SLS was the idea that resilient design starts long before a crisis. It begins with decisions about location, layout, infrastructure, and even community engagement.

When we talk about resilience, we’re not just talking about buildings; we’re talking about systems that hold up under pressure. And in a major storm or disaster, that pressure is multifaceted.

We must anticipate:

  • Power grid disruptions that can knock out critical systems.
  • Municipal water failures that jeopardize basic sanitation.
  • Loss of sanitary sewer service, especially in areas reliant on external lift stations.
  • Limited access to medically supported shelters, particularly for elderly populations.
  • Communication breakdowns, like downed cell towers.
  • Fuel shortages and post-storm access to gasoline.
  • Delays in permitting and inspections as local building departments recover.
  • Supply chain breakdowns that strain already stretched resources.

These aren’t theoretical risks—they’re the real, documented challenges hospitals face during and after disaster events. Designing for resilience means anticipating these disruptions and ensuring facilities can absorb, adapt, and maintain operations when they happen.

We must design:

  • Surge-ready spaces that can flex to accommodate more patients.
  • Elevated facilities in flood-prone areas.
  • Wind- and seismic-resistant structures where storms or earthquakes are likely.
  • Redundant systems for power, water, HVAC, and communication.

But that’s just the structural piece. Non-structural strategies matter just as much:

  • Where is the facility located in relation to major roads?
  • Is there space to store essential supplies for a “just in case” moment, not just “just in time”?
  • Can the facility serve as a resilience hub—a place for cooling during heatwaves, for volunteers to gather, for community connection when normal life pauses?

Looking ahead, a new code requirement is already taking effect in some states, with others soon to follow. The Facility Guidelines Institute (FGI) introduced the Disaster, Emergency, and Vulnerability Assessment (DEVA) in its 2022 Guidelines. This asks healthcare facilities to formally assess and document the risks they face, from natural disasters to infrastructure weaknesses. While not adopted everywhere yet, it signals a shift toward making resilience a foundational part of planning and design, not an afterthought.
Van Wert Health Surgery and Inpatient Center Surgery Expansion Medium Patient Room Mechanical unit. Pharmacy storage room with racks and blue containers.
Van Wert Health Surgery and Inpatient Center Surgery Expansion Medium Patient Room Mechanical unit. Pharmacy storage room with racks and blue containers.

A Framework for Moving Forward

A useful model heard at the summit laid out the path to resilience in six steps:

  1. Categorize hazards relevant to your facility and region.
  2. Assess vulnerability and risk for both the building and the community.
  3. Investigate design options that mitigate those risks.
  4. Prioritize and plan based on impact and feasibility.
  5. Take action.
  6. Repeat. Resilience isn’t a one-time checklist—it’s an ongoing commitment.

Built Through Collaboration

If there’s one thing I took away from the summit, it’s that resilience isn’t something we build alone. It’s a collaborative effort—between architects, engineers, administrators, frontline workers, and communities themselves.

Every community also has a local emergency management coordinator and engaging with these individuals is key to understanding the specific risks a facility may face. From localized flooding to nearby industrial threats, these coordinators bring essential insights that can shape smarter, more targeted design decisions.

The storms aren’t slowing down. But with thoughtful, intentional design, we can make sure the facilities at the heart of our communities are ready to stand strong, serve well, and support all, regardless of what’s happening outside.

Interested in exploring how to make your healthcare facility more resilient? Let’s talk. From infrastructure planning to flexible, community-centered design, we can help you prepare for what’s next.

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