Designing a Sustainable Hospital of the Future

By prioritizing critical care, streamlining support services, and designing for long-term adaptability, hospitals can minimize environmental impact and integrate seamlessly into their communities.

A building with a curved roof.
Horizon Hospital, Gensler’s prototype for a sustainable hospital of the future.

The global healthcare industry exerts a disproportionate impact on our climate, accounting for around 5% of greenhouse gas emissions. To put this in perspective, if the health sector were a country, it would be the fifth largest emitter. Hospitals, as the primary culprits, consume 2.6 times more energy than other commercial buildings and churn out a staggering 13,000 tons of waste daily. This environmental strain directly affects human health and deepens disparities, particularly in marginalized communities. Despite urgent calls for change and the introduction of new state regulations, healthcare lags other industries in the implementation of sustainable design solutions.

Typical approaches to sustainable hospital design involve improving the efficiency of conventional buildings within established delivery systems. What if, instead, we thought bigger? What if we asked how redesigning service delivery and infrastructure could not only mitigate climate change but also enhance community health outcomes? Could asking bigger questions provide more impactful solutions for the financial challenges, workforce shortages, and equity imbalances that plague the industry?

Compounding Impacts

As our understanding of the intricate relationship between environmental health, climate change, and human well-being deepens, the strain on our health system becomes increasingly evident. The correlation between air pollution and the rise in ED visits due to asthma attacks underscores this burden. Additionally, heat-related deaths are on the rise, with older adults and Blacks at disproportionate risk. With a projected increase in individuals experiencing the health effects of climate change in the coming years, the demand on our healthcare infrastructure will inevitably surge. However, within this challenge lies an opportunity: by prioritizing climate action, healthcare systems can keep our communities healthier and reduce the need for hospitalization.

Upstream Solutions

Healthcare resembles a flowing stream, characterized by the currents of health, cost, and climate impacts. At its upper reaches lie strategies focused on optimizing health with minimal resource consumption, while at the lower end lies the intensive treatment of severe illness. Today, a significant portion of healthcare resources are channeled into downstream interventions within the hospital setting for unnecessary ED visits, surgeries, prolonged inpatient stays, and radiation therapies. Not only are these facilities expensive to construct and operate — they’re characterized by their substantial carbon footprints. To make a tangible difference in community health and climate impact, we must shift upstream.

Upstream solutions address the socioeconomic and environmental factors that influence health as well as individual health behaviors and access to quality healthcare. The healthcare industry is already investing in housing, transportation, and prescriptions for healthy food and time in nature. Meanwhile, advancements in science, technology, and artificial intelligence are showing the potential to eliminate diseases like cancer before they manifest, provide hospital-quality care in the comfort of our own homes, and replace surgical procedures with IV infusions. In a future where we better leverage preventative strategies and most healthcare services are performed at home or in outpatient settings, what role will the hospital serve?

A Sustainable Hospital of the Future

We see a future in which hospitals become smaller and focus on the most complex and critical care. Gensler’s healthcare practice, alongside engineering partners BR+A and Thornton Tomasetti, have designed a prototype to illustrate how environmental, financial, and experiential goals can align to support community health. We call this prototype Horizon.


Horizon includes far fewer beds and procedure rooms than an average community hospital, with a focus on critical care, high-risk procedures, and trauma care. All but the most high-risk procedures shift to advanced ambulatory care centers, which can utilize existing buildings to reduce climate impact, and support services are consolidated into logistics hubs for improved system-level efficiency. Shrinking the resource-hungry hospital is perhaps the single most impactful sustainability strategy we can implement.


Hospitals’ increasingly specialized designs and vertical stacking of program have resulted in a steady decrease in useful life. Given the exponential pace of scientific and technological advancement, it’s unlikely that whatever we build today will meet the standard of care 50 years from now. Horizon’s U-shaped form enables long-term adaptability, with inpatient wings designed for conversion into other compatible uses at the end of their useful life as a hospital.


Acknowledging that each community has different existing real estate assets and needs, the site is flexible enough to accommodate additional elements from the ecosystem. This could mean a community health hub, flex zone, or even housing. Additionally, the site’s trellis-like roof serves as a versatile framework, adapting to local climate conditions with modular inserts for shading, rainwater harvesting, vegetative roofing, and photovoltaic panels.

Engineering drawing.

The intimately-scaled, low-rise structures transform the canonical idea of the hospital as a fortress on a hill into a welcoming neighbor and an integral part of the 20-minute city. The site’s porous nature engages with the community it serves, offering civic spaces that cater to essential fitness, educational, and social needs.

A large building with many bikes parked outside.

Well-known for its healing potential, our vision for Horizon employs biophilic design as a powerful backdrop for patients, families, and staff. More than a superficial nod to “sustainability,” Horizon blurs the lines between community garden, city park, and hospital.

A group of people outside a building.

While mass timber construction is seeing a resurgence across the world, it’s yet to be meaningfully employed in the U.S. healthcare sector; but it’s only a matter of time. Mass timber structures can meet the strict life safety and vibration requirements of hospitals — especially in low-rise structures — and an all-timber structure offers a 50% embodied carbon reduction over a conventional steel superstructure.


Future hospitals will continue to require more energy per square foot than other building types, but Horizon’s reduced size will greatly reduce the overall demand. Not only is it dramatically smaller, it’s significantly more efficient: Horizon uses 40% less energy than a conventional hospital of the same size and is operationally carbon neutral.


A sustainable future for healthcare embodies a paradigm shift. By prioritizing critical care, streamlining support services, and designing for long-term adaptability, hospitals can not only minimize environmental impact but also integrate seamlessly into the fabric of their communities.

Embracing innovations such as mass timber construction and renewable energy sources, Horizon Hospital represents a bold step towards more resilient, equitable, and environmentally conscious healthcare. As we navigate the path towards sustainability, it’s imperative that stakeholders across the healthcare industry unite in their commitment to fostering healthier communities and a healthier planet.

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Bonny Slater
Bonny is a design director and global healthcare practice leader at Gensler. She has spent 20+ years creating inspiring environments to support health and wellness for diverse populations. With a background in design and environmental psychology, she brings a unique perspective and research-driven approach to crafting meaningful experiences by supporting physical, cognitive, emotional, and spiritual needs. Bonny is based in Washington, D.C. Contact her at .
Randy Guillot
Randy is a design principal who serves as a global Healthcare leader at Gensler with a portfolio of work spanning across five continents. Projects under his design leadership are celebrated for their critical design success and enhanced access to healthy, dignified, optimistic, and engaging environments for all. Randy is based in Chicago. Contact him at .
Geoffrey Diamond
Geoffrey is a design director and senior architect in Gensler’s New York office. He integrates renewable energy strategies, eco-friendly materials, and advanced resilience technologies into his projects, creating award-winning, LEED-certified buildings that are both functional and responsible. His leadership extends to mentoring the next generation of architects and inspiring them to prioritize green building principles in their work, while his innovative approach continues to shape the future of sustainable architecture. Contact him at .