Author: Deanna Tursellino

By Rhonda Malone Wyskiel, RN, MSN, EDAC, LSSGB
Principal
HORD COPLAN MACHT

At the outset of every healthcare project whether we’re responding to an RFP or celebrating a new project award I find myself scanning for something deeper than the scope, budget, or schedule. I’m searching for the problems they are trying to solve, the story behind the performance goals, the alignment to their strategic objectives. What’s not yet visible in the plan but will define success months or years from now?

My lens is grounded in performance improvement, quality, and safety, but it’s also about curiosity: uncovering how a building can truly perform to support a care delivery system. These complex adaptive systems in healthcare are where the intersection of people, process, technology, and space come to life.

Before a line is drawn, I start with questions.

1. What problem are we really trying to solve?
   Every project comes with a rationale; growth, modernizing, improving access/equity, and compliance. But there’s often a deeper operational challenge beneath it that architects and designers may not see. A lens they may not wear. As a clinician it is second nature for me to clarify the project rationale early on and reframe design as a change strategy rather than a capital project.
2. What outcomes will define success and how will we measure them?
   It’s critical to translate aspiration design and improvements into metrics. Reduced staff travel time and distance, improved response times, decreased HAI risk, more efficient patient throughput. All design choices must ladder up to measurable performance goals. That’s where alignment to strategy is so important.
3. Where are the current friction points in the system?
   Before improving flow with design, we have to understand where it breaks down. Observing patient and staff journeys, process and value stream maps, and staff handoffs helps us diagnose the operational “pain points.”
4. How will this project improve safety and high reliability?
   Safety isn’t simply a checklist; it’s a mindset, a way of doing business. The design team’s role is to ensure we embed principles of human factors, visibility, and standardization into every square foot. We have to understand the way care is delivered now and the way it will be done in the future in order to “design out” the unsafe workflows, and “design in” principles of safe design.
5. How can we design for adaptability and learning?
   Performance improvement doesn’t end at occupancy. Spaces should enable teams to adapt, experiment, and measure what works and what does not, supporting continuous improvement and resilience. Learning through post occupancy evaluation supports the mature process improvement tools and approaches which healthcare has utilized for many years.

Each of these questions shapes the way I listen, analyze, and design. They also help align diverse stakeholders’ clinicians, administrators, improvement specialists, and architects around shared performance goals from day one.

In the end, this curious mindset and these early conversations aren’t just about the look of the building and workflows happening on the inside; they’re about creating the target conditions for high quality safe care delivery.

About the Author:

Rhonda brings over two decades of national leadership in patient safety, quality, and performance improvement to healthcare design. At The Johns Hopkins Hospital and the Armstrong Institute for Patient Safety & Quality, she led national collaboratives that achieved landmark reductions in preventable harm across more than 1,700 ICUs worldwide.

Today, Rhonda applies this expertise to the intersection of healthcare operations, safety science, and the built environment. She helps health systems and design teams translate evidence-based practices, human factors, and Lean principles into spaces that promote reliability, efficiency, and safe, high-performing care.

A recognized voice in healthcare innovation, Rhonda has guided organizations through large-scale performance transformations and helped design and implement successful Lean Management Systems. Her leadership also contributed to one hospital’s receipt of the Malcolm Baldrige National Quality Award. Through her work, Rhonda continues to shape how design and safety unite to advance the future of healthcare delivery.

By Annette Ridenour, President & CEO, Aesthetics Inc.
Adapted from her keynote address at the 2025 Healthcare Facilities Symposium & Expo (HFSE).

When my mother took her last breath, she did so in a hospital room that was sterile, windowless, and cold. The walls were a tired shade of green, the fluorescent lights flickered, and there was nothing in that space that reflected warmth or care. The last thing she saw wasn’t her family—it was the flickering light on the ceiling. That moment changed the trajectory of my life.

