Designing Connection: How Customized Engagement Improves Care Environments

Canada’s hospitals, clinics, care homes, and treatment centres are more than physical buildings. They are lifelines, cultural touchstones, and pillars of community trust. When engagement falls short, the consequences are immediate and material: underused facilities, costly redesigns, project delays, community opposition, and reputational harm. Healthcare facilities are designed to serve entire communities, and when engagement fails, the impacts are felt across the full spectrum of users.

Meaningful Engagement is a Form of Risk Management

Functional and cultural feedback leads to safer, more intuitive spaces. Engagement, grounded in meaningful conversations with the people these facilities are intended to serve, is not optional. It is a core determinant of performance, adoption, and long-term success. When done early and well, it identifies issues before they escalate, reduces rework and delays, improves safety and accessibility, and helps facilities reflect real user needs.

Engagement is Not One-Size-Fits-All

Healthcare facilities serve the full spectrum of people within a community. Engagement must reflect this range through tailored approaches that fit the context of each community and the realities of how people access and experience care. When it does not, facilities risk being underused, inaccessible, or misaligned with user needs, ultimately limiting their effectiveness. 

Skilled engagement practitioners are essential to mitigating these risks and delivering high-performing facilities. They apply flexible, context-specific methods to translate community input into design and planning decisions, helping facilities reflect real users, operational needs, and local conditions. This supports spaces that are accessible, intuitive, and inclusive, and that function as intended over the long term.

With experience supporting the planning and design of major healthcare facilities across jurisdictions, HDR’s specialists have developed customized engagement strategies aligned with user group expectations. On many projects, we typically engage the following user groups:

• Healthcare workers 
• Seniors 
• Youth and young adults 
• Newcomer and multilingual residents 
• Indigenous Communities 
• People with disabilities

For example, on a recent healthcare project, early and sustained engagement with clinical staff and community members led to measurable design improvements. Patient flow layouts were revised, family spaces were expanded, and wayfinding strategies were simplified based on direct user input. Engagement with equity-deserving groups also informed more accessible entry points and culturally responsive design elements. These changes, made during planning and design, helped avoid costly redesign during construction and improved usability once the facility became operational.

Focus on Shared Values, Acknowledge Disagreement, Provide Transparency

The goal of engagement is not to force consensus. It is to identify shared values, acknowledge points of disagreement, and document both so decisions are made transparently. In practice, participation is often shaped by power imbalances, systemic inequalities, tokenistic invitations, and historical mistrust. These realities can fuel skepticism and disengagement, making full consensus unrealistic.

Clear documentation and transparency are essential to making decisions that are understood, credible and defensible, particularly in high-profile or contested healthcare projects.

Co-designing clear terms of engagement with communities early in the process helps build trust, reduce risk, and foster a sense of shared ownership. This includes establishing who is involved, the purpose and scope of engagement, decision-making boundaries, expectations, ground rules, transparency mechanisms, and accountability structures from the outset.

Full Project Life Cycle Engagement

Engagement does not end with the first shovel in the ground. It should begin during early planning and continue through design, construction, and post-occupancy operations. Without a life cycle approach, engagement risks becoming a one-time exercise that is disconnected from what is ultimately delivered. 

When done well, engagement provides key design and operational outcomes that can be clearly traced back to community input. 

This may include elements such as healing spaces, inclusive washrooms, culturally relevant wayfinding, and operational practices that reflect users' needs and experiences.

A life cycle approach strengthens continuity, improves responsiveness as needs evolve, and maintains alignment between what communities identified early on and what is ultimately delivered.

Designing for the Full Spectrum of Community Needs

Healthcare facilities are often experienced differently across communities. These differences are shaped by systemic barriers, cultural context, and lived experience.

Engagement must move beyond standard approaches to reflect these realities. This requires embedding principles such as cultural safety, accessibility, trauma-informed practice, and inclusive participation into how engagement is designed and delivered. Different communities require different approaches, timelines and methods to meaningfully participate.

In practice, this means creating space for community-led input, providing representation where appropriate, and integrating diverse perspectives into both design and operations. Engagement should be ongoing and relational, not a one-time activity.

Organizations that take this approach are better positioned to reduce barriers to access, strengthen trust, and deliver facilities that are more responsive to the communities they serve.

Indigenous Engagement as a Distinct Practice

Indigenous communities require distinct and dedicated approaches to engagement. Their relationship to healthcare systems and institutions more broadly is shaped by unique rights, histories, cultures, and ongoing inequities. Engagement must recognize and respect these realities.

Principles such as Free, Prior, and Informed Consent (FPIC), respect for cultural protocols, long-term relationship building, and co-developed or co-led decision-making should be elevated throughout the process, as standard consultation approaches are often insufficient.

In practice, this may include community-led design, spaces for ceremony, inclusion of Indigenous art and symbols, culturally relevant wayfinding, support for traditional medicine, Indigenous health liaison roles, governance inclusion, capacity building, and land and language recognition.

Meaningful Indigenous engagement is ongoing, relational, and institutional, extending beyond project delivery to include continued dialogue, formalized roles where appropriate, and sustained investment in relationships and organizational capacity. When done well, this approach strengthens not only project outcomes, but also long-term relationships, trust, and health outcomes. When done poorly, the consequences are equally lasting.

Next Steps

Healthcare infrastructure projects operate in increasingly complex environments, where patient needs, community expectations, regulatory requirements, and delivery risks are closely linked. Organizations that treat engagement as a strategic function, rather than a procedural requirement, are better positioned to improve outcomes, reduce risk, and maintain public confidence.

To strengthen project performance and delivery certainty, organizations should:

• Embed engagement as a core project function
  Integrate engagement from early planning through to operations, to inform design, approvals, and delivery, not a parallel activity. 
• Shift from consultation to co-creation
  Move toward co-creation models where communities directly shape design decisions, priorities, and operational considerations. 
• Define governance and decision-making upfront
  Establish clear terms of engagement, including roles, scope, decision rights, and accountability structures. 
• Build and resource specialized capability
  Invest in experienced engagement practitioners and tailored approaches that reflect the complexity of healthcare environments. 
• Translate engagement into measurable outcomes
  Input should be documented, traceable and visibly integrated into design and operations, with clear feedback loops. 

Organizations that take these steps are better equipped to deliver healthcare facilities that are aligned with community needs, resilient over time, and positioned to avoid the reputational, financial, and operational risks associated with poor engagement.