Nurse-Informed Flexibility in Healthcare Design: Stakeholder Perspectives on Feasible Strategies for Practice

Aim This study aimed to identify practical design strategies that improve flexibility in hospital environments during day-to-day operations and emergency conditions, and to explore their feasibility. Background Hospitals must operate continuously while adapting to evolving clinical practices, workforce pressures, policy shifts, and episodic crises. While prior studies identified strategies to support flexibility, questions remain about their feasibility and relevance over time. Methods We conducted a two-phase exploratory qualitative study. Forty-five nurses documented barriers and opportunities for flexibility using mobile phones to share photos and text messages. Their input generated 22 design strategies, which were presented in five panel discussions with 17 healthcare design stakeholders. Discussions were thematically analyzed, and panelists rated the feasibility of each strategy against seven parameters using a structured matrix. Results Strategies spanned multiple scales (public spaces, units, rooms, and furnishings) and were grouped descriptively into multipurpose functions, space conversions, and distributed amenities. The most feasible strategies were localized, code-aligned, and low-disruption (e.g., multipurpose rooms, portable equipment, modular/adjustable furniture and equipment). Lower feasibility ratings were associated with strategies requiring major infrastructure changes or re-licensure (e.g., outpatient-to-inpatient conversions; large public-space conversions), constrained by staffing, systems capacity, and regulatory requirements. Converting entire units to negative pressure was the most polarizing strategy. Stakeholders identified feasible pathways to reduce barriers through incremental adaptability, context-specific planning, and clearer approval pathways. Conclusions Flexibility in healthcare design is best achieved through planned, context-sensitive strategies. This study offers an evidence-informed catalogue of strategies, hosted in an online portal designed to be expanded through future updates.