Hospitals are designed years before clinicians ever care for a patient inside them. By the time a team discovers that an outlet is unreachable, a critical supply is too far away, or a patient transport route creates unnecessary risk, making a change may be difficult, expensive, or impossible.

That is why simulation is becoming an increasingly valuable tool in healthcare design.

In this episode of The Architecture of Healing, pediatric critical care physician Dr. Nora Coleman shares how her background in simulation-based education evolved into a new way of evaluating the built environment. During the development of Children’s Healthcare of Atlanta’s Arthur M. Blank Hospital, simulation became more than a training exercise. It became a way to identify risk, test workflows, and understand how clinicians would actually interact with a facility before construction decisions became permanent.

From Training People to Testing Systems

Healthcare simulation traditionally focuses on education. A clinical team may respond to a deteriorating mannequin, practice an emergency procedure, or rehearse an algorithm in a controlled environment. The goal is often to evaluate how well participants recognize a problem and respond.

Design simulation changes the question.

Instead of asking, “Did the clinician perform correctly?” the team asks, “Did the environment make it easier or harder for the clinician to perform correctly?”

That distinction is important. A staff member may struggle not because of a lack of knowledge, but because oxygen tubing cannot reach the patient, equipment blocks access to the bed, supplies are difficult to locate, or a hand sanitizer dispenser is positioned outside the natural workflow.

In this context, simulation becomes an investigational platform for identifying what Dr. Coleman describes as latent conditions: features of the environment or system that can contribute to future errors.

Test the Work, Not Just the Room

A traditional design walkthrough can generate useful feedback, but it often produces opinions: “I like this,” or “I don’t like this.”

Simulation produces something different.

Teams perform realistic clinical tasks inside a mock-up while observers watch how the environment supports or interferes with the work. During the Arthur M. Blank Hospital project, clinicians tested scenarios ranging from routine care to intubation, CPR, line placement, and ECMO cannulation.

The purpose was not to evaluate their clinical decision-making. Participants were intentionally directed through specific tasks so the design team could observe questions such as:

• Can clinicians reach the outlets and medical gases they need?
• Where does equipment accumulate during an emergency?
• Do tubing and cables create obstacles?
• Are supplies located where staff naturally need them?
• Can a clinician activate an emergency response without leaving the patient?

This approach reveals behaviors that are extremely difficult to identify during a meeting. Clinicians frequently adapt to poorly designed environments without consciously recognizing that they are doing so. Mock-ups allow designers and operational leaders to see those workarounds in action.

Simulation Can Expose Operational Consequences, Too

One of the most important lessons from the new hospital came from scale.

The new facility is dramatically larger than the hospital it replaced. That additional space creates valuable opportunities for patients, families, and staff, but it also changes how work gets done.

Travel distances increase. Supplies may be farther apart. Staff spend more time moving between clinical areas. Vertical transportation, badge-controlled doors, and departmental adjacencies all influence how quickly people and resources can move.

Dr. Coleman noted that the organization ultimately required additional staffing to operate effectively within the larger footprint.

For healthcare executives and planners, this is a critical reminder: square footage is not simply a capital planning decision. It is an operating model decision.

An illustrative example is a respiratory therapist supporting several units. If the new facility increases the time required to travel between patients, the organization may need additional coverage even if patient volumes remain unchanged.

Healthcare organizations should therefore evaluate travel distances, transport routes, supply locations, and staffing models together rather than treating them as separate planning exercises.

Document Design Decisions Through Risk

Simulation becomes especially powerful when observations are systematically documented.

During the project, the team used a form of Failure Mode and Effects Analysis, or FMEA, to evaluate potential design risks. Before each simulation, they identified specific elements they wanted to test. Observed issues were then scored based on factors such as patient safety implications, ergonomics, regulatory considerations, severity, and potential frequency.

Across the design process, the team identified more than 1,000 latent conditions.

This created more than a list of design comments. It created an institutional record explaining why decisions were made.

That documentation becomes particularly valuable when projects face cost-reduction discussions later. Instead of defending a feature because someone preferred it during design, leaders can point to a documented safety or operational rationale.

Integrate Frontline Care With Back-of-House Operations

Perhaps the episode’s broadest lesson is that healthcare environments cannot be designed effectively in silos.

Clinical care depends on an enormous network of supporting systems: medications, laboratory services, blood products, supplies, equipment, transportation, and increasingly automated technologies.

When these systems work well, clinicians often barely notice them. When they do not, frontline teams compensate by searching for equipment, calling about missing medications, traveling longer distances, or creating informal workarounds.

Dr. Coleman argues that healthcare organizations should think more intentionally about the intersection between these back-of-house systems and frontline clinical care.

For future hospital projects, that means simulation should not stop at the patient room. Organizations should test the entire journey of care, including supply movement, patient transport, staff circulation, departmental adjacencies, and the technologies that connect them.

Key Takeaways

• Use simulation as a risk-management tool, not simply a design review. Ask how the environment affects safety, workflow, and human behavior.
• Test realistic clinical work. Observing teams performing actual tasks reveals problems that floor plans and tabletop discussions may miss.
• Define testing objectives in advance. Identify the specific workflows, adjacencies, equipment interactions, and safety questions each simulation should evaluate.
• Connect facility design to staffing and operations. Larger spaces and longer travel distances can materially change workforce requirements.
• Document decisions through structured risk assessment. Tools such as FMEA can create a defensible record of why design changes were made.
• Test systems beyond the patient room. Supply distribution, transportation, medications, laboratories, equipment, and technology all shape frontline performance.
• Return after occupancy. Post-occupancy evaluation can determine whether design assumptions actually produced the intended outcomes.

Healthcare facilities will continue to become more technologically enabled, operationally complex, and adaptable. The opportunity for healthcare leaders is to ensure they also become more human-centered.

Simulation offers a practical way to close the gap between how a hospital is imagined and how it will actually function. By testing the work before building the environment around it, organizations can identify risks earlier, make more informed investments, and create spaces that better support patients, families, and the people caring for them.

Listen to the full episode of The Architecture of Healing to hear Dr. Nora Coleman discuss the lessons learned from simulation, hospital design, and the transition into Arthur M. Blank Hospital.