Rethinking Circular Hospital Design: A Systematic Review

Why are most hospitals or buildings of a rectangular design only? Compared to the standard rectangular Nightingale nursing unit design, why has a circular/elliptical nursing unit or hospital design not been developed to date? This study reexamines the concept of circular hospital building design. It aims to understand the reasons behind the limited existence of circular hospitals/buildings and compare circular with shaped buildings and their pros and cons. The study proposes a design concept based on further investigation to make economical, structurally stable, and efficient circular hospitals with modern technologies to improve patient safety, quality, and proper space utilization. The literature search was conducted using the MeSH terms “Circular Hospital”, “Round Hospital”, “Hospital Design”, “Doughnut design”, “Circular Building”, “Round Building” from Web of Science, PubMed, Scopus, and Google Scholar databases, last accessed October 27, 2025. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guideline but was not registered. The inclusion criteria were strictly assigned as circular building or hospital design only. Only 19 records were screened out of 96,210 records analyzing the pros and cons of circular design hospitals. The results show that the concept of circular hospital design is old enough, with the most significant advancements in the 1960s, 1988s, and 2015. Advantages of circular hospitals include wider visibility; reduced staff travel time; cost-effectiveness; improved light, air, and ventilation; and more bed head space. Limited literature evidence was found, with major limitations including wastage of central core areas and construction complexity. The author proposes that the design concept of a central elevator and modern construction technology reduces the central core waste and construction complexity. Use of modern amenities such as pneumatic tubes, capsule transportation systems, and heating, ventilation, and air conditioning and a medical gas pipeline system can help avoid transportation delays, reduce travel time, and reduce human error, ultimately improving patient safety, quality, and operational efficiency in the long term.