It sparked a question that has driven me for more than four decades:

What if every place we go for care was so welcoming, so comforting, and so beautiful that it became part of the healing process itself?

The Forgotten Standard: “Loved”

In healthcare design, we often measure everything—safety, efficiency, sustainability, and evidence-based performance—yet “loved” rarely makes the list. And yet, when people love a place, something extraordinary happens: they trust it, they care for it, and they protect it.

Designing spaces that are loved isn’t merely about aesthetics for its own sake. It’s about forming emotional connections—creating environments that comfort the fearful, uplift the weary, and honor the dignity of everyone who enters.

This idea has guided my work at Aesthetics Inc. and is reflected in a simple but powerful framework inspired by Abraham Lincoln’s words: Of the People, By the People, For the People.

• Of the People means engaging staff, patients, and families as active decision-makers.
• By the People means inviting them to co-create spaces that reflect their voices and values.
• For the People means designing environments that serve not just physical health, but emotional and spiritual well-being.

These are not lofty ideals. They are the foundation to design spaces that people genuinely love.

The Science of Beauty and Belonging

Today, neuroscience confirms what many of us in the healthcare design field have intuitively felt for years: Being in an environment that positively resonates with you, can have a similar emotional effect on us as being in love with a person. When people are in spaces where they find beauty that they relate to, their brains release neurochemicals—such as dopamine, serotonin, and oxytocin—that are associated with feelings of love, calm, and trust. These emotions help reduce stress, improve mood, and can even support the body’s healing processes.

The emerging field of study, known as neuro-aesthetics, demonstrates that our environments are not neutral; they are powerful influences on how we perceive and respond to the spaces we inhabit. In healthcare, this means that design decisions can have a direct impact on health outcomes. By designing for beauty and a sense of belonging, we create spaces that promote healing.

Designing With, Not For

Early in my career, I overheard a group of nurses say, “Let them spend all the money they want—six months from now, we’ll be back to doing things the old way.” That moment was humbling. It reminded me that no amount of design brilliance can compensate for a lack of engagement.

At Aesthetics Inc., we’ve learned that true transformation occurs when the people who use a space are part of its creation. Involving staff, patients, and families in visioning sessions, workshops, and creative collaborations ensures that the environment reflects their desires—not just our vision.

One of my favorite examples of this approach comes from Penn State Health in Lancaster, Pennsylvania. As the organization prepared to open a new hospital, leaders asked a profound question: How can we make this place feel like it belongs to everyone? Together with their Director of Humanities, Claire DeBoer, we formed a multicultural art committee composed of community members and staff. We specifically sought artists of color to ensure the collection reflected the diversity of the region.

The result? Over 25% of the art featured diverse perspectives—far above the industry average. Patients began to say things like, “I’ve never seen someone who looks like me on these walls before.” That’s not just inclusion—it’s belonging. And belonging is one of the deepest expressions of love.

Community as Creator

We’ve witnessed the same power of collective creation at Montreal Children’s Hospital, where a visioning session led to something extraordinary: a 15-by-30-foot mural made from 750 individual tiles painted by patients, families, caregivers, and community members. Each participant received a small canvas and a few colors to express whatever they wanted. When assembled, the tiles revealed the Montreal skyline and an image of a mother and child whale.

When the mural was unveiled, the room was filled with the very people who had helped paint it. They weren’t just looking at art—they were looking at themselves, reflected in their healing space. That’s the essence of “of the people, by the people, for the people.”

Four Pillars of a Loved Space

Throughout my career, four guiding principles have shaped how I approach every project—from children’s hospitals to rehabilitation centers to community clinics:

1. Never Stop Learning – Every challenge and mistake is a classroom.
2. Design Beauty That Moves People – Beauty with meaning heals.
3. Build Relationships That Last – Collaboration is the soil where great ideas grow.
4. Lead with Courage and Heart – Because leadership without heart is hollow.

When we design healthcare environments through these lenses, we create not just facilities, but supportive communities.

