Community Engagement, Safety and Equity

Jennifer Youssef: The culmination of your mission is to ultimately transform human health through research, education, and clinical care. How does Memorial Hermann–TMC maintain this mission while adapting to changing patient needs and circumstances?

Lance Ferguson: We’ve built a strong infrastructure for community engagement. One example is our long-standing school-based clinic program, which we’re continuing to grow. We’ve also partnered with Aldine ISD to launch the Health Education and Learning (HEAL) High School, integrating healthcare career training into the curriculum to create new pathways in underserved communities.

In acute care, we ensure patients receive the right level of care, working to place those who don’t need high-acuity services to more appropriate settings within Memorial Hermann. Our Patient Flow Command Center helps to match patients with the right location. We’re also layering in technology—AI-assisted tools—to help streamline this process. It’s all part of a broader care navigation strategy. It’s complex, but we’re seeing steady progress.

Craig Passey: Care navigation is such a challenge. People often don’t know where to go, and they end up in the emergency department when they don’t need to be there.

Lance Ferguson: Memorial Hermann has recognized that ED overcrowding can’t be solved within the ED itself. We’ve built infrastructure in the community—health centers, clinics, and educational resources—to raise awareness and provide alternatives. That helps improve community health and reduces the burden on emergency services.

Jennifer Youssef: How do you adapt to the diverse needs of a wide range of patients—culturally, linguistically, acuity levels, etc.? And how does design play a role?

Lance Ferguson: Our campus consistently ranks among the top 2–4 academic medical centers nationally in terms of patient acuity. We care for the entirety of the Houston area, including affluent and underserved populations. It is essential that we provide effective treatment for everyone. Memorial Hermann, in partnership with UT Health, conducts constant surveillance to ensure there’s no variation in care—regardless of who you are. We also look at consistency of outcomes. And we’re training new clinicians to carry that mindset forward. It’s a disciplined practice, and I’m proud of how seriously we take it.

Lessons from the Pandemic

Craig Passey: The pandemic was an unprecedented event that reshaped healthcare globally. For a system as influential as Memorial Hermann–TMC, what’s one key lesson from that experience that the industry should carry forward, or misstep to avoid?

Lance Ferguson: Pre-pandemic, we prioritized convenience, with multiple access points. That shifted quickly, and we’re not going back—security and controlled access have become essential. It’s relatively easy to plan for in new builds, but retrofitting a large, multi-generational campus is much harder.

Craig Passey: Another major challenge was bed capacity, especially airborne infection isolation (AIIR) and protected environment rooms. Some systems are investing in entire air isolation units, while others view it as too costly to plan for a once-in-a-century event. What’s your take?

Lance Ferguson: It’s a tough balance. You want to be prepared, but you can’t build for every scenario. The solution is flexibility—designing spaces that can be converted quickly when needed. It’s about readiness without overbuilding.

Future Vision and Adaptive Design

Craig Passey: Looking ahead, what’s the one challenge in healthcare that requires a complete rethink? How might design help shape that change?

Lance Ferguson: The biggest shift is data. We’re at the start of a massive change, comparable to the launch of the internet. AI is everywhere, but its application is still a work in progress.

Workflows will certainly change, particularly in automating administrative tasks like scheduling and care coordination. It may not reduce staff, but it could shift where and how they work—and that’s something we’ll need to plan for.

Does this impact design? Possibly. We’re still figuring out future workflows, and design should follow that evolution. Ideally, it’s about integrating the tech into the existing infrastructure without needing to redesign the entire space.

Craig Passey: What do you think is driving the continued increase in demand? Years ago, futurists predicted fewer hospitals and smaller footprints—but today, health systems can’t build fast enough.

Lance Ferguson: A decade ago, hospital beds were thought to become like rate-regulated utilities—build just enough to meet demand. But that “right amount” has turned out to be much higher in large, growing metro areas with academic medical centers. Unless there’s a major breakthrough in treatment, demand will keep rising. Rural hospitals are, however, facing challenges, both with demand and funding.

Craig Passey: Is part of that tied to the need for a broader investment in prevention and wellness?

Lance Ferguson: Partly. A big piece is simply educating people on where to go for care. The emergency department isn’t always the right place. We’ve been working on that for years, but population growth—especially in Houston—is outpacing any reduction in admissions. Plus, many existing beds need to be replaced.

Craig Passey: Looking ahead, how do you see the role of design evolving over the next five to ten years?

Lance Ferguson: Design will need to be data-driven, linking facility information with health outcomes, to see empirically what does or doesn't make a difference. The challenge is access; architects don’t always have the raw granular data needed. Collaborating with organizations like Epic, which is building massive datasets like Cosmos, could help. Imagine using billions of patient encounters to compare outcomes across different spaces—that’s the future. We should apply the same analytical mindset we use in medicine to design.

Jennifer Youssef: Given the complexity of your campus, what advice would you give other healthcare leaders looking to embrace adaptive design?

Lance Ferguson: Hire great architects. Work with a design team that listens and understands your culture.

There’s always tension between building for what you know and planning for what’s ahead. In Houston, demand is outpacing projections. We shouldn’t be planning five or ten years out—we need to think 20 or 30 years ahead. My advice: extend your view. Think about the leaders who will follow you, and what your community will need decades from now.

Jennifer Youssef: Just to close out—what advice would you give us as designers to help you navigate these challenges?

Lance Ferguson: Be curious. Ask questions. Push for partnerships. Most importantly, understand the culture of the organization you’re designing for. Adaptive design isn’t just about flexibility in space—it’s about flexibility in thinking. The best outcomes come from collaboration, empathy, and a shared vision for the future.

I was recently in a conversation with COOs from AMCs across the country, and one theme that emerged was that today’s COO is a translator. We’re constantly translating between clinical teams, finance, design, and more. Understanding what’s being communicated—and what’s actually meant—is a skill that takes time to develop.

Also, recognize that in large organizations, decisions rarely come from one person. That can be frustrating for design teams, but it’s the reality. Decisions go through many channels, and while that can feel bureaucratic, it’s often necessary. The checks and balances are there for a reason—even if they slow things down. So, my advice is: be patient with us. Sometimes we know the right answer and want to move forward, but the process takes time.