It might be tempting to think of hospitals and large medical centers as indestructible entities that once built stay built and can be ignored. While that is probably more or less true of the structural system, almost everything else that has been constructed has a lifespan measured in decades and will require some level of investment. That’s just the architecture and engineering—advances in technology, increasing patient acuity, improved clinical protocols as well as strategic positioning and growth (or decline) are constantly changing and require attention. All of this leads to master planning—determining the range of options for capital investment over time.
Master plans come in a variety of types, from the all-inclusive A (assessment) to Z (zoning) with demographic and market demand for every service line on every