Walk into almost any modern hospital room and first notice what you hear.
Alarms. Beeps. Alerts. Devices competing for attention, each announcing its own piece of information, few aware of what the others know. The sounds interrupt sleep, distract clinicians and remind patients, hour after hour, that they are sick.
Then notice what you see and feel. Monitors. Pumps. Computers. Sensors. Bare walls and little that feels personal. Patients often cannot control the temperature, dim the lights or quiet the room. Hospital rooms contain extraordinary technology and carry extraordinary costs, yet patients may still struggle to understand the plan, sleep through the night, control their surroundings or know what they need to do to go home.
We have filled hospital rooms with extraordinary technology. Yet together, those technologies often form something remarkably unsophisticated: a collection of parts rather than a system.
Imagine if United Airlines built an airplane this way. It would purchase the best engine from one company, avionics from another, landing gear from another and hundreds of components from hundreds of vendors. Then it would roll everything into a hangar and ask pilots and mechanics to make it all work together.
No airline would do this. A pilot would never tolerate one screen showing altitude, another showing speed and a third requiring a different interface to determine whether the landing gear was up or down. Aviation understands something healthcare too often forgets: Great components do not make a great system. The interactions among the components determine the performance of the system.
Systems engineering starts with the outcomes we want to realize and works backward to define what is needed to produce them. It considers how people, processes and technology interact, then builds, tests, learns and redesigns.
Hospitals largely do the opposite.
Walk down a hospital hallway and seemingly identical rooms may contain different monitors, beds, communication tools, sensors and generations of equipment. Few organizations can easily tell you everything installed in every room, how frequently it is used, whether the technologies communicate or whether they produce enough value to justify their costs.
We have digitized the room without designing it.
The result is expensive for health systems and exhausting for clinicians. Nurses become the human integration layer, moving information among technologies that cannot communicate, responding to alarms that lack context and compensating for poorly designed workflows.
Most importantly, the room often remains remarkably indifferent to the person lying in the bed.
Patients may not know the day’s plan, when physical therapy will arrive, what tests remain or what they need to accomplish to go home. Families often know even less. The health system possesses enormous information about the patient, yet remarkably little is designed to be visible and useful to the patient.
The hospital room of the future should therefore begin not with technology but with a simple question: What does the patient need this room to do?
The answer is larger than treating disease. The room should support human flourishing.
That means preserving what makes us human even when we are sick: agency, dignity, connection, mobility, sleep, cognition, purpose and hope. The room should know what matters to the patient, not merely what is the matter with the patient. It should help patients remain participants in their care rather than passive occupants of a bed.
For older adults, the room should help recognize frailty, delirium risk, high-risk medications, mobility limitations, malnutrition and social vulnerabilities. Our design concepts bring together patient goals, medication management, frailty, mobility, nutrition, cognition and social vulnerability rather than treating them as separate programs.
The room should become an information system rather than a warehouse for information-producing devices. Monitoring, beds, pumps, environmental controls, the EHR and communication systems should share a common architecture. The room should know who the patient is, what risks matter, what the care plan is and what has changed.
We should rethink monitoring as well. Aviation does not put its most expensive analytic capability inside every sensor. Sensors collect information and sophisticated systems integrate and interpret it. Hospitals could use simpler, standardized bedside sensors connected to shared analytic platforms that integrate signals, detect deterioration and deliver meaningful information rather than another alarm.
The goal is not more alarms. It is more signal and less noise.
A truly intelligent room should therefore be remarkably quiet. Alarms could be analyzed away from the bedside and escalated only when human attention is needed. Care could be bundled to protect sleep. Patients could control lighting and temperature. Voice technology could answer questions and support workflows. Virtual nurses, specialists, interpreters and family members could appear when needed.
The room should also give patients something healthcare too rarely gives them: agency.
Imagine waking and seeing one simple display: Here is your care team. Here is what matters to you. Here is today’s plan. Here are the three things we need to accomplish before you can go home.
Imagine saying, “I’m cold,” and having the room respond. “Dim the lights.” “When is my CT scan?” “What do I need to do to go home?” The best technology may be technology that almost disappears because the environment itself becomes responsive.
The same architecture could give clinicians back something equally precious: time. That matters because nursing demand is expected to rise while the physical demands of hospital work contribute to nurses leaving bedside roles. As health systems face ongoing nursing workforce pressures, room design should reduce avoidable work and make bedside care more sustainable. Health systems must reduce burden rather than simply ask nurses to carry ever more complexity.
This requires rethinking productivity.
Productivity should not mean extracting more from people. It should mean wasting less of them.
Every minute a nurse spends hunting for equipment, silencing a meaningless alarm or compensating for technologies that do not communicate is human capability wasted. Every minute a physician spends searching for information already in the system is capability wasted. Every hour a patient lies awake because alarms are sounding, waits because the plan is unclear or remains immobile because care was not coordinated is human potential wasted.
Automation should remove work that does not require uniquely human capability. Technology should organize information before presenting it and anticipate needs rather than wait for someone to discover them.
Technology should work for nurses so nurses can work with patients.
That is productivity worthy of healthcare: not asking people to run faster through badly designed systems but designing better systems so their time can be spent on what only people can do — listen, notice, reassure, teach, touch, think, connect and care.
Trust must be built into the room. Nurses are consistently ranked among the most trusted professions, and patients rely on them to notice concerns, explain what is happening and act in their best interest. Technology should strengthen trust, not stand between nurses and patients or make care feel less transparent.
There is also an economic argument. Every hospital pays an integration tax. We buy overlapping technologies, maintain multiple interfaces, train clinicians on different devices and devote expensive human labor to making disconnected systems function. Standardization could reduce hardware, integration and training costs while allowing us to finally measure whether technologies create value.
Instead of asking vendors to sell us another device, health systems should define an open architecture and ask vendors to plug into it.
The opportunity is larger than building a “smart room.” A smart room can simply become a room containing more technology. What healthcare needs is an integrated hospital room built through systems engineering and human-centered design.
Start with patients and clinicians. Define what they need to accomplish and the workflows and information required to accomplish it. Only then determine the technology. Prototype the room. Measure noise, sleep, mobility, safety, nursing workload, patient experience, clinician experience and cost. Learn. Redesign. Repeat. Then standardize the architecture so innovation becomes easier.
A system is not a pile of excellent parts. It is a set of parts intentionally designed to achieve a goal. We will not realize the promise of technology by continuing to add it one device at a time.
For decades, hospitals have asked patients and clinicians to adapt themselves to the room.
The hospital room of the future should reverse that relationship.
Design the room around the patient. Make technology disappear into the architecture. Waste less of our clinicians. Give patients back their agency. And turn one of the most expensive rooms a person will ever occupy into what it should have been all along: a system designed for healing, dignity, connection and human flourishing.
Peter Pronovost, MD, PhD, FCCM, Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland, and President of the UH Veale Healthcare Transformation Institute
Michelle Hereford, MSHA, RN, FACHE, System Chief Nurse Executive and Ethel Morikis Endowed Chair in Nursing Leadership, University Hospitals Cleveland
Jennifer Carpenter, DNP, RN, CENP, System Chief Nursing Informatics Officer, University Hospitals Cleveland, and Chief Nursing Officer, UH Rainbow Babies & Children’s Hospital and UH MacDonald Women’s Hospital
