Every healthcare organization needs to prepare for inevitable change. They face a context of continuous and flux and so must be capable of appropriate anticipatory or reactive adjustments. In the past, organizational effectiveness might have most often been based on the concept of stability (Worley & Lawler, 2010b). In today's healthcare world, successful organizations are often described as agile, or change-ready (Worley & Lawler, 2010a). It is clearly undesirable to be described as change averse or a late adopter. Naturally, there is a premium associated with that is productive rather than disruptive. One way to address the unknown prospect of is to design with an eye to flexibility. It is assumed that facilities that are flexible may be better able to accommodate the new situations that result from the need to change.Design and ChangeDesign professionals who work with healthcare organizations can be seen as agents of change. Facility is expensive and semipermanent, and architectural can take considerable time. Architects and design professionals are skilled at planned and in the past have intentionally supported their clients' organizational stability. There is now an imperative for flexible design that economically supports client organizations' ability to accommodate unplanned change.There is an obvious difference between deliberate, strategic and unplanned, reactive or adaptive (Kotter, 1996). Organizations with the foresight to plan in an anticipatory fashion can be spared many future headaches (Lawler & Worley, 2006). Because the future is unknown, how is one to evaluate various strategies to accommodate that is difficult or impossible to predict? Organizational agility lies somewhere between planned for a stable organization and unfocused adaptability (Worley & Lawler, 2010b).Because the future is unknown and largely unpredictable, healthcare organizations and their design professionals might be advised to consider alternate scenarios for the future. Peter Schwartz (1991) has proposed a thoughtful model in which organizations consider multiple alternate futures. The principal plan moves toward the most predictable future, but other contingency plans are developed for plausible alternative futures whose appearance would have a major impact on the organization. These alternate future scenarios include the identification of events that would indicate that an alternate scenario is occurring. When a trigger occurs, the organization has already planned a response for this new situation. This kind of scenario planning might be seen as flexibility in planning.The influence of the external context, the socioeconomic environment, and demographics create the need for in healthcare organizations. In response to in the operational context, organizations must adopt a strategy that is aligned with the demands of the external environment. Changes in the external environment lead to the development of suitable strategies. Changes in strategy often require changes in organizational structure, which in turn lead to changes in facilities and technologies. Facilities and technology support the organization design, which has been adjusted to align with strategy.Just as there are many types of strategy, there are, of course, many different types of facility change. There must, therefore, be many ways of understanding these differences, which suggests that one form of response may not be sufficient to address an issue. There are multiple types of flexibility to address each different form of possible change.Scale of ChangeChange can occur on many different scales, and at times it may be simultaneously occurring on more than one scale. Change can happen on the scale of a single room, a unit or department, an entire building, a campus, or within a system that has multiple sites. …