One of the great ironies of modern medicine is that the very environments created to heal are the cause of countless injuries, illnesses and death to the vulnerable population they were created to serve. Not since Florence Nightingale visited the pestholes in which wounded and sick British soldiers were housed in the Crimea, has there been a growing international awareness of the harm caused by the healing environment. There is growing recognition that risks and hazards of health care associated injury and harm are a result of systemic design problems rather than poor performance by individual providers. The evidence is overwhelming that current hospital design is not sufficient to prevent medical errors, rates of infection and injuries from falls, and even contributes to slow patient recovery and high nurse turnover.

Today's challenges are even steeper than a half-century ago due to:

a) Rising concern and demand about health care costs and quality

b) Large population increase with an exponentially growing elderly proportion

c) A proliferation of complex and confusing local, state and federal regulations

d) A dramatically evolving technological environment

e) A sicker, more debilitated and compromised patient population, and

f) A workforce with higher expectations of the work environment should be like

The present hospital construction boom provides an opportunity to rethink hospital design, and especially to consider how improved hospital design can help reduce staff stress and fatigue, reduce patient and family stress and improve patient outcomes and quality of care. A key challenge remains how to incorporate technology into the local learning environment and culture in ways that optimize its implementation and use.