Abstract
Healthcare facilities’ built environments are critical community assets that support healthcare systems by providing supportive work environments for caregivers and safe care delivery for patients. However, increasing system complexity and performance variability have revealed a persistent problem, as many healthcare safety issues arise from adjustments and inefficient design interventions implemented by users during facility operations to cope with actual operational conditions. These adaptations are often not anticipated or overlooked in Work-As-Intended (WAI) designs, resulting in a misalignment with actual Work-As-Done (WAD) practices. This problem highlights the need for resilient built environment designs that support operational needs without compromising safety requirements. To address this problem, this research aims to shift healthcare facility designs from traditional reactive design approaches towards adopting proactive, resilient, safe, user-centered design approaches that support real-world practices and decrease the gap between WAI in designs and WAD in real daily operations. The research adopts a comprehensive systematic review methodology to synthesize current knowledge related to WAI, WAD, resilience, and safety in healthcare facilities. Based on this synthesis, an integrated conceptual framework is developed to integrate user knowledge, resilience, safety, WAI, and WAD in the healthcare design process. Design strategies were extracted to support their integration in healthcare facilities’ early design phases. The findings provide architects and healthcare planners with a robust basis for early design decision-making, supporting the development of resilient, safe, and operationally efficient healthcare facilities that meet the needs of both patients and caregivers.