When we think about building a new healthcare facility, we are often discussing a multi-million to multi-billion dollar, 10 to 50-year gamble on the future.

These projects often come together because of immediate, real world demands and move forward with such incredible cost and complexity, that the pressure on all involved can be immense. This is amplified by the ticking clock of regulatory deadlines (especially in our home state of California), rising costs of construction and persistent pressure to improve reimbursement. 

High Pressure, Higher Stakes

The seemingly safe path is to build a newer, bigger version of what exists today. The urge is to design facilities and pour concrete around known technologies and operational models while managing the process with a singular focus of getting the thing built.

But this singular approach can be a trap. With such a limited field of view, this method for facility development is precisely why so many state-of-the-art healthcare facilities can be underutilized and obsolete even before the CEO cuts the oversized ceremonial ribbon and the proud project team breathe a sigh of relief.

If we truly want to maximize the value of these immense investments and mitigate long-term risk to healthcare systems, we cannot create facilities that confuse efficient project delivery for long-term excellence and innovation. 

Diagnosing the Real Problem

Projects often begin with a tactical request, something like: “We need more space for administrative staff, but our campus is fully built out.” The demand for more space becomes the focus, blinding both hospital and project leadership to the underlying pressures that drive the need for change. 

When we step back from the straightforward demand for additional space, we inevitably find a web of miscommunication, misalignment, and mistrust that bubbles to the surface. We have led dozens of meetings with clinical, operational, and administrative leaders, seeing firsthand how multiple departments function in entrenched silos, rarely aligned around a cohesive strategy for future success. We are often brought in to support thoughtful, yet overwhelmed facility leaders that are tasked with solving the "space problem," only to find that they are not empowered or enabled to address the deeper, systemic challenges. 

For example, in a project that we led, the challenge was initially framed as a "space" issue, but when we asked the right stakeholders the right questions, we uncovered that the shortage isn’t simply about available space, it’s a problem rooted in a tangle of outdated policies. The demand for more space was driven by the absence of an institutional policy for remote or hybrid work and inconsistent expectations about where work gets done. In order to tackle this sticky problem, we stepped back and reframed the challenge from “how do we deliver more space” to "how do we want to work in the future." In doing so, we delivered immediate savings by keeping the client from developing a new and ultimately unnecessary building. 

When we realize that a space problem is a systems design problem, projects must pivot. What begins as a real estate exercise transforms into a strategic conversation about space, people, and enterprise demands, revealing a truth in healthcare: without strategic alignment, we are trying to solve the wrong problems.

What can we do about it?

Addressing long-term demands in hospital design requires a fundamental shift.  

Today, facility development for health systems is hit with the double whammy of (a) reacting to the problems of today and (b) the incredible urgency to complete projects as fast as possible. These issues lead to short-sighted projects, compromised facilities, and processes that fundamentally miss the broader strategic opportunities that a new building embodies. 

To improve the quality of healthcare spaces, we need to improve the sophistication of healthcare design. The opportunity is to change our focus solely from building design to a broader mindset of systems design. We know that many health systems are a finely tuned choreography of people, processes, and policies. However, these systems need to be fully understood and integrated into the design of facilities. The goal is to make the building a dynamic physical manifestation of this choreography, now and into the future. (We know many exceptional health systems have this mindset and the ability to execute, but due to many factors, others struggle to put this into action.) 

The "go-live" date for a new building is a non-negotiable deadline. Because the demands are so immediate, and implications are so (ahem) concrete, we have an opportunity to use the mandated construction timeline as a forcing function to compel leaders into making complex, strategic, and impactful decisions together. 

A New Framework for Facility Design

This systems-focused approach requires a new set of principles to ensure investments in the built environment deliver on their full potential. 

1. Move with Strategic Speed: Rather than rushing into a project, we must slow down to go fast. The huge investment of a new or upgraded building provides the necessary leverage to bring leaders together to make critical decisions. Strategic engagement upfront ensures the final facility doesn't just open on time and on budget; it delivers lasting value. An initial investment in strategic alignment and project vision is one of the most crucial (and overlooked) products of the entire project. Early in our workflow, we regularly co-develop a project charter with stakeholders, including the operational and administrative staff of the facility, ensuring alignment on immediate and long-term goals. This upfront work allows the project to be more resilient and enables the team to move faster into the future.
   
   

2. Embrace Systems over Structures: When developing a new facility or building, it's critical to do the unglamourous and difficult work of understanding the interdependencies of people, processes, and technology that will inhabit the building for decades to come. Though seemingly straightforward (and often not done), it is critical to understand: “Which patients does this facility serve?” “What staff will bring this space to life?” and “How does this project impact overall enterprise strategy?” By implementing a ‘systems over structures’ approach, we can ensure that the new facility is not seen as just a standalone project, but an integrated and critical piece of delivering tangible long-term value.
   
   

3. Design a Preferred Future: Hospital leadership must proactively engage with and shape the future of healthcare. Beyond the regular strategic planning process, each facility design project is an opportunity to navigate external and internal pressures and to identify a preferred path forward. To achieve this, we guide our clients through a strategic foresight process that explores speculative futures and potential scenarios. This approach enables leadership to clearly identify emerging opportunities and preemptively mitigate risks, establishing a clear and desired future. By anticipating long-term needs and challenges, we ensure that the facilities we design today are highly adaptable, integrated, and remain valuable assets for decades, avoiding the costly and disruptive pitfalls of short-sighted planning.

Every time we undertake the development of a new healthcare facility, we arrive at a critical, high-stakes, and time-sensitive decision point: Will we settle for the conventional, or embrace the opportunity to create something with lasting value and long-term resilience? The choice is clear. Success begins with strategic collaboration, a rigorous systems approach, and a unified vision for a preferred future. We must now embrace the complexity of delivering the future of healthcare by asking the right questions and doing the hard work—together.