Building a new hospital or undertaking a major renovation is likely to be the biggest financial decision that a CEO or hospital board of trustees will ever make. There is a growing body of evidence that now links the physical environment with safety and quality outcomes for patients and staff. As part of their management and fiduciary responsibilities, hospital leaders and boards must base decisions about built-environment investments that include cost-effective evidence-based design (EBD) interventions in their strategic plan and investment portfolio or risk suffering the economic consequences in an increasingly competitive and transparent environment.