What We Protect, We Love

Over the years, I’ve noticed a pattern: hospitals and clinics that are loved don’t just age well—they endure. Staff take pride in them. Communities rally around them. Administrators fight to preserve them.

Why? Because we protect what we love.

That’s why our design goals must extend beyond compliance and efficiency. We should be asking:

• Does this place feel safe?
• Does it foster connection?
• Does it reflect the people who use it?
• Does it support the dignity of all patients, families and staff?

When we design with beauty, empathy and courage, we create places that don’t just serve care—they inspire it.

A Call to Leaders and Change Agents

As healthcare leaders, designers, and decision-makers, out facilities must reflect the best practices and state of the art technologies. In addition, we need to design environments that improve the experience of being in a medical center for all of the people who visit and work there.  When we invite people into the process, they don’t just use the space, they love it, they protect it, they make it their own.

We need:

To listen deeper.
To invite more voices in.
To create places that are not just for people—but of them and by them.

When we do, the patient who walks in afraid will feel calm.
The nurse who walks in exhausted will feel valued.

The family member who walks in heartbroken will feel hope.

Because in the end, we’re not just building healthcare environments.
We’re building trust.
We’re building community.
We’re creating environments that are loved.

~ ~ ~

Annette Ridenour is the president and founder of Aesthetics, Inc., and has led the field of healthcare design for over 45 years. For these nearly five decades, Aesthetics has collaborated with hospitals, clinics, and wellness centers throughout the U.S. and Canada to create spaces that promote healing, reduce stress, and reflect the values of the communities they serve.

By: Mike Domitrz, CSP, CPAE
Charlotte, N.C.

The future of healthcare won’t be built solely with cutting-edge design or advanced technology. Its real strength lies in something less visible, but far more powerful: a culture of respect practiced daily.

Step into any hospital and you’ll hear the familiar buzzwords: innovation, safety, patient experience. But beyond the public messages and polished mission statements, a quieter crisis plays out. Staff burnout. Departmental silos. Disengagement. These are not symptoms of a flawed floor plan or outdated HVAC system. They are cultural fractures, and they run deeper than design.

What sets thriving healthcare facilities apart from those that struggle, even when resources are comparable? It isn’t always funding or staffing. It’s the often-unseen framework that holds everything together: respect.

Respect in healthcare isn’t just politeness or professionalism. It’s a shared commitment to seeing the human being behind the role, whether that’s a custodian, a nurse, or a facilities manager. It shows up in the small moments: the architect who includes maintenance staff in early planning meetings, the OR manager who asks for feedback before rolling out a change, the contractor who listens before jumping to solutions.

Respect in Design: From Concept to Construction

Respect begins long before the ribbon-cutting ceremony. In fact, some of the most powerful decisions about culture are made during design charrettes and early-stage planning meetings.

Architects, engineers, and facility planners have a unique opportunity to embed respect into the very blueprints of a healthcare space. For example, engaging frontline staff early in the design process can result in more efficient workflows and fewer costly redesigns later. A nurse’s insight about patient flow or a custodian’s comment on access points can dramatically impact how well a facility functions.

Even decisions about shared spaces, such as restrooms, locker rooms, and break areas, signal how much a facility values inclusivity and well-being. Are there quiet spaces for reflection? Are restrooms gender-inclusive? Is there daylight in the staff lounge? Each of these seemingly minor choices communicates volumes about whether an organization sees its team members as expendable or essential.

It’s also about how construction teams are treated during the build. Do they have proper break areas? Are their voices included when adapting plans to site realities? Respect at the construction level models the values that will later permeate the completed facility.

The design and construction phase is also where values are either honored or abandoned. If time pressures push stakeholders to skip listening sessions or redesign meetings, respect erodes before the doors even open. Instead, honoring process and presence, especially with the people who will live and work in the space, cements trust early.

