About

Built from the inside of hospital operations, not the outside.

Intelligent by Design comes out of three decades of running hospitals — not a framework applied to healthcare from consulting or architecture first.

Origin

Why systems before spaces.

Across roles running hospital operations in multiple countries and health systems, the same pattern kept showing up: the building came first, and the operating model — staffing, workflows, technology, governance — was worked out afterward, inside whatever the architecture allowed.

Intelligent by Design was developed to reverse that sequence: define the operating system in full — including how the hospital runs on AI, automation, and secure digital infrastructure — then hand the architect a design brief that reflects how the hospital will actually run.

Founder

Brian de Francesca

An international healthcare executive with more than 30 years in hospital operations, based in Dubai. Career roles include COO of Johns Hopkins Medicine International–UAE, EVP at Althea International (Europe, India, China), Deputy Director/COO at Bangkok Dusit Medical Services, COO at Kuwait Hospital, and Director of Operations at Al Jalila Foundation's Hamdan Bin Rashid Cancer Charity Hospital.

He is currently Special Envoy for AI & Synthetic Workforce Development at the Arab Hospitals Federation, Managing Partner of MAVEN L.L.C. (a boutique healthcare advisory), and founder of VAI, a company building AI-native hospitals in partnership with the Arab Hospitals Federation. He also collaborates with the World Health Organization on AI and hospital-operations research.

Most hospital inefficiency isn't operational — it's designed in, at the planning stage, before a single brick is laid.
Where the work continues

Applied, not theoretical.

Intelligent by Design is actively applied on greenfield hospital and health-network developments, and informs advisory work with health authorities and industry bodies across the Middle East, Asia, and Europe on AI-native hospital planning and governance.