If the health care system is in a state of change, logic follows that health care facilities must fall in line. That can be a daunting task when it’s impossible to pinpoint exactly how the changes will play out in the real world. Instead of designing hospitals to respond to the health care system of today, or even of tomorrow, hospital officials have to figure out how to design for the unknown.

That is just what architects, clinicians and executives set out to do at San Diego’s Palomar Health, which opened a 739,000-square-foot, 288-bed medical center in 2012. Costing nearly $1 billion, the hospital wasn’t built for the future as much as it was built to accommodate it.

From the moment Palomar Health began its nine-year journey to build the new facility, the focus remained on “sustained functionality,” or “Can a building continue, in a perpetual way, to renew itself in terms of its functions and operations?” Michael Covert, former president and CEO of Palomar Health, told attendees at the 2015 ACHE Congress. Covert is now president and CEO of St. Luke’s Health System, Houston. The guiding principle divided itself into two categories: Design for humanity and design for innovation.

The human factor rested on healing attributes embedded into the building. Natural lighting, noise abatement, garden views from every patient room, dedicated family spaces, etc., are elements “you will always need in a hospital” no matter how much the health care system changes, Covert says. Everything else, however, is fair game.

In building a hospital for the future, Thomas Chessum, principal at CO Architects, Los Angeles, said that you need to set a framework for innovation and “see the current [best practices] as not being the right thing, but as being probably wrong.” That way, hospitals won’t lock themselves into non-adaptable, non-expandable boxes. Palomar Health developed a single-story warehouse space that can house a variety of service lines — treatment rooms, emergency department, operating room, diagnostics, and more — and each space can be modified or changed entirely as the hospital’s demands shift. The towers host private patient rooms — all acuity-adaptable.

“This is about establishing a framework in which flexibility can continue so the building itself has a life into the future,” Chessum says. “The building itself becomes a venue for different types of opportunities, like a plug-and-play.”