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.