About FGI

February 14, 1947—Appearance in Federal Register

The FGI Guidelines for Design and Construction has a long history as a federal and privately written document. The original General Standards appeared in the Federal Register on February 14, 1947, as part of implementing regulations for the Hill-Burton program.

1974—Document retitled; public input requested

1984—Last edition revised and published by federal government

In 1984 the Department of Health and Human Services (HHS) removed from regulation the requirements relating to minimum standards of construction, renovation, and equipment of hospitals and medical facilities, as cited in the Minimum Requirements, HEW Publication No. (HRA) 81-14500. Since the federal grant and loan programs had expired, there was no need for the federal government to retain the guidelines in regulatory format.

To reflect its non-regulatory status, the title was changed to Guidelines for Construction and Equipment of Hospital and Medical Facilities. However, the document was, and still is, used by many state AHJs for licensure or registration. Further, HHS staff members use the Guidelines to assess Department of Housing and Urban Development applications for hospital mortgage insurance and Indian Health Service construction projects. For these reasons, regulatory language has been retained. The 1983–84 edition of the Guidelines was the last one revised and published by the federal government.

1987—AIA publishes the Guidelines

(Following) 1987—Future of Guidelines at an impasse; HGRC is formed

At this point, revision of the Guidelines would have ceased, or the document would have ceased to exist, if J. Armand Burgun, Joseph G. Sprague, and Douglas S. Erickson had not taken it upon themselves to approach the Public Health Service and the Health Care Financing Administration to request a federal grant to fund a revision cycle.

These same three people, working with the AIA/CAH, put together the first Steering Committee, which in turn set up the first Health Guidelines Revision Committee (HGRC) not under the aegis of the federal government. The members of this multidisciplinary group came from the federal and state governments and the private sector and offered expertise in design, operation, and construction of health care facilities.

1992-1993—Federal funding from HHS secures another revision cycle; public input process refined

The 1992-93 edition of the Guidelines was published and distributed by the AIA. The Steering Committee from the 1992-93 cycle requested and received federal funding from HHS for another revision. Substantial funding was also provided by the American Hospital Association and the AIA/CAH.

The consensus process was enhanced and the input base broadened by asking the public to propose changes to the Guidelines and then to comment on the proposed changes accepted by the HGRC. The HGRC met to discuss the merits of all the proposals and comments. To better reflect its content, the title of the document was changed to Guidelines for Design and Construction of Hospital and Health Care Facilities. It was during this revision cycle that the AIA Committee on Architecture for Health became the AIA Academy of Architecture for Health (AIA/AAH).

1998—FGI founded as independent, not-for-profit corporation

In an effort to create a more formal process and to keep the document current, the Facility Guidelines Institute was founded as an independent, not-for-profit 501 (c)(3) corporation in 1998. (Read about FGI’s mission and vision and goals here.)

2001—Increased state use and AHJ involvement; further revision of the document

The 2001 edition of the Guidelines resulted from the first revision cycle to be completed under the aegis and direction of FGI. It received major funding from HHS/Health Care Financing Administration and the AIA/AAH. The American Society for Healthcare Engineering (ASHE), the National Institutes of Health (NIH), and the AIA provided staff and technical support. The membership for this revision cycle included an increased number of state AHJs, consistent with the increasing number of states utilizing all or portions of the Guidelines as state regulation by adoption. The work of the HGRC was greatly enhanced by the attendance and participation of these AHJs.

A major change in format was adopted for the 2001 edition, placing appendix material at the foot of the relevant pages in the main text to make it more accessible to users. In addition, a glossary of terms was added to the book.

2006—Committee-generated changes: document reorganization, user-friendly functions

The 2006 edition of the Guidelines also received major funding from HHS/Centers for Medicare and Medicaid Services, ASHE, and NIH, and the AIA again provided staff and technical support. The 2006 HGRC took on the challenge of two goals stated in the preface of the 2001 edition: to prepare more committee-generated changes to reflect the collective knowledge and experience of the members and to improve the format, readability, and indexing or searchability of the document to make it a more useful, user-friendly tool.

The HGRC approved a complete reorganization that presented the content in four parts: one with information applicable to all health care facility types, one on hospitals, one on ambulatory care facilities, and one for other health care facilities.

2010—New sections added to align with health care focus, ASHRAE 170 included in its entirety

The 2010 edition of the Guidelines again received funding from HHS/Centers for Medicare and Medicaid Services, and ASHE provided staff and technical support. The 2010 HGRC took on numerous challenges to modernize the document and meet the needs of the enforcing, design, and owner communities. A number of subcommittees worked to develop major new sections on acoustics, patient handling and movement, bariatric accommodations, cancer treatment/infusion therapy services, freestanding cancer treatment facilities, and telecommunications areas in hospitals, along with new material on wayfinding, patient safety assessments, and outpatient rehabilitation facilities.

To make the usability of the Guidelines more consistent with other national standards, a further reorganization of the document was undertaken for the 2010 edition.