Respect in design also extends to post-occupancy evaluation. Too often, the conversation ends when construction wraps. But the most successful facilities integrate feedback loops long after the ribbon cutting. Asking, “How is this space working for you now?” signals that respect doesn’t end with the build, it evolves with the people who occupy it.

Building Trust Across Departments

One of the biggest obstacles in healthcare environments is the silo effect. Clinical, facilities, operations, and administrative teams often work in parallel, rather than in true partnership. This disconnects leads to delays, miscommunication, and a breakdown in trust.

Respect is the bridge. It can dissolve silos by encouraging cross-functional collaboration and validating every team member’s perspective. Consider this: when facilities teams are regularly invited into conversations about patient experience, they begin to see themselves as integral to healing, not just maintenance.

A real-world example comes from a regional medical center in the Midwest. The hospital implemented a monthly interdepartmental “walk and talk,” where leadership, housekeeping, clinical staff, and engineers toured the facility together. These informal rounds allowed everyone to share feedback in real time, from lighting issues to noise levels, and created a shared sense of ownership. The result? Increased morale, faster problem-solving, and even a drop in safety incidents.

Cross-training and job-shadowing are other powerful tools. When team members understand each other’s pressures and priorities, empathy increases and assumptions decrease. Facilities staff shadowing a nurse during a shift or IT observing environmental services operations during turnover deepens understanding and eliminates stereotypes.

Facilities planners can take the lead in bridging silos by creating opportunities for connection: joint planning retreats, multi-disciplinary task forces, or even informal lunch-and-learns. These settings foster shared purpose and bring voices into alignment.

Respect and Leadership: More Than a Buzzword

Leaders set the tone. When respect is modeled from the top, it becomes the norm rather than the exception. Leaders who admit mistakes, ask questions, and listen actively encourage others to do the same. This vulnerability doesn’t signal weakness, it signals strength rooted in trust.

Yet too often, leadership development focuses on efficiency and decision-making without equally investing in relational skills. That imbalance creates tension. When decisions are made quickly without cross-level input, frontline staff feel sidelined. Over time, disengagement grows, and the organization suffers.

A respect-centered leader doesn’t just talk about open-door policies, they actively create spaces where people feel safe bringing hard truths. These leaders routinely ask:

• “How are we making space for others to lead?”
• “Who is missing from this conversation?”
• “What have I assumed that I should instead ask?”

In design and facilities leadership, this means involving not just department heads but those who clean the floors, repair the HVAC, and escort patients through the hallways. Because the people who experience the space every day know where friction lives, and where opportunities for healing begin.

Operationalizing Respect: Daily Choices, Measurable Outcomes

Respect doesn’t have to be vague or aspirational. It can be tracked, taught, and reinforced.

One effective model is the “9 Daily Displays of Disrespect.” These are common, often unintentional behaviors that erode trust, like interrupting, dismissing input, or failing to follow through. Naming them openly helps teams develop awareness and language around the subtle ways culture is weakened.

The solution? Leaders and teams can intentionally practice the “9 Daily Choices for Respect”:

• Active listening without distraction
• Acknowledging others’ stress or contributions
• Asking before advising
• Following through on small commitments
• Giving others the benefit of the doubt
• Respecting personal space and time
• Being transparent about decisions
• Admitting when you’re wrong
• Creating space for others to speak

These aren’t corporate fluff. These are practical behaviors that can be observed, modeled, and encouraged.

Hospitals and health systems that have embraced this approach are seeing measurable results. Turnover rates decrease. Patient satisfaction scores rise. Communication improves. Even profitability increases as staff retention saves money and improves service continuity.

Some facilities go further by incorporating respect into performance metrics. For instance, evaluating team leads not just on efficiency but on psychological safety and trust-building. When the reward system aligns with the culture vision, behaviors follow.

Incorporating respect training into onboarding and annual reviews is another way to normalize these expectations. When new hires see respect modeled from day one, and tenured employees are held to the same standard, a clear and consistent culture begins to take shape.

