For decades, Sanford L. Smith, FAIA, helped corporations find the value in more sustainable designs. Today he is focused on changing the concept of healthcare delivery.
As senior vice president of real estate and facilities for Hoag Memorial Hospital Presbyterian, the nonprofit regional healthcare system, Sanford L. Smith is helping to guide the design of a new generation of healthcare facilities. His work includes the $1 billion expansion of the Sun Family Campus, designed in collaboration with LPA, which reimagines the traditional hospital model into a green, pedestrian-scaled healthcare village focused on improving patient experience and outcomes.
Smith is also the founder and current chair of the Healthcare Design Initiative at Cal Poly Pomona, which is dedicated to training a new generation of healthcare-focused architects.
Before joining Hoag in 2008, Smith was real estate manager for Toyota Motor Sales, where he helped transform corporate America’s approach to sustainable building, demonstrating the value proposition for higher-performing facilities. In 2024, he was elevated to the AIA College of Fellows in recognition of his contributions to bringing sustainability and environmentally sensitive design to corporate and healthcare facilities.
What role can designers and architects play in the future of healthcare? When people are accessing what we describe as traditional healthcare, typically they’re having, as we say, a failure of health and they’re seeking care. It tends to be a very stressful experience. We’re trying to think about the problem from a patient perspective and reduce some of the things that are very stress inducing.
The Irvine hospital that we’re doing together [with LPA] is a good example. From the healthcare provider’s standpoint, a traditional tower scheme is very functional in terms of resource optimization. But you’re walking into a big impersonal building sorted out by floor for whatever condition you’re dealing with. It can be good for providers, but not necessarily good or very nurturing for the patient.
Our goal is to create a healthcare village that is warm and embracing. Rather than sorting everybody out in an elevator system, they’re dispersed in the low-rise village, where you’re around people with similar conditions and needs. We’re trading off some hospital efficiency with the goal of improving the patient experience and outcomes organized around our clinical institutes.
Sanford L. Smith Senior Vice President of Real Estate and Facilities, Hoag Memorial Hospital Presbyterian
What did you like about the design process? It was an engaging and highly collaborative process. We had a series of workshops and meetings with physicians and clinical staff where we really challenged them to think about healthcare delivery today and how it might evolve in the future. We were able to engage with them about their perspectives on emerging technologies and innovations in care and how the physical environment could be an enabling tool rather than a limiting factor. The result is that it is the input from the providers that ultimately influenced and shaped the building program. From that input, the planners and the designers at LPA worked together to come up with this concept. Throughout that process, the patient experience was always our true north. The result is this human-scaled healthcare village, which comprises these very efficient, low-rise buildings.
Can you see the ROI in bringing biophilia and nature-based elements into the healthcare setting? We’ve tried to be very thoughtful about the arrangement of the buildings, how they’re set in a series of gardens to provide for those moments that are calming and relaxing. We’ve created places of quiet and reflection so patients, their families and staff can detach from the stress and anxiety that often accompanies healthcare. For the physicians, we have created a place for them to optimize their time and increase their ability to interact with patients. We’re trying to find that balance that allows us to have an environment that is both clinically efficient but also nurturing from a patient’s perspective. At the end of the day, the work we do is all about serving our community.
What did you learn in the process that might carry over into your future plans? Once we got through the design of the major spaces, we mocked up the rooms and then had a series of workshops led by LPA. The goal was to simulate a day in the life of clinical operations. We were able to focus on small but important details, such as: Is the medical gas in the right place on the head wall? Can the patient plug in and charge their phone so they can call their loved ones? Doing these mockups and conducting these simulations really helped to identify and resolve a number of issues. That was a really important process. If they bear out the way that we think they will, it’s definitely something we will repeat on a going-forward basis.
Why did you start the healthcare design program at Cal Poly Pomona? When I joined Hoag, I didn’t know very much about healthcare other than I’m married to a nurse. I was really surprised by the complexity that permeates the industry. There’s this tremendous wealth of knowledge in the industry of people that have been solving the problem based upon a very hospital-centric perspective of delivering healthcare. My industry colleague, the late Bob Kaine, AIA, and I thought: If we could get access to a generation of people who, for the most part, haven’t experienced healthcare in any meaningful way, would they think about the problem (and therefore solutions) fundamentally differently? That was the initial premise.
Would a new generation of thinkers look at the problem completely differently and not be stuck in the current paradigm? Thanks to tremendous support from the architectural, construction and development community, the program is now over 10 years old, and many of the students who participated are now leading healthcare practices at many firms across the Southland.
How has the program evolved? This year, the program is expanding to include more health and wellness thinking as opposed to simply healthcare design. As a result, we’re hoping to engage in a more multidisciplinary process incorporating urban planning and urban design, landscape architecture and graphic arts.
The nature of health is deeply embedded in the built environment. An aging population, longer life expectancy, climate change and advances in technology will reshape our notion of city planning with workspace, housing and transportation changing significantly in the future. As we think about the future, the time is right to engage with the next generation of design thinkers and to be bold.
