Marion Fraser and Alison Wesley-James are in remarkably good spirits, considering what they have to accomplish over the next several hours: squeezing 27 surgical beds, six operating rooms, labs, CT scanners, and support areas into 30,000 or so square feet of planned hospital space.

Sitting with healthcare architects in a meeting room at the Omaha, Neb., headquarters of the firm HDR, Fraser and Wesley-James—the CFO and planning manager, respectively, of the Ottawa Heart Institute in Canada—study CAD drawings and stacks of spreadsheets as they weigh all the factors. These include work hours (If the ORs were used more hours per day, wonders Fraser, could they make do with five?) and hospital politics (Where is the best spot to put the CT scanners, so as many doctors as possible can have them close by?).

Most tortuous of all is phasing, the logistics of which can be paradoxical: “You have to build new, to take out the old, to be able to refurbish, to build new,” says Fraser, who wears the sensible clothes of an accountant but a ready smile.

The planned cardiac unit might be new construction or an existing facility that's been renovated—or a combination of both. It's too early to say, since ground won't be broken on the project, a major expansion of the Ottawa Hospital, for another decade. And some of the changes that Fraser and Wesley-James foresee won't take effect until 2031.

2031: That's 24 years from now. To put it in context, 24 years ago, the world's .first “test-tube baby” had just turned .five. Researchers had not yet discovered the cause of AIDS, and balloon angioplasty was a new procedure.

  • A love of historic buildings fueled the second career of Tammy Felker (left, with colleague Teri Oelrich), a former critical-care nurse who obtained her architecture license in April. The only registered architect at the firm NBBI who also has been a nurse, Felker says her integrated experience is a great asset: When someone [at a hospital] says, 'We'll get a balloon pump in the elevator,' I know what that equipment is.

    Credit: William Anthony

    A love of historic buildings fueled the second career of Tammy Felker (left, with colleague Teri Oelrich), a former critical-care nurse who obtained her architecture license in April. The only registered architect at the firm NBBI who also has been a nurse, Felker says her integrated experience is a great asset: "When someone [at a hospital] says, 'We'll get a balloon pump in the elevator,' I know what that equipment is."

No area of architectural practice today is as fast-moving and complex as healthcare, with its heady (or, depending on your perspective, bone-dry) mix of data crunching, value engineering, and crystal-ball gazing. But the crucial ingredient in healthcare architecture, say its practitioners, is really empathy: for patients who are unsteady after an operation; for doctors and nurses who can treat cancer but can't think in square feet.

Which is why the person running the meeting in Omaha is not a hospital administrator or even an architect. She's the one with frosted hair and stylish glasses at the back of the room, who listens more than talks, asking occasional, to-the-point questions. The one who keeps the discussion on track. The one who makes sure that everyone eats a decent lunch.

That last part figures: Debra Sanders, the director of healthcare consulting at HDR, is a registered nurse.

A Twist in the Career Path

“I often think back and scratch my head about how I ended up on this career path,” Sanders told me by phone prior to my trip to Omaha. Fourteen years ago, Sanders, a Nebraska native, was working as nurse executive at Clarkson Hospital in Omaha as the hospital underwent a redesign. “Organizations from around the world wanted to come and visit Clarkson and see what we had done,” she remembers, and she spent a lot of time leading them on tours.

But it was a chance meeting that crystallized her interest in healthcare architecture. “I happened to be at a social event where I met the healthcare leadership from HDR, and they said, ‘Will you come talk to us?' They were contemplating developing a consulting practice.” Now Sanders leads a 45-person team at HDR that handles master planning, space programming, signage and way finding, and technology and medical equipment on projects across North America.