The Guerin Children's pediatric medical-surgical inpatient unit at Cedars-Sinai Medical Center in Los Angeles
The Guerin Children’s pediatric medical-surgical inpatient unit at Cedars-Sinai Medical Center in Los Angeles is by HGA. Photography by Kim Rodgers.

May 15, 2023

Words: Mike Zimmerman

Interior Design Spotlights 2023 Healthcare Giants

What’s most interesting about the Healthcare Giants isn’t the numbers so much as how the business has evolved during the pandemic—and in general. Consider colonoscopies, tonsillectomies, and other minor procedures that were always a little too major to happen outside a hospital setting. The rise of skilled-care facilities and those dedicated to a single function, such as outpatient procedures or diagnostic imaging, have resulted in lots of smaller design projects. In 2019 the Healthcare Giants worked on 3,200; in 2022 that number rose to 5,500—a 73 percent increase partially attributed to smaller COVID-related projects that may not have otherwise happened. But there’s no question that the design of the physical environment is changing.

And yet, hospital design work remains a stalwart: Acute-care hospitals accounted for half of 2022’s $698 million fees—a bit below the COVID-boosted $790 million in 2020, but handily beating the $607 million pre-pandemic dollars. (The most growth, however, is projected for behavioral health and walk-in/urgent-care clinics.) Furniture, fixtures, and construction products also now outstrip 2019 numbers—$17.8 billion versus $14.6 billion.

But there’s a catch: forecasts. The Healthcare Giants predict $562 million fee income and $14.9 billion FF&C income in 2023, both healthy drops. Whether this is something to fear or just the nature of a market over-boiled by a public health emergency and point-of-service changes remains to be seen. This odd combination of instability and prosperity might just stay with us a while longer.

Healthcare Giants Rankings 2023

wdt_ID 2023 Rank Firm Headquarters Design Fees (in millions) FFC Value (in millions) Sq. Ft. (in millions) 2022 Rank
1 1 CannonDesign New York 70 2
2 2 HDR Omaha, NE 67 214 1
3 3 Perkins&Will Chicago 66 1,586 3
4 4 SmithGroup Detroit 57 8
5 5 HKS Dallas 51 7
6 6 AECOM Dallas 46 2,742 6
7 7 Perkins Eastman New York 42 867 5
8 8 Page Southerland Page Washington 41 1,891 7 18
9 9 Stantec Edmonton, Canada 32 12
10 10 HOK St. Louis 30 2,814 32 9

Project Categories

Growth Potential Over Next Two Years

U.S.

wdt_ID Region Percentage
1 Southwest 57
2 Southeast 55
3 Northeast 53
4 Mid-Atlantic 43
5 Midwest 40
6 Midsouth 40
7 Northwest 28

International

wdt_ID Region Percentage
1 Canada 13
2 Europe 11
3 Middle East 11
4 Asia/Australia/New Zealand 9
5 China 9
6 Central/South America 6
7 Mexico 4
8 Caribbean 2
9 India 2
10 Africa 0
11 Other 2

Fees by Project Type

wdt_ID Project Type 2022 Actual 2023 Forecast
1 Acute-care Hospital 49 50
2 Outpatient Procedure/Surgery Center 16 13
3 Health Clinics 10 9
4 Mental-health Facility 5 6
5 Rehabilitation Facility 4 3
6 Other 4 6
7 Senior Living 3 2
8 Doctor/Dental Office 3 4
9 Health & Wellness/Fitness Center 3 3
10 Assisted Living 2 2
11 Skilled-nursing Facility/Hospice 1 2
12 Telehealth Facility 0 1

Editor’s Note: Take a look at recent coverage of our Healthcare Giants most admired firms of 2023 below. CannonDesign tops the list followed by Perkins&Will, and ZGF.

Read More About CannonDesign

Read More About Perkins&Will

Read More About ZGF

Firms with the Most Fee Growth

wdt_ID Firm 2021 2022
1 Page Southerland Page 11,746,560 40,961,000
2 SmithGroup 34,237,879 56,697,832
3 HKS 40,249,723 51,171,914
4 CannonDesign 60,000,000 70,000,000
5 Perkins&Will 56,400,000 66,300,000
6 Jacobs 3,180,325 11,763,190
7 Stantec 23,913,460 32,112,724
8 HDR 60,873,600 67,111,200
9 AECOM 40,526,200 45,705,240
10 ZGF 17,158,000 21,238,955

Forecasted Change by Segment Over Next Two Years

wdt_ID Segment More Projects No Change Fewer Projects
1 Hospital 54 26 4
2 Assisted/Senior Living 54 25 4
3 Rehabilitation Facility 35 35 7
4 Outpatient Procedure/Surgery Center 54 24 2
5 Mental-health Facility 76 4 0
6 Doctor/Dental Office 26 41 7
7 Health Clinics 67 17 0
8 Health & Wellness/Fitness Center 43 30 4
9 Skilled-nursing Facility/Hospice 20 41 4
10 Private Sector 28 35 4
11 Public Sector 22 40 2
12 Other 50 17 17

Methodology

The Interior Design Giants annual business survey comprises the largest firms ranked by interior design fees for the 12-month period ending December 31, 2022. The listings are generated from only those surveyed. To be recognized as a top 100, Rising, Healthcare, or Hospitality Giant, you must meet the following criteria: Have at least one office location in North America, and generate at least 25% of your interior design fee income in North America. Firms that do not meet the criteria are ranked on our International Giants list. Interior design fees include those attributed to:

1. All aspects of a firm’s in­terior design practice, from strategic planning and programming to design and project management.

2. 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 rank from last year. Where applicable, all per­cent­ages are based on responding Giants, not their total number. 

All research conducted by ThinkLab, the research division of SANDOW Design Group.

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