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The three hospital design trends Philip Tobey highlighted in 2012 were a shift toward ambulatory care, greater integration of medical systems, and the bundling or separation of hospital functions. They are best read as a snapshot of what one healthcare design leader expected at the time—not as a current forecast or proof that every prediction came true. For construction and facility-planning readers, the ideas remain useful because they frame durable project questions: where care belongs, how information follows it, and which functions need to share a building.
| 2012 trend | Planning question | What the article described |
|---|---|---|
| Ambulatory care | Which services need to be in a hospital, and which can be delivered elsewhere? | Care moving into outpatient settings, alongside continued attention to primary, urgent, and emergency care. |
| Medical-system integration | How can clinical information and operations work across locations? | Connected systems, coordinated care, and further electronic medical record implementation. |
| Bundling and unbundling | Which functions need the hospital’s full infrastructure, and which can be separated or grouped differently? | Some support services moving out of the main hospital, with certain designs grouping beds over a shared diagnostic and support base. |
What did the 2012 article mean by hospital design trends?
In a July 20, 2012, Building Design + Construction article, Philip Tobey, FAIA, FACHA, then senior vice president at SmithGroupJJR, described three forces he believed would influence hospital planning: more care outside traditional inpatient buildings, better integration of medical systems, and a changing relationship between the hospital’s core and its support functions. The article also asked whether hospitals were ready to adopt lean approaches.
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That framing matters. This was a trade-publication interview and trend analysis, not a clinical study, a current market forecast, or a retrospective audit of completed projects. Its projections and reimbursement context belong to 2012. Later Building Design + Construction coverage discusses related themes—such as outpatient decentralization, flexibility, technology, wellness, infection control, and decarbonization—but those later reports provide context, not proof that Tobey’s specific predictions were fulfilled. See the [original 2012 article] and [BD+C’s 2024–2025 healthcare-building coverage] for their respective time frames.
Why did Tobey expect more care to move to ambulatory settings?
Tobey’s first trend was the movement of services from hospitals into ambulatory settings. He put it plainly: “The trend to push services out of the hospital into ambulatory settings will only intensify.” The practical implication for a project team is not simply to make a hospital smaller. It is to decide which services belong in a high-intensity hospital and which can be delivered in other settings, while planning how those settings connect.
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The original article reported a prediction that inpatient volumes would fall 5% while outpatient volume would grow 30%. Those figures were forecasts in the 2012 article, not observed outcomes or current estimates. They should not be used as a present-day demand model. Their value here is to show the scale of change Tobey anticipated and the planning tension it created.
That tension appears in the article’s more nuanced point: moving care outward did not mean that every service would scatter into separate facilities. Tobey also described the possibility that freestanding surgery and imaging facilities could be consolidated into larger hospital centers. In other words, decentralization and consolidation can occur at the same time: some encounters may be delivered closer to communities, while certain specialized services or facilities may be grouped. The right layout depends on the particular service, care model, and project—not on a one-way rule that every function should leave the hospital.
The article also said that primary care, urgent care, and emergency-department capacity would need attention. For construction planning, that is a reminder to test the whole service network rather than focus only on inpatient bed counts. A project may need to consider the hospital alongside outpatient venues, access points, and the clinical relationships between them. Later BD+C coverage continues to discuss outpatient care and shifting delivery models, but it should be read as later sector reporting rather than confirmation of the 2012 volume forecast.
What does integration of medical systems change in a building?
Tobey’s second trend linked integration with operational efficiency, quality, and coordinated care across hospitals and community venues. In his account, integration also meant making information available to clinicians where care was taking place. “Providing the right information where it’s needed is essential for clinical care,” he said, while anticipating further implementation of electronic medical records.
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This is a broader idea than installing a particular technology. A hospital project can involve clinical and operational systems that need to function across departments and locations. If care is distributed among a hospital and other venues, coordination depends in part on information being available in the setting where the work happens. The design question is therefore not only where to put equipment or services; it is how the planned care model and the information supporting it fit together.
Integration also changes how project teams should evaluate a proposed layout. A design that groups functions physically may not, by itself, ensure coordinated care. Conversely, separate locations do not automatically make coordination impossible. The relevant question is whether the operational model and the systems planned for the project support the intended work across those spaces. The 2012 article identifies the goal, but it does not prescribe a technical architecture, specify an implementation method, or establish a measured result for a particular facility.
For owners and construction teams, this makes early coordination important. Facility planning, clinical operations, and the systems intended to support care should be considered together rather than as isolated workstreams. The article’s historical emphasis on electronic records is one example of technology’s role; later BD+C reporting includes technology integration among continuing healthcare-building themes. Neither source supports treating one technology platform or building configuration as universally appropriate.
What are “bundling” and “unbundling” in hospital planning?
