Mastering the master planning process

Evolving market requires new master planning approaches

By Steven Alby / Special to Healthcare Facilities Today
May 22, 2020

Now, more than ever, it may seem difficult to identify time to address major planning goals, but a widespread industry challenge such as the COVID-19 pandemic exposes opportunities for improvement as infrastructure is tested.

Simultaneously, there is also time to pause infrastructure development efforts as non-essential activities grind to a halt, making way for strategic efforts such as master planning.

As healthcare transitions to a value-based model with an increasing focus on wellness and preventative care, healthcare organizations are seeking opportunities to tailor their services to the communities they serve.  To support these services, the facilities being planned are evolving as well, making the planning process more complex and involved than it has been historically.

Traditionally, master planning has focused on the acute care hospital campus by identifying ideal locations for expansion and addressing both infrastructure deficiencies and building obsolescence through a lens of future growth. In today’s competitive healthcare industry, the process must also address how to leverage an organization’s physical plant to support the full continuum of care and develop an ambulatory strategy that deploys wellness, primary care, and specialties. Below are insights for navigating and mastering the master planning process.

Participation Is key. The positioning and “evolution” of an organization’s total real estate holdings must be in alignment with their high-level mission and strategic direction. Because of this organic connection, the master planning must be developed internally and not as a passive activity outsourced to consultants and then presented to senior leadership at the end of the engagement.  Successful master plans are the result of a robust, collaborative process involving hospital leaders at multiple levels.

While the facilities manager may be responsible for coordinating the process, diverse stakeholder input is critical. Seek to engage and obtain input from all levels of the organization, including C-suite decision makers, physicians, nursing staff, board members, and community representatives, involving patients and their families. This ensures that multiple viewpoints are considered and contributes to consensus building that gives participants ownership of the master plan and empowers them to implement it.

Every hospital is different. Many healthcare organizations use metrics and benchmarking to streamline the master planning process, but it is important to account for unique demographics that drive different service lines and use rates. For example, a patient population in Florida, which has the highest percentage of residents over 65 in the country, will require different service lines and different ratios of high acuity and outpatient spaces than one in Colorado, where the median age is 37.6 years.


Data. Data. Data. Often healthcare organizations take a Field of Dreams approach to adding new service lines, assuming an “if you build it, they will come” strategy based on potential high profit margins for certain service lines like orthopedics and oncology. Incorporating specific data based on the communities served in the master planning process mitigates the potential for an overbuild – for example, a cancer center with 40 infusion bays when the market catchment area will only support 20.


Operationalize your strategy. Use the master planning process to better understand how each service line works: The patient flow, volume, and caregiver-to-patient ratio can vary significantly from one service to another. As a starting point, planning teams want to understand how each service line currently operates in its existing space, creating a foundation for Current State vs Future State workshops to identify potential space saving efficiencies. 

It is also worth considering a department’s current location relative to other departments and whether they could be collocated more effectively to optimize efficiency. For example, perhaps a department that appears to have outgrown its space could simply move, rather than grow. Getting an accurate picture of their day to day operations and how they use their existing space is crucial in developing strategies for growth and future flexibility. 

Factor in financials. At the core of planning, budget drives implementation. A master plan that does not reflect the financial realities of the healthcare organization will only sit on the shelf. A cost estimator who has specific experience in pricing healthcare projects can be an important member of the master planning team, aligning strategy with financial capability. 

When planning budgets, remember that the costs for a new facility or expansion into a new service line include more than the cost of the physical assets of building and equipment. There are costs for staff and the operation of the facility that are key to the budget planning as well as costs associated with physician recruitment, training, and marketing.

Less is sometimes more. Many healthcare organizations approach master planning as an exercise in understanding how best to expand and build new on their campus. With healthcare becoming increasingly focused on population health management and wellness initiatives, a robust ambulatory strategy is often needed to complement the inpatient campus strategy.  The acute care campus is naturally a transition to smaller, more compact, higher-acuity facilities that deploy growth in the form of lean operations strategies and other creative means rather than strict physical expansion.

Effective hospital master plans have expanded to address community care and an ambulatory strategy. Ambulatory overlay strategies examine how outpatient buildings might be deployed into the community to improve access to care at lower costs. The master planning process can be a tool to scrutinize the utilization of existing buildings and investigate options for repurposing them to support priorities such as outpatient services. While examining renovation options, be sure to include estimates for new construction, which can often be less expensive than retrofitting.

New projects continually break the mold as the care model shifts from treatment to wellness. The ultimate manifestation of this is a migration to active, retail-oriented community spaces that have multiple wellness-related offerings that forma “wellness village.” These could include open park settings with walking trails, farmer’s markets, or yoga classes. The surrounding facades include medical offices interspersed with fitness centers and health eateries, offering visitors a robust and appealing wellness solution that promotes the idea of keeping people healthy over treating them when they are sick.


Mastering master planning. The master planning process can be complex and difficult to navigate. When done correctly, a successful master plan provides a “living document” that functions as a framework and clear directive for decision-making.

Involving diverse stakeholders in the process ensures that the master plan establishes a uniform vision that is shared among all members of the organization. That ownership fosters an increased level of commitment to the organization and its goals, improved quality of service, and a pathway for future growth.

By the end of the planning process the master plan becomes your master plan. Because of their hands-on role, stakeholders understand the decisions that led to the final plan and how those visions inform its implementation. They’ll also understand what not to do thanks to the detailing in the plan itself. Leaders who to have taken the time to participate in the plan’s creation not only understand it, they own it, having mastered the master planning process.

Steven Alby, NCARB, LEED AP, is vice president, healthcare, with GMC.  He can be reached at

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