Strategic by Design: Accelerating Facility Planning to Turn Vision into Value

Many rural hospitals are constrained by outdated infrastructure—spaces designed for inpatient volume that no longer reflect today’s patient needs or care models. Coupled with financial constraints and limited capital, rural leaders must be especially strategic when considering any facility investment. Every dollar must count, and every decision must be future-ready.

This session explores how accelerated, Charrette-based master facility planning can help rural hospitals align infrastructure with evolving demand, unlock operational efficiency, and build with confidence. Attendees will gain insight into the master planning process, how to assess market demand, and what it takes to ensure their next facility investment delivers long-term value.

At the end of this session, attendees will be able to:

  • Evaluate Market Demand and Facility Needs – Use market data and service trends to inform future infrastructure requirements.
  • Understand the Master Planning Process – Learn a step-by-step approach for developing an effective, adaptable facility master plan.
  • Identify Keys to a Successful Plan – Recognize the strategic, operational, and financial factors that lead to smart, high-impact facility decisions.
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Q&A

How can hospitals balance addressing urgent infrastructure needs- like an outdated emergency department- with the long-term flexibility required for future growth and changing market demands?

Fantastic question. I’d say the first key is to quantify the type of infrastructure needs…separating out things like exterior envelope (roof, walls, windows) from the MEP systems (mechanical, electrical and plumbing).

Where possible, it’s always best to use a master plan as a time to think about getting out of some of the oldest structures, or to at least decrease the intensity of use (e.g., old inpatient units becoming administrative spaces…therefore needing less air, plumbing, electrical load, etc.).

When specifically thinking about replacing or renovating an outdated emergency department, the key elements to consider are:

  1. Is the current location able to be expanded?
  2. Can you improve overall site circulation by keeping ED traffic separate from other vehicles?
  3. What is the long term plan for inpatient / swing / observation spaces? Those areas will need to maintain adjacency to the ED from a flow and a staffing perspective, so considering both simultaneously, even if phased is critical.
What are some of the most important factors to consider when deciding which facility projects to prioritize first?

Excellent question. I would start by understanding your market as deeply as possible. Who are you serving, and what portions of their care are you providing today? Is there an opportunity to grow the population served or capture more of their volume?

Once you know who you’re serving, it’s important to be realistic about the shift towards outpatient care. Where will you touch the most people? Typically, clinics, imaging, lab, PT and the ED represent a significant majority of all volume at a critical access hospital, so investing in those areas will touch the most lives. Of course this must be balanced with the impact on finances, but it’s critical not to let the cost report “tail” wag the “dog”. If you’re meeting the needs of the majority of your community, the need for investments will often work itself out, but it is important to build facility and volume scenarios through the cost report to understand the true impact.