What the 2026 Facility Guidelines Institute Changes Mean for Healthcare Design

The Facility Guidelines Institute (FGI) has recently released the latest version of their design and construction standards used across healthcare and residential care environments. These standards are also often the basis for state-level healthcare guidelines. The FGI Facility Code outlines a wide range of architectural and supporting building systems requirements to support minimum standards of healthcare. The 2026 version has a variety of changes that will be essential for professionals within the industry to understand.

Shot of Brigham and Women's Faulkner Hospital's Exterior

Reception Area at Healthcare Facility

Exterior shot of medical office building

From “Guidelines” to “Facility Code” and Increased Authoritative Language

Among the most basic, but perhaps most critical, changes in the 2026 edition, is a nomenclature shift away from “Guidelines” to “Facility Code”. This aligns the standards better with its position within building codes. Forty-two states have adopted some edition of the FGI Codes/Guidelines as a minimum criterion for healthcare facility design. Throughout the document verbiage has been updated to reflect stricter delineation between mandatory requirements and supplemental design advice. 

Blue print example

• Mandatory code language/verbiage is used within 2026 FGI Facility Code

• Former advisory material, commentary, best practices, etc. have been relocated to an accompanying series of FGI handbooks

• AHJs will have clearer language to adopt as part of licensing and plan review

• Reduced opportunity for design teams to misunderstand or misrepresent the requirements

This split is impactful because previous editions blended requirements and guidance in ways that often confused design teams and reviewers into thinking non-mandatory language was enforceable. In the 2026 Code, that ambiguity largely disappears.

Clarified Minimum Requirements for Healthcare Spaces

The 2026 FGI Facility Code also introduces new and revised requirements that reflect changes in clinical practice, care delivery, and facility needs. These changes are particularly impactful on design firms working within the healthcare sector.

1.     Clinical Room Determination Requirements

Key clinical spaces are no longer used the way FGI intended for them to be categorized. Procedure rooms become hybrid spaces, imaging areas become interventional suites, and recovery spaces get used for long-term care. The 2026 FGI provides clearer minimum requirements tied more directly to clinical intent, meaning spaces may be classified based on how they are used, not what they are named.

Shot of Surgery Room

Shot of an MRI Suite

2.     Clinical Risk-Based Planning

The 2026 language supports a greater emphasis on tools like Clinical Risk Assessment (CRA). The idea puts greater emphasis on actual patient risk, procedure type, and operational workflow rather than defaulting to prescriptive assumptions. This aims to eliminate gray areas where project teams have difficulty defining a clinical space such as procedure, exam, treatment, etc. It also looks to designate spaces used for vulnerable populations (e.g., behavioral health, post anesthesia care, etc).

3.     Behavioral and Mental Health Space Requirements

Behavior health is a major focus in the 2026 FGI Facility Code. These updates include further defined requirements around:

• Safety and ligature resistance

• Staff observation strategies

• De-escalation and seclusion spaces

• Patient toilet and shower arrangements

• Circulation and egress planning

There is also greater recognition that behavior health is no longer limited to standalone psych units and many Emergency Departments (EDs) now have embedded behavioral health intake and holding spaces.

Shot of Patient room at Behavioral Unit

Shot of waiting area at community health center

Shot of play room at a behavioral unit

4.     Water Management

Waterborne pathogen control is an increased focus. The 2026 Facility Code adds water system management requirements focused on water age and stagnation — two major contributors to Legionella diseases risk. These requirements include more explicit minimum requirements for:

• System design to reduce stagnation

• Increased commissioning and flushing protocols

• Fixture selection

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Shot of pipes at plumbing room

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5.     Discharge Lounges and Transition of Care Spaces

Hospitals are constantly under pressure to increase throughput of patients. Because of this, designated discharge lounges are more and more common. The 2026 FGI Facility Code looks to fully define these spaces including their minimum design requirements. They will be treated as an intentional clinical support space rather than an improvised waiting room. Baseline requirements include:

• Privacy considerations

• Accessibility and ADA implications

• Patient monitoring

• Required proximity to relevant support spaces

• Environmental requirements

• Support of mobility devices

Shot of discharge area at community health center

Shot of discharge area at behavioral health unit

Shot of discharge area at mental health facility

6.     Emergency Department Requirements

The 2026 Facility Code works to better reflect that the ED has become the hospital’s primary intake point not just for trauma patients and injuries, but also for behavioral health and infectious disease cases. The new standards strengthen expectations around:

• Triage and intake separation

• Patient flow

• Signage & wayfinding

• Infectious isolation — including the addition of required Airborne Infection Isolation (AII) spaces

• Functional separation of high-risk or behavioral patient areas from normal ED

Many of these will increase supporting MEP requirements for compartmentalization, pressurization, and system configuration and centralization.

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Shot of waiting area at an emergency department

The Bottom Line

The 2026 FGI Facility Code is more than an update, it’s a strategic reorientation of how minimum design requirements and supplemental guidance are presented for planning healthcare facilities within the commercial construction industry. With this new version, FGI separates enforceable code from advisory material, clarifies space determination criteria, and establishes a more user-friendly structure for a lot of stakeholders within the industry. In doing so, FGI hopes to better support safer, more predictable outcomes across planning, design, and construction; as a result, design teams should be better equipped to provide quality healthcare spaces for all clients.

Written by:

Derek Day

Associate, Mechanical Group Leader