Healthcare Giants 2021

No one could have predicted what madness 2020 would bring—and on ever-increasing levels as the year went on. So we have been naturally curious to see what our Interior Design business trends data show from this crazy stretch. We’ll be taking in-depth looks at information from all our Giant groups as the year goes on, but first up are the top 40 Healthcare Giants. This is of primary interest, of course, as the healthcare industry was the first and hardest hit by the pandemic. How would this disaster affect a sector that had already predicted a pre-pandemic downturn in 2020?

First, what no one expected: The Healthcare Giants brought in $790 million in total 2020 fees. That crushes the $607 million tally from 2019, especially when the Healthcare Giants had previously forecasted a drop to $481 million in 2020, a recession-tinged prediction that makes sense if you go back in time before the pandemic was a gleam in our eyes and experts weren’t so optimistic about the 2020 economy.

Normalcy will continue to be restored as the year progresses and more people are vaccinated. Business-wise, the Healthcare Giants project growth in telehealth facility projects, possibly as much as $1 million. They also expect to see more projects in most segments, with most of them predicting assisted/senior living, outpatient procedure/surgery centers, and mental health facilities having the highest growth rates in the next two years. To boot, 95 percent of these firms foresee overall U.S. growth, with more than half of them expecting it in all regions, with the Southwest, Northeast, and Southeast experiencing the most.

In terms of design business, 2020 may go down in history as a surprising outlier. But given the disaster of the pandemic and the overall impact it had on society and the economy, one can see it as a lucky windfall for the Healthcare Giants.

2021 Healthcare Giants Ranking

wdt_ID 2021 Rank Firm HQ Location Website Design Fees (in millions) Value (in millions) Sq. Ft. (in millions) ID Staff 2020 rank
1 1 HOK St. Louis, MO 72.00 2,368.00 26.70 296 3
2 2 Perkins+Will Chicago, IL 63.40 4,895.00 449 1
3 3 HDR Omaha, NE 59.00 180.30 105 2
4 4 CannonDesign New York City, NY 56.00 18.00 210 7
5 5 Page Washington, DC 51.00 730.00 198 18
6 6 AECOM Los Angeles, CA 46.10 896.60 494 5
7 7 HKS Dallas, TX 43.30 6.00 152 6
8 8 Flad Architects Madison, WI 42.20 2,003.00 11.10 247 14
9 9 Perkins Eastman New York, NY 42.00 817.00 291 4
10 10 NBBJ Seattle, WA 33.00 9

Most Admired Healthcare Design Firms

wdt_ID Rank Firm
1 1 Perkins+Will
2 2 CannonDesign
3 3 ZGF Architects


The first installment of the two-part annual business survey of Interior Design Giants comprises the 100 largest firms ranked by interior design fees for the 12-month period ending December 31, 2020. The 100 Rising Giants ranking will be published in July. Interior design fees include those attributed to:

  1. All types of interiors work, including commercial and residential.
  2. All aspects of a firm’s interior design practice, from strategic planning and programming to design and project management.
  3. Fees paid to a firm for work performed by employees and independent contractors who are “full-time staff equivalent.”

Interior design fees do not include revenues paid to a firm and remitted to subcontractors who are not considered full-time staff equivalent. For example, certain firms attract work that is subcontracted to a local firm. The originating firm may collect all the fees and re­tain a management or generation fee, paying the remainder to the performing firm. The amounts paid to the latter are not included in fees of the collecting firm when determining its ranking. Ties are broken by dollar value of products installed, square footage of projects installed, and staff size respectively. Where applicable, all percentages are based on responding Giants, not their total number. 

All research is conducted by ThinkLab, the research division of SANDOW.

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