Opinion piece by Frédéric Pitard, Director of Development at Kardham Digital, and Romuald Dobrzynski, Associate Architect at Kardham, published on Construction21 on 18 May 2026.
Digital technologies can no longer be considered as an additional layer added to healthcare facilities once buildings have been delivered. In response to the energy, operational and organizational challenges facing the sector, architecture, operations and digital systems must now be designed together. “Smart by design” is therefore emerging as a key driver of flexibility, resilience and long-term performance for healthcare infrastructures.
Moving beyond a layered approach
Even today, many hospital projects are still developed through a sequential process. Architecture comes first. Questions related to operations, maintenance, energy management or digitalization are addressed later, once the building has already been designed — or even completed.
Yet hospitals are living organisms, constantly evolving, deeply connected to their environment and required to orchestrate complex human, technical, logistical and digital flows. Every change in medical practices, patient pathways, regulatory requirements or energy constraints profoundly transforms the way these facilities operate on a daily basis.
In this context, continuing to separate architectural design from digital design means creating infrastructures that will constantly need to be adapted to meet uses that could, for the most part, have been anticipated during the design phase. The very principle of smart by design is precisely to embed digital technologies into the DNA of the project itself, rather than adding them afterwards as a technical overlay.
Anticipating future uses from the design phase
This evolution is all the more necessary as the healthcare sector is currently undergoing profound transformations. The rise of outpatient care, pressure on human resources — 71% of healthcare and social care facilities report recruitment difficulties, further reinforcing the issues of staff attractiveness and workplace well-being (1) — soaring energy costs, the progressive automation of certain logistical functions, and the development of connected medical equipment all require a far more integrated vision of hospital buildings.
Hospitals now operate as data and service platforms whose efficiency depends on the ability of systems to communicate seamlessly with one another. This is precisely what smart by design enables by simultaneously designing the physical building and its digital environment.
In many projects, BIM is already used as a design and technical coordination tool. Digital twins now extend this approach by enabling future building uses and interactions between systems to be modeled in advance. In healthcare facilities, this makes it possible to anticipate from the design stage how equipment, networks, logistics and hospital flows will interact. For example, when a logistics robot transports medical supplies, elevators, access systems, networks and technical equipment must all have been designed from the outset to work together. Without such anticipation, healthcare facilities are forced to retrofit infrastructures that were not originally designed to accommodate these new uses.
Making data a driver of operations
In healthcare environments, data is becoming a central lever for managing buildings and operations. Smart by design now makes it possible to consider data as the building’s “fourth utility”, alongside electricity, water and air treatment systems.
Because hospitals operate 24/7, house highly energy-intensive equipment and must guarantee constant sanitary conditions, they rank among the most energy-consuming buildings within the tertiary sector. According to ADEME (2), healthcare alone accounts for 12% of the French tertiary sector’s energy consumption. In a context of rapidly increasing energy costs — with the energy budgets of some university hospitals having multiplied by 2.5 between 2020 and 2023 (2) — having a precise and dynamic understanding of building usage has become a major strategic challenge.
Building Operating Systems (BOS) therefore play a central role. As the hospital building’s true information system, the BOS must also be designed from the very beginning of the project in order to integrate the infrastructures, data and interactions required for future operations. While digital twins help anticipate building uses and interactions, the BOS enables the day-to-day orchestration of operations. This approach paves the way for much more refined management of healthcare infrastructures, capable of optimizing energy consumption, technical interventions, maintenance and operational organization, while also meeting increasingly demanding cybersecurity and infrastructure resilience requirements.
Breaking down silos to design differently
Smart by design also requires a profound transformation of working methods and project governance. This approach calls for greater collaboration between disciplines by bringing together architects, engineers, operators, digital specialists and healthcare professionals from the earliest project stages. This co-construction model also involves new governance structures and new roles capable of overseeing the digital dimension throughout the building’s entire lifecycle. The emergence of positions such as Smart Project Management Assistants (AMO Smart) or digital systems and services coordinators reflects the growing need to better connect buildings, operations and digital technologies.
Digital technologies can no longer be added to healthcare facilities once buildings have already been designed. They must be integrated from the very beginning of the project through a smart by design approach capable of sustainably combining technical and energy performance, user experience and infrastructure operations. This approach therefore requires a holistic vision in which architecture and digital are no longer considered separately, but rather as components of a single healthcare project designed to support evolving uses and operations throughout the building’s lifecycle.
(1) HAS Strategic Plan 2025–2030
(2) Energy transition in healthcare and social care facilities and the impact of the Ségur investment plan on these challenges – April 2024