E4H is dedicated to creating flexible environments for health
that enhance the well-being of patients, families, and staff.


Emerging Professional Friendly Firm
Emerging Professional Friendly Firm

E4H was recently recognized as a AIA New England Emerging Professional Friendly Firm. This award is given to firms who display an outstanding commitment to the development of their Emerging Professional staff. E4H is proud of the diversity and drive of our emerging professionals and we are excited to support the future visionaries of Healthcare Design.


Baylor Scott & White - The Heart Hospital - Plano North Tower Expansion
Baylor Scott & White - The Heart Hospita

Baylor Scott & White – The Heart Hospital Plano is a 116-bed heart and vascular hospital that first opened its doors in January 2007. In 2018, E4H designed a new 164,000SF addition, which offers world-class cardiovascular care to the North Texas community.

The new six-floor North Tower allows for improved operational efficiency and increased patient load. The first floor features a renovated and expanded lobby, a new coffee shop, and the Heart Rock Café—a restaurant caliber dining area. The new education suite is comprised of a 190-seat auditorium with state-of-the-art conferencing ca-pabilities. A new bio-skills classroom allows physicians and residents to practice new surgery techniques. The cardiopulmonary rehabilitation unit has been relocated from the original building and features an indoor track and specialized consultation and care areas for physical therapy patients.

The second floor includes four (three completed, plus one future) new operating rooms with an expanded central core, new blood bank, new central sterile processing department, and an expanded post-anesthesia recovery unit. The new physicians’ lounge—complete with conference rooms and a new residents’ suite—helps retain the top physicians in this field by making it a premier place to work. The third floor houses 28 private patient rooms in a new inpatient unit. The fourth floor is currently shelled for a future 28-room expansion to match the floor below. On the fifth floor, the Baylor Research Institute has moved into the space conducting long term research into pro-cedures and medications.

Research &

Micro-hospitals are on the rise
Micro-hospitals are on the rise

Smaller medical facilities have found favor with healthcare providers, are convenient for patients, and might offer opportunities to investors

Micro-hospitals, ranging in size from about 15,000 square feet to 50,000 square feet, are springing up around the United States, in part because they are positioned to deliver care in a more economical and operationally efficient manner than larger-scale facilities. What’s more, they can thrive in urban, suburban and rural areas, and are considered a patient-friendly model of care.

Architect Jason Carney, partner at E4H Environments for Health Architecture, has 15 years of healthcare-facility design experience encompassing a broad range of project sizes and types, including the design and construction of micro-hospitals.

What Is the definition of a micro-hospital?

Micro-hospitals are an affordable, effective way to provide a large variety of big-hospital services in the community, including surgery, radiology, emergency departments and related services. Typically, they are 24/7, small-scale inpatient facilities, roughly 15,000 to 50,000 square feet, with between five and 15 inpatient beds for observation and short-stay use. In some cases, based on market demand, these facilities can reach 50 beds. While micro-hospitals can treat some high-acuity needs when necessary, more are located within 20 miles of a full-service hospital to ensure a seamless transfer process when warranted.

Why are they growing in popularity?

Because not only do they offer a full set of services that are typically found in large hospitals, they provide greater accessibility and convenience for many consumers, as well as affordable market-growth opportunities for providers.

What problem do they solve or advantages do they offer?

Cost, convenience and location are three of the leading advantages micro-hospitals offer. Compared to large medical centers, micro-hospitals can be 90 percent less expensive to build, staff and operate, and the format allows providers to deliver services in locations that, because of population density or other factors, could never sustain a full-size hospital. Micro-hospitals also offer communities a much more robust suite of medical services than you find in a typical urgent-care clinic or outpatient facility. Compared to a standard full-size hospital, however, the smaller footprint makes them feel much more intimate and calm for patients, and makes daily work flow more efficient for physicians, and nurses and care providers.

From a real estate investment standpoint, how do micro-hospitals perform?

We think the overall numbers and continued growth of micro-hospital design proposal requests are the strongest validation of the financial merits of the concept. As of the beginning of this year, 19 different states have at least one micro-hospital in operation, and across the country more than 50 micro-hospitals are now serving patients. These hospitals are particularly popular in parts of the Midwest and certain Western states, notably Arizona, Colorado, Nevada and Texas. Most of the micro-hospitals in operation or under construction are located in states facing the strongest pressures to control the growth in healthcare costs and get the historical overbuilding of healthcare facilities under control.

You have suggested the healthcare industry can learn some design lessons from the hospitality business. Give us some examples.

A great example is E4H’s recent work with a New York hospital to create a long-term space for immune-compromised patients going through a procedure such as a bone-marrow transplant (BMT). The first phase of a BMT— surgery and initial recuperation — obviously must take place in an inpatient hospital setting. But in later phases, when patients are recovering and need mainly to be monitored closely for infections or complications, they do not require a standard inpatient hospital room and can enjoy a much better, less-costly experience in a specially designed, hotel-like space. For our client, we created a space for this in-between population that has private, suite-style rooms; specialized water-filtration systems to protect immune-suppressed patients; and more of a hotel aesthetic. Patients are served by a concierge instead of a charge/ desk nurse. If any of them develop complications, of course, they are quickly detected, and patients can rapidly be brought back into the hospital for treatment. But if their recovery proceeds without incident, they can enjoy the equivalent of a long-term hotel stay, instead of long-term hospitalization, after their BMT. We find that these lessons are also relevant for those serving rural populations. Patients and families who must travel great distances for healthcare will often seek out options that provide a balance of the best patient care and the most comfortable experience for family members during the stay. Providing a comfortable, welcoming space that accommodates family members at the patient’s bedside adds important practical and emotional support to the patient experience. The availability of family support improves outcomes.

On the Boards

Central Hub for Kettering Health Network
Central Hub for Kettering Health Network

A conceptional design for Kettering Health Network Outpatient Surgery Waiting and Café encompasses all the latest evidence based design and human needs that are vital in healthcare environments. The concept was developed based on Ohio’s native botany and referenced throughout the design to create soft forms and use of indigenous materials. The space is a destination in the hospital that includes an open lounge area for staff to patient interaction, a café with ample seating, natural day light, and connectivity to the outdoors. The space has a monumental greeters desk which acts as the central framework from which additional features spire. The space overlooks a lush evergreen botanical garden - a space of respite for patients and staff.