Aaron McKenzie
Healthcare leadership teams often put immense effort into developing thoughtful strategic plans intended to guide the future of their organizations. This future-focused thinking is essential for addressing projected growth, patient experience, access to care, operational performance, workforce needs, and long-term sustainability. However, too often the built environments that stem from these strategic plans fail to connect back to the larger experience, operations, and culture that these guiding initiatives seek to create.
Working in both the worlds of strategy and physical environments, we regularly witness the challenges of translating strategic intent into tangible outcomes.
Though vexing, the disconnect is not due to a lack of commitment, but a lack of communication and understanding. With creativity and commitment, it is solvable.
The Misalignment of Space and Strategy
Although both leadership teams and facilities groups are deeply committed to improving outcomes and creating lasting value, they are often operating with different information and different understandings of what success ultimately looks like.
Healthcare leadership understands the ins and outs of their strategic plans, but by the time a project reaches the facilities teams, project managers, architects, and consultants who are tasked with getting things built, much of that strategic context has disappeared.
Facilities teams are asked to deliver major investments without understanding the larger initiative that inspired them. Questions such as why this project is taking place now, what strategic goal it supports, and how success will be measured remain unanswered.
As a result, these projects become focused on delivering space rather than delivering strategy. Design decisions become disconnected from organizational priorities and miss opportunities to reinforce long-term goals and the institutional mission. The challenge is not misalignment of intent, but rather the absence of connective tissue.
From Strategic Intent to Operational Reality
Understanding how strategic intent intersects and interacts with project design and delivery is key before moving forward with most facilities related projects (perhaps the ventilation upgrade in the compounding hood of the pharmacy may not require this rigor).
Our team often acts as the missing voice, on projects ranging in complexity, budget, and impact. We bridge the gap between strategy, design, and project delivery. The processes that we implement ensure that strategic intent remains an active driver throughout the life of a project, strengthening project results and impact.
Listen Before You Design
To build this connective tissue, we like to engage the people who will oversee, operate, maintain, and experience the spaces and services driving the work. We seek to clearly understand not just what the strategic plan says, but why it says it and where friction is likely to emerge once real budgets, schedules, and constraints enter the conversation.
Though this can feel slower at first, it is the most reliable way we have found to create alignment between strategy, project teams, and design teams. It is within this alignment that long-term value is identified and realized.
Bringing Strategic Leadership into Projects
Too often, strategy exists as a document written at 30,000 feet while project teams are making decisions at ground level. A strategic framework is only useful if the people delivering the project understand how to apply it.
When working with the US-based leadership at Falck, we had a partner that cared deeply about understanding the granular details of how their services were delivered, received, and experienced. Together, we created a highly detailed service and experience blueprint, informed by intensive research, that outlined the current delivery of services, identified opportunities for value creation, and outlined both strategic and day-to-day actions for improvement. By being so ‘in the weeds’ with the design team and those delivering care, the leadership at Falck developed both a strategic plan that directed their future decisions, but also clear and actionable steps that critical stakeholders understand, relate to and can enact on a consistent basis.
When leaders dive in and create new means for staff to elevate new ideas, research findings, operational insights, and observations, strategic planning extends beyond mapping a preferred future and becomes a tangible tool for enacting it.
Make Strategic Intent Valuable, Not Optional
Strategic intent should be translated into practical tools that help project teams make decisions under pressure. It must explain not only what to do, but why.
Many healthcare organizations provide detailed standards for materials, finishes, room layouts, and equipment requirements, but do not provide guidance about how spaces should support operational goals, patient experiences, staff workflows, or cultural priorities. This creates a gap where teams understand what they are supposed to build but not necessarily what they are trying to achieve.
Project delivery teams connect design to strategy, so they need clear documentation, a thorough orientation, and steady communication. When everyone understands why and how decisions get made, each person can tie their daily choices to the project’s strategic intent.
Align Stakeholders Around Shared Goals
Healthcare organizations may benefit from adopting principles similar to integrated project delivery by bringing leadership, operations, facilities, and project teams together earlier in the process. A shared understanding creates better decisions that lead to stronger outcomes.
We don't have to look far for successful examples of integrated project delivery. The design and construction industry offers its own. On complex facility projects, architects, contractors, and consultants often work side by side in a "big room," co-located for the life of the project. Open communication and shared accountability keep everyone aligned from planning through construction, so decisions get made together and challenges surface early. When strategy, planning, and implementation stay connected this way, the goals that inspired a project keep shaping it.
While it’s unlikely that hospital leaders and project managers will work together in a construction trailer to ensure strategic alignment, the underlying lesson of building and maintaining an integrated project team to ensure quality in delivery is a good one. Designing and upholding an integrated system of project alignment between strategy and delivery is possible, with high-performing examples in near-proximity
Unlocking Lasting Value—Linking Strategy and Delivery
The need to plan for the future, and the pressure to build right now will never go away. The goal is not to replace strategic planning and project design and delivery, but to strengthen the connections between strategy and delivery.
When organizations successfully bridge these two, projects become more than responses to immediate needs. They become rallying points for organizational alignment, chances to see challenges in new ways, and opportunities to test, refine, and advance long-term organizational goals.
The organizations that figure out how to connect strategic intent to project delivery will do more than build better buildings. They will build systems that continue creating value long after the ribbon is cut because the decisions guiding them were never confined to a single deadline, a single budget, or a single set of drawings.