Imagine a hospital where patients recover more quickly, staff are happier and more likely to stay, and the building itself helps reduce operating costs. That is the vision behind Fable Hospital—a fictional healthcare facility created to explore a real question: can better hospital design improve care while paying for itself? In a new study published in BMJ Leader, researchers led by Texas A&M University Distinguished Professor Dr. Leonard Berry use this imaginary hospital to demonstrate how evidence-based design can produce measurable financial, clinical and environmental benefits. Although Fable Hospital does not exist, the strategies behind it are grounded in decades of research and real-world experience.
The researchers modelled a 300-bed community hospital, asking what would happen if every aspect of the building—from daylight and airflow to materials and energy systems—was designed to promote healing and efficiency. Their analysis suggests that investing an additional US$25 million to US$30 million, roughly 3% of construction costs, would allow the hospital to recover that expense within its first two years of operation. Beyond that point, the savings would continue to accumulate. “This research shows that designing a better hospital is not a luxury, it’s a smart investment,” Berry said. “When you build with evidence in mind, you improve care, support staff and reduce costs all at the same time.”
The projected savings come from multiple sources. Better indoor air quality, reduced noise and greater access to nature are associated with shorter hospital stays, which alone could save about US$7.25 million annually. The model also estimates yearly savings of roughly US$1 million from fewer medical errors, more than US$1.2 million through improved staff retention, and hundreds of thousands of dollars from lower energy and water consumption. Reduced renovation needs and more durable building materials further cut costs, resulting in projected net financial gains exceeding US$100 million over the hospital’s first decade.
The study reflects a growing movement towards regenerative design, an approach that goes beyond reducing environmental harm by creating hospitals that actively support human and community health. This could include patient rooms with views of nature, accessible healing gardens, healthier building materials and resilient infrastructure capable of withstanding extreme weather. According to Berry, hospitals should be viewed not as isolated buildings but as part of a broader system that influences patient outcomes, employee well-being and the health of surrounding communities.
The latest version of Fable Hospital builds on more than 20 years of research. Earlier editions, published in 2004 and 2012, helped shape the evidence-based design movement in healthcare, with many of their recommendations now incorporated into modern hospitals. Berry notes that while Fable Hospital itself is fictional, the design principles are supported by extensive research and have already proven beneficial in practice. The project was developed with collaborators from Texas A&M University, Rady Children’s Hospital in San Diego and the architecture firm Perkins&Will.
Ultimately, the researchers argue that hospital design should be viewed as a long-term investment rather than an upfront expense. Because hospitals influence healthcare delivery for decades after they are built, thoughtful design can generate lasting benefits for patients, staff and healthcare systems alike. As Berry concludes, the lesson of Fable Hospital is straightforward: a better hospital is not only possible—it is practical, financially sound, and worth the investment.
More information: Ashley Dias et al, Fable Hospital 3.0: the business case for building better healthcare facilities, BMJ Leader. DOI: 10.1136/leader-2025-001522
Journal information: BMJ Leader Provided by Texas A&M University