Driven by higher deductibles, better technology and drugs, shrinking reimbursement and patient demand for convenience and lower costs, health systems are incentivized to promote prevention and keep patients with chronic diseases out of the hospital, while providing care throughout Houston's major markets. Expect to see fewer overnight beds and growth in cardiac surgery, operating rooms, ICU beds and health system-sponsored clinics in locations citywide. Some hospitals are using available floors for hospice or rehab space, while others are doing a straight real estate deal, offering the floors for lease. The shift to outpatient care is well underway and accelerating.

GlobeSt.com: What are some of the features of the modern medical center?

Young: Patients throughout Houston will choose where they go for care based on the customer experience. Retail settings near residential communities may include urgent care, freestanding emergency centers, MOBs, imaging centers, ambulatory surgery centers, oncology care, post-acute care facilities and perhaps senior-care properties. Some larger healthcare systems will provide multiple services in one location near homes, ranging from primary care visits, imaging, cardiology, gastroenterology and orthopedics to entertainment and exercise (to keep patients busy while waiting to see doctors) and casual dining options in one building.

Not only do successful hospitals and health systems increase locations, but successful physician groups and specialty services are also following the trend, opening locations in major submarkets around the city. Often, physicians share clinic space with compatible specialists in multiple locations so they can refer business to each other.

GlobeSt.com: How have hospital designs evolved in recent years?

Young: A growing recognition of the need to treat behavioral and mental health (including addiction management) is resulting in a demand to accommodate cognitively impaired patients more effectively and sensitively. In larger hospitals, emergency departments are being reconfigured to reduce risk while ensuring compassion and dignity for these patients. Because they often require longer stays in the emergency department, an emerging design practice is adding features like bathroom showers, storage areas for belongings and decompression space. Occasionally, smaller vacated hospitals are converted into behavioral and mental health treatment facilities and some of these buildings are used for substance abuse clinics for children, teens and adults.

Patients in smaller towns in 19 states are benefiting from micro-hospitals, providing services similar to larger hospitals, but on a smaller footprint, often 15,000 to 50,000 square feet with between five and 15 inpatient beds.

Another hospital trend is learned from the hospitality industry, says Noe Ramirez, a healthcare architect with RS&H Architects. Besides design changes that include a trend toward soothing interiors, immune-compromised patients, like those needing bone-marrow transplants, need a different type of hospital setting for extended care. After the surgery and post-op, these patients are vulnerable to infection and require monitoring for complications, but they don't need full hospital services. So the new design for this time in a patient's stay will feel more like a hotel than a hospital, with a more comfortable interior design including some suite-style rooms and possibly a skilled concierge rather than a nurse.