Facilities That Heal Need Cultures That Care

Space design influences behavior. But culture determines whether that design can fulfill its promise.

A well-designed patient room is only effective if the staff using it trust each other. A state-of-the-art surgical wing only delivers exceptional outcomes if the team inside feels heard and supported.

During the COVID-19 pandemic, many organizations learned this the hard way. Facilities scrambled to adapt, but the environments that adapted best were those where respect was already embedded. These teams had the agility and cohesion to pivot quickly, not just because of protocols, but because of trust.

Even something as small as signage can be infused with respect. Wayfinding that considers different languages, abilities, and anxieties transforms the patient journey. Likewise, staff-only spaces that are clean, calm, and thoughtfully placed signal to teams: “You matter here.”

How space is maintained also speaks volumes. Facilities management isn’t just about upkeep; it’s about supporting well-being. Respect means cleaning schedules that consider noise levels during rest periods, temperature control that accounts for different comfort needs, and lighting that supports circadian rhythms.

An emerging area of interest is trauma-informed design, which aligns perfectly with respect-based values. From sound scaping to materials selection, design decisions can calm the nervous system and promote psychological safety, especially for populations with heightened stress, such as pediatric patients or veterans.

The Respect Blueprint for the Future

As healthcare continues to evolve, respect must become a standard design input, as essential as square footage or infection control.

Future-ready facilities will:

• Co-design with input from every department
• Build physical spaces that promote collaboration and care
• Evaluate staff experience as rigorously as patient experience
• Train leaders in respect-based communication
• Use respect as a lens for every policy, from scheduling to signage

Organizations must also be willing to confront hard truths. If high turnover persists or communication breakdowns continue, it’s time to ask: Where is respect breaking down? Is it the environment? The workload? Or how feedback is handled?

Respectful cultures don’t emerge overnight. They are cultivated through consistency and accountability. They require aligning mission statements with daily behaviors. And they depend on people willing to pause, ask, and listen, especially when it’s uncomfortable.

Most importantly, respect is a shared responsibility. It isn’t the burden of one department or leader. It’s the daily commitment of every individual, in every role, across every square foot of a facility. And when that commitment is sustained, it becomes the unseen architecture of transformation.

Conclusion: Leading with Respect

As we look ahead to the next Healthcare Facilities Symposium & Expo, one truth is clear: We cannot design for healing without designing for humanity.

Let’s go beyond square footage and cost per bed. Let’s build facilities that empower everyone inside to thrive, because when we build with respect, we build spaces that truly heal.

The strongest foundation isn’t poured in concrete. It’s practiced, moment by moment, in the way we treat each other.

Respect is not a trend, it is infrastructure. And like any infrastructure, it must be maintained, tested, and renewed. Every interaction becomes part of the blueprint. Every team member becomes part of the build.

Let’s start there.

By: Melanie Viquez, Yellow Brick Consulting

When your construction timeline is locked, your activation schedule is tight, and your equipment list is approved, there’s one thing you can’t control — external risks. In 2025, tariffs on imported electronics and medical devices have become silent disruptors behind many hospital activation delays.

Even as the U.S. healthcare system continues to build, renovate, and modernize, a shifting tariff landscape is extending lead times for essential equipment. From patient monitoring systems and infusion pumps to the digital clocks that keep entire facilities synchronized, tariff-driven reengineering and supplier rerouting are slowing the delivery of critical components that brings a hospital to life.

The new tariff reality

Recent trade actions have created a patchwork of overlapping duties on medical devices and components sourced from China and Southeast Asia. Some categories now carry combined rates exceeding 50% (https://www.aha.org/news/headline/2025-10-17-aha-expresses-concernspotential-tariffs-ppe-other-medical-goods), while others have temporary exemptions under review. Hospitals and suppliers alike are navigating a moving target one that changes as investigations and countermeasures unfold.