2010 (cont)—ASHRAE 170 included in its entirety

One monumental change in the 2010 edition was the incorporation of the 2008 edition of ANSI/ASHRAE/ASHE Standard 170: Ventilation of Health Care Facilities in the Guidelines. During the 2010 revision cycle, the HGRC voted to abandon the Guidelines ventilation table and partner with ASHRAE (then the American Society of Heating, Refrigerating and Air-Conditioning Engineers) by adopting ASHRAE 170 along with all subsequently issued addenda as part of the Guidelines.

2014—Cost-Benefit Committee formed; location terminology added

As were previous editions of the Guidelines, the 2014 edition was developed and written during a three-year period by dedicated health care experts serving on the HGRC. Focus groups and specialty subgroups focused on specific topics, reviewing existing text and writing proposals and comments to update it, writing new material, and reviewing proposals and comments from the public. Efforts were made to increase clarity and consistency in the content of the 2014 Guidelines for Design and Construction of Hospitals and Outpatient Facilities, including development of a table of location terms included in the glossary and used consistently throughout. A Cost-Benefit Committee, a standing committee of FGI, was convened to review changes in the Hospital/Outpatient Guidelines and estimate the impact they would have on construction cost.

2014 (cont)—Separate residential health care document published

In addition to the customary revisions of the Guidelines content, for 2014 the Facility Guidelines Institute’s Board of Directors implemented a longstanding goal initiated by founding member Martin Cohen, FAIA, FACHA, to separate the hospital and outpatient requirements from those for nursing homes and other long-term care facilities. Jane Rohde, AIA, AIA, FIIDA, ACHA, AAHID, LEED AP, of JSR Associates was appointed to chair this monumental undertaking, and a specialty subgroup made up of industry leaders, including representatives of residential care and health organizations and the Rothschild Foundation, was carefully chosen. The result was a new standard, published separately, that supports contemporary concepts in health, care, and support services for the elderly and others who require long-term services.

2018—Guidelines further updated and revised; Separate outpatient facilities document published

The 2018 cycle reflected the emergence of several trends: surgeries once limited to hospital settings, such as joint replacements, were being offered in ambulatory surgery centers; some procedures formerly limited to procedure rooms were now conducted in exam rooms; and some exams were performed via telemedicine. To support this evolution in practice, FGI separated its design and construction requirements for outpatient facilities from those for hospitals. The primary goal in developing the new outpatient Guidelines was to make its requirements flexible enough to address the variety of outpatient facilities being designed. As with previous revision cycles, updates were made to each of the Guidelines documents.

2018 (cont)—FGI took over publication of the Guidelines and offered first true digital version; Documents revised

Beginning with the 2018 edition, FGI assumed publishing responsibilities for the Guidelines documents. In addition to the paperback documents, FGI partnered with MADCAD to develop a platform offering single- and multiple-user digital access to the Guidelines.

Review of the Guidelines documents resulted in several revisions, including a classification for imaging rooms; a new table to help designers and owners quickly determine which procedures should be performed in each room type; updated clearances required for operating rooms; requirements addressing sustainable design; accommodations for patients of size; and accommodations for telemedicine services. In addition, the existing acoustic criteria in the Guidelines were reviewed by the Acoustics Proposal Review Committee (APRC), leading to proposals and updates to acoustic requirements.

2022—Health care organizations looked to the Guidelines for guidance during global pandemic; Emergency Conditions Committee formed

After receiving requests for guidance on setting up temporary facilities and adapting existing facilities in response to the COVID-19 pandemic, FGI convened a special committee to assemble design guidance for facilities during emergency situations. The resulting work of the Emergency Conditions Committee was a white paper titled “Guidance for Designing Health and Residential Care Facilities that Respond and Adapt to Emergency Conditions,” published in March of 2021.

Chapters included information on risk assessment; surge response; alternate care sites, including modular facilities; resiliency; renovation and future facility design; small and/or rural health care facilities; and residential care facilities. The final section presented the draft of a new Guidelines document: the proposed Guidelines for Emergency Conditions in Health and Residential Care Facilities. Recommended changes written by each subcommittee were aggregated into one supplemental document that suggested new minimum standards for emergency preparedness.

2022 (cont)— FGI launched new e-commerce site and digital licensing platform; New sections added to Hospital and Outpatient Guidelines; glossary terms updated

In May of 2022, FGI announced publication of the 2022 Guidelines for Design and Construction documents and the simultaneous launch of a new, FGI-hosted, dedicated e-commerce site and digital licensing platform, featuring a suite of functional tools to increase Guidelines users’ productivity.

New to the 2022 Guidelines documents was the addition of the disaster, emergency, and vulnerability assessment (DEVA) as part of the safety risk assessment. In addition, two clinical treatment spaces were included in the Guidelines to help reduce overcrowding in emergency departments: low-acuity patient treatment stations and behavioral health crisis units. Several terms in the Guidelines were updated in the glossary for the 2022 edition to keep pace with evolving usage in the industry (e.g., “behavioral and mental health” replaced “psychiatric”).

As with the previous revision cycle, all three Guidelines documents were reviewed and updated with the input of public stakeholders through the proposal process.