In the 2012 article, bundling and unbundling describe choices about which hospital functions share a facility and which are separated. Tobey discussed moving lower-intensity support functions—such as pharmacy, lab support, materials handling, and environmental management—out of the main hospital. He also described designs that group beds over a central diagnostic and support base.
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These are different spatial strategies, not contradictory instructions. Separating some support work can change what has to fit in the main hospital. Grouping beds over a shared diagnostic and support base, by contrast, can concentrate selected functions beneath or near inpatient areas. The article does not provide a universal formula for which strategy is better. A project team has to identify which activities need the hospital’s high-intensity infrastructure, which can operate separately, and which benefit from being grouped.
One specific number in the article needs careful handling. BD+C reported that a study for a 100-bed community hospital found 39% lower construction cost per bed under the described configuration. The article page does not identify the study, its assumptions, or its methodology. That makes the figure an attributed, project-specific report—not a generally applicable savings estimate, a current benchmark, or a promise of what another hospital could save. A team evaluating a similar configuration would need project-specific evidence before using a cost comparison in a budget or business case.
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Outbyte PC Repair FREEClear out junk files and repair common Windows errorsFree Scan →Outbyte Driver Updater FREEScan for outdated or missing drivers - takes under a minuteDriver Scan →The larger planning lesson is to compare options on more than floor area or construction cost. Consider the care setting and access the layout supports; how information and clinical work connect across locations; which functions require hospital-level infrastructure; and whether the arrangement can adapt to the project’s expected needs. Later BD+C coverage also emphasizes flexibility and futureproofing, as well as infection control and decarbonization. Those are relevant considerations to test against a project brief, not automatic requirements that dictate a single plan.
How do the three trends fit together?
The three ideas form a connected planning problem. If services move to ambulatory settings, care is delivered across more than one place. Integration becomes relevant because the article’s model depends on coordination and information being available where care occurs. Bundling and unbundling then ask which functions should remain together in the hospital, which can be separate, and what shared support the remaining core needs.
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A useful way to assess a proposal is to compare alternatives against the same set of questions:
- Care setting and access: Which services remain at the hospital, and which are planned for other venues?
- Coordination: How will clinical work and information connect across those settings?
- Operational intensity: Which functions need the hospital’s infrastructure, and which can reasonably be housed separately?
- Cost evidence: Are savings claims based on a transparent, project-relevant comparison, or on an attributed example with unknown assumptions?
- Adaptability: Does the option allow for the project’s anticipated growth, technology needs, infection-control priorities, or decarbonization goals?
This is a decision framework, not a claim that the 2012 article supplied answers to every question. Its contribution is to put service location, systems, and functional organization on the same planning agenda. Later BD+C reporting broadens the conversation with examples and discussion of flexibility, wellness, infection control, and decarbonization. Those later themes can inform a current brief, but they should not be treated as a retrospective scorecard for Tobey’s 2012 analysis.
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1Fix the driver behind crashes, sound loss and screen glitches2Clear out junk files and repair common Windows errors3Scan for outdated or missing drivers - takes under a minuteWhat should readers take from this historical forecast today?
Read the article as a record of three design questions that were prominent in 2012, not as a current checklist of what every hospital should build. Its outpatient projection and 39% construction-cost figure are especially unsuitable as stand-alone planning inputs: the former was a forecast, and the latter is an incompletely documented report tied to one described configuration.
The themes can still help construction professionals organize an early conversation with owners and planners. First, define the intended care network instead of assuming all activity belongs inside the inpatient hospital. Second, connect the facility plan to the clinical information and operations needed across that network. Third, decide deliberately which functions should be grouped with the hospital and which can be separated. Finally, evaluate those choices against current project objectives, including adaptability and the priorities identified in later healthcare-design reporting.
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For historical context, read the [2012 interview and trend analysis] alongside BD+C’s later [hospital facilities market trends] and [2024–2025 healthcare building report]. They are useful for seeing how the discussion evolves; they do not turn a 2012 forecast into current data.
Frequently Asked Questions
Was the 5% inpatient decline and 30% outpatient growth prediction accurate?
The available sources do not establish whether those projections came true. The figures were reported as a prediction in the 2012 article, so they should not be presented as measured results or used as current volume assumptions.
What does ambulatory care mean in a hospital planning discussion?
Here it refers broadly to care delivered outside the traditional inpatient hospital setting. The 2012 article discusses a shift toward such settings but does not define a single facility type or say that every outpatient service should be moved.
Can a hospital use the reported 39% cost reduction in its business case?
Not without independent, project-relevant support. The article does not identify the underlying study or its assumptions, so the number is not a reliable stand-alone estimate for another facility.
Did later healthcare design reports confirm all three 2012 trends?
Later BD+C coverage discusses overlapping subjects, including outpatient care, technology, and flexibility, alongside additional priorities such as infection control and decarbonization. That thematic continuity is not a formal validation of each older prediction.
