Most health systems want to increase access, serve more patients and drive growth, which often involves adding facilities. However, when building new facilities, leaders must navigate capital constraints, inflation and high labor costs.
To learn more about facility expansion trends and how architects help health systems scale faster, Becker’s Healthcare spoke with Leanna Albright, senior interior designer at Gresham Smith.
Growth prerequisites: Goals, strategies, facilities
A health system’s facility strategy is based on the organization’s growth plans. Where do leaders want to grow — nationally, regionally or locally? Over what time period? For what service lines?
In today’s competitive environment with limited capital and tight operating margins, Ms. Albright increasingly sees health systems focused on growing specific service lines that generate the most revenue and profit, with the greatest growth potential.
“Each health system thinks about their facilities differently,” Ms. Albright said. “It’s about how they operate and what are their goals for expanding operations, revenue and costs to implement that growth.” For example, a few of Gresham Smith’s clients had separate growth-focused strategies that involved building single-specialty hospitals in one region, within a tight time frame. Changes of federal and state requirements, such as Certificate of Need laws, spark scaling needs to achieve speed to market.
A major trend impacting facilities: Decentralization
During the COVID-19 pandemic, consumer reluctance to visit hospital campuses accelerated demand for care delivered outside traditional acute settings. This trend has continued and still informs growth and building strategies for health systems.
“Instead of focusing solely on the main medical campus, we’re continuing to see more decentralized, distributed care networks,” Ms. Albright observed. “This allows health systems to target key demographic shifts, capturing new patient bases.”
Other driving factors are the reimbursement rates around federal programs. Decentralized satellite sites, including freestanding inpatient sites and outpatient centers, are an increasing strategy to both capitalize on high reimbursable services and spread-out capital investments.
As this trend takes off, Ms. Albright is seeing a shift in mindset. “It is changing from a project mindset to a portfolio mindset,” she said.
Enabling decentralization through rapid scaling
The shift to decentralization often means smaller capital projects, where multiple sites in a market offer the same services. Key considerations for health systems include:
- Speed with low disruption: Leaders want quick construction to start revenue earlier, often using offsite methods to maintain ongoing operations.
- Cost Control: With significant capital constraints, prototyping repeatable facilities helps accurately project capital needs and reduce expenditure.
- Operational Efficiency: Consistent layouts optimize staffing and help address labor shortages.
To help health systems meet these needs while rapidly scaling, Ms. Albright suggests early involvement of all stakeholders—from C-suite to frontline staff—is crucial in planning. Since 2D floor plans don’t easily represent the scale of a space, the design team can use visual aid tools such as 3D models, VR, or mock-ups to better engage the stakeholders. This collaborative effort helps health systems align on scope, costs, and operational needs before construction begins.
Prefabrication of building components further supports speed, cost control, and consistency. Health systems with repeatable platforms are able to bulk purchase preassembled building components and increase their quality of construction.
“Health systems are shifting from thinking about one project to a scalable platform for multiple projects,” Ms. Albright said. “Prototyping and prefabrication help you scale fast. You use a standard to replicate efficiently across multiple markets.”
Beyond construction: Considering a building’s life cycle
Underestimating cost and timeline are among the most common challenges health system leaders face when building new facilities. That’s why early planning and prototypes are an effective strategy.
Leaders also tend to focus on a building’s construction costs but less on the total operating costs over a building’s lifecycle. Along with prototypes, Gresham Smith can create digital twins to help facility managers monitor the building systems in real time. By analyzing this data, facilities can make informed decisions that prevent costly repairs, avoid downtime, and extend the lifespan of assets.
Early architectural involvement transforms facility scaling from a reactive building process into a proactive, operationally aligned strategy. Designers like Ms. Albright help ensure the facilities are built to meet today’s needs while maintaining flexibility to support tomorrow’s growth. “We strive to support cost savings, efficiency gains, and improved patient and staff outcomes,” said Ms. Albright.
Ultimately, the intersection of innovative architecture and operational insight enables health systems to scale rapidly while reducing risk in an ever-evolving healthcare landscape.
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