The U.S. government’s Section 232 investigation into medical supplies, launched this fall, adds another layer of uncertainty. Meanwhile, manufacturers are reporting steep production costs, cancelled U.S. orders, and delays as they re-engineer or relocate assembly lines.

The American Hospital Association (AHA) (https://www.aha.org/lettercomment/2025-10-17-aha-responds-department-commerces-rfi-ppe-and-medical-equipment) and industry groups such as AdvaMed have publicly urged policymakers to exclude essential healthcare products from these tariffs, warning that they could compromise access to vital equipment. But until that happens, healthcare construction and activation teams must treat tariff exposure as a project risk — not an afterthought.

How tariffs translate into activation delays

Even when a product is labeled “Made in the USA,” its components often aren’t. A patient monitor, for example, may contain circuit boards, power modules, or display panels produced in China or Malaysia. When tariffs apply to any part of that chain, the ripple effects cascade
quickly:

1. Price pressure: Manufacturers pass through higher landed costs or impose temporary surcharges.
2. Re-engineering: Components are swapped for alternatives, triggering new quality testing or regulatory recertification.
3. Supplier rerouting: Shifting assembly to new facilities often resets the production queue and extends delivery windows.
4. Allocation limits: Original Equipment Manufacturers (OEMs) prioritize large health systems or high-margin customers, leaving smaller projects waiting.

The result? Key activation items that once shipped in 8–10 weeks can now take 16–20 weeks or longer — even before considering logistics or installation sequencing.

The top product categories at risk

Based on recent industry data, the following categories have been identified has vulnerable to tariff-related delays and shortages:

• Imaging components and subsystems: Ultrasound transducer modules, detector panels, MRI console parts (8–20+ week delays).
• Patient monitoring systems and telemetry boards: Specialized PCBs and chipsets (6–16 weeks).
• Automated dispensing cabinets: Screens and sensors used in medication management (8–14 weeks).
• Infusion pumps and smart IV devices: Firmware-dependent systems (6–12 weeks).
• Network and wireless hardware: Routers, PoE switches, and access points (4–12+ weeks).
• Touchscreen displays and mobile workstations: Panels and processors assembled overseas (6–16 weeks).
• Digital clocks and synchronized time systems: Often overlooked but critical to testing and operations (4–8 weeks).

While each delay may seem manageable in isolation, multiple lagging components can ripple across readiness milestones and delay the overall occupancy timeline.

What project and procurement teams can do now

1. Identify high-risk items early.
   Start with your top 25 equipment categories and map each by vendor, origin, and regulatory sensitivity.
2. Confirm lead times directly with manufacturers.
   Don’t rely solely on distributor data — request updated factory lead times and certification that no design or component changes are pending.
3. Negotiate tariff clauses in contracts.
   Require vendors to disclose country of origin and current tariffs at the time of purchase order execution. Include language that limits pass-through surcharges or mandates advance notice of price changes.
4. Build lead-time buffers into your schedule.
   For high-risk items, apply 20–30% schedule float. Flag any equipment dependencies tied to installation sequencing, such as network activation or pharmacy readiness.
5. Secure alternate suppliers or models.
   If your primary vendor’s equipment is tariff-affected, identify equivalent systems from U.S. or non-affected regions. Maintain flexibility in your specifications where clinically appropriate.
6. Pre-purchase or stage critical items.
   Where storage permits, buy early. If not, explore vendor-owned inventory or local warehousing or staging options.
7. Stay close to your procurement consultant and supply chain team.
   They can help assess which equipment lines are most affected in your region and navigate group purchasing contracts or tariff exclusions.

Contract language worth revisiting

Hospitals executing new contracts should work closely with legal and procurement teams to ensure the following:

• Origin certification: Require disclosure of country of manufacture and subcomponent sources.
• Fixed-price periods: Lock pricing for a defined term or require written justification for any tariff-driven increase.
• Lead-time notice: Vendors must notify buyers within 30–60 days of any expected delay or cost change.
• Priority allocation clause: Define escalation paths if supply is constrained.
• Force majeure language: Ensure tariffs trigger collaboration, not automatic cancellation or penalty.

Even small contractual refinements can help mitigate both cost and timeline exposure later.

The takeaway: plan, buffer, and verify

Tariffs and trade policies may feel distant from the realities of hospital activation — but their impact is very real. Lead-time extensions, re-engineered models, and cost escalations are no longer isolated events; they’re structural risks that must be tracked and managed alongside
construction milestones.

To keep projects on schedule, engage early and stay aligned:

• Confirm with your equipment procurement consultant which products face risk in your market.
• Coordinate with your health system supply chain to understand any region-specific challenges or alternative sourcing options.
• Build procurement checkpoints into your activation timeline to verify that each system — from monitoring to medication dispensing — arrives ready for Day 1 operations.

Make tracking the policy landscape and supply chain data part of your readiness plan to help teams stay ahead of risk.

By: Heather Hayes, Senior Advisor, McMillan Pazdan Smith Architecture

Healthcare leaders are navigating extreme constraints — juggling persistent workforce shortages, rising labor and supply costs, unpredictable reimbursement and growing pressure to expand access to care.

At the same time, expectations are rising. Patients want more convenient options. Providers need spaces that support new care models. And administrators are tasked with modernizing facilities without overextending already strained budgets — all while facing rising Medicare Advantage denials and looming Medicaid cuts that threaten long-term financial stability.

Expansion and renovation aren’t off the table. But the margin for error is gone. Every capital investment must be sharper, more data-informed, and more tightly aligned with real community needs.

That’s where advisory services come in.

Why Advisory Services Belong at the Starting Line

Traditionally, the design process begins when a client approaches an architecture firm with a defined vision: often a general sense of size, location and services based on internal planning. Advisory services build on that foundation, bringing added rigor and objectivity to the process. Instead of starting with assumptions, we start with analysis, helping teams test ideas against real data and explore new possibilities before making major investments.

In healthcare, data drives everything. It’s how clinicians diagnose patients, and it should be how leaders diagnose markets too. Advisory services bring that same clarity to facility planning. They help teams uncover what is truly needed, what is sustainable and where investments will have the greatest impact.

This includes both quantitative data (e.g. market projections, service line utilization, demographic shifts) and qualitative input like patient and provider feedback. Together, these insights help define what the facility should be before we ever sketch a floor plan.

When advisory services are integrated within an architecture firm, that strategy doesn’t get lost in translation. It travels with the project. The team responsible for programming and design understands the “why” behind every decision, making it easier to stay aligned, resist scope drift and plan for every square foot to be working towards the overall project mission.

How the Right Questions Changed the Outcome

The value of early advisory engagement comes into sharper focus when you see it in action. Two recent projects — one urban, one rural — show how data-driven planning helped healthcare systems make smarter, more sustainable capital decisions.

Prisma Health | Northeast Columbia Medical Park
Prisma Health came to the table with a bold goal: create a model for ambulatory care that could be adapted and scaled across markets. The challenge was to right-size the facility in a way that aligned with both community demand and long-term operational efficiency.

Through a combination of patient surveys and analytics, we helped the team define what the community wanted from their care experience and what the health system needed to deliver it sustainably. One surprising insight was a significant overestimation of the number of check-in kiosks required. By modeling actual patient flow and preferences, we reduced the total number of kiosks, saving both space and cost.

We also helped establish a standardized clinical pod model, avoiding the inefficiencies that arise when individual providers dictate custom layouts. This flexibility facilitated higher utilization rates across teams. In total, the data-driven programming process helped Prisma reduce the building size by over 14,000 square feet and save more than $6.3 million in construction costs without compromising quality or access.

CIHA | Tsali Long Term Care Facility
In rural Western North Carolina, the Cherokee Indian Hospital Authority faced a fundamental question: where to build? McMillan Pazdan Smith was initially brought in to support programming, but it soon became clear that larger strategic decisions needed to be addressed first.

Our advisory team conducted a financial feasibility study and market assessment to evaluate multiple sites and service scenarios. The data showed that a high-elevation site would require significant earthwork, costing $20 million more to develop than an alternative lower-elevation location. The analysis also confirmed a strong market demand for assisted living services, supporting the case to include it in phase one of the project.

Site selection also influenced building form, from the number of floors to the organization of wings, which directly impacts operational efficiency and long-term staffing needs. Because labor is one of the highest costs healthcare systems face, this connection is critical. By evaluating these downstream implications early, the team was able to align the site, building layout and staffing model, ultimately moving forward with confidence that their investment would deliver long-term value to both patients and the broader community.

Getting It Right Before You Build

Across the industry, healthcare organizations are reexamining how they plan and invest. As many health systems regain operational footing and capital planning gains renewed focus, leaders are shifting to more deliberate, enterprise-wide growth strategies. Strategic planning is no longer reserved for isolated initiatives — it is the foundation for aligning financial, clinical and operational priorities before major decisions are made.

Today’s capital projects face more scrutiny than ever before. Decisions around location, sizing and service mix have real financial consequences and must be made with precision. Advisory services offer a strategic advantage by helping systems:

• Ground planning in real data (not assumptions)
• Balance flexibility and standardization to optimize operations
• Avoid costly missteps that derail projects or erode ROI

Perhaps most importantly, integrating strategy and design under one roof enables continuity. It creates a single, accountable team that carries the vision from initial planning through design execution, what we often call the “keeper of the strategy.”

In an environment where the stakes are this high, that kind of alignment isn’t just helpful. It is essential.

About The Author
Heather Hayes, MHA, is a senior advisor with McMillan Pazdan Smith Advisors, helping healthcare organizations make smarter capital investments through data-driven decision-making and community-aligned strategy. From market assessments to service distribution planning, MPS Advisors works at the intersection of design and strategy to help clients right-size facilities, align operations with future demand, and bring stakeholder priorities into focus. Learn more at mcmillanpazdansmith.com.

By: Dr. Wayne Ruga, Founder, Healthcare Facilities Symposium & Expo

In Alessandro Caruso’s reflective life account, he describes a chance encounter with a Zen monk, who told him: ‘that the duty of a Zen chef is to prepare the best and most succulent meal with the ingredients available, even if they’re only water and rice.’  Alex then reflects, ‘There’s no point in complaining about the ingredients that aren’t available.’  This extract from design & meditation is just one of so many life experiences that Alex so vividly renders and uses to explain how they inform his life and design practice, as he progresses in his career as a successful architect focused on the creation of life-enhancing environments.  Another of Alex’s extracts, explains:

‘No matter how serious my accident was, I chose to change the course of my life by expressing my creative energy with positive meditation, daily exercise, and trying to improve people’s lives through my designs.  I believe that my increased sensitivity to pain has given me the best opportunity to understand the sense of euphoria when experiencing a healing environment.  With an open mind towards the full range of human experiences, I’ve learnt that sickness and healing are inseparable and require constant balancing and mindful choices.  The ongoing investigation into the perception and observation of other people’s feelings through the lens of my own experience, is put into practice through our projects and is observed again through the lenses of the building users.’

Alex Caruso will present a talk about design & meditation in the Symposium Expo, on Wednesday, 24 September.  Copies of the book will be available for purchase and a personal inscription by the author.  Please check the Special Events calendar for the time and location.

On Wednesday, 24 September, 11.15 – 12.15. Alex will also be facilitating a session titled:    A Participatory Discussion to Explore How New Understandings of Quantum Architecture Can Enhance Health and Wellbeing.  Please check the Schedule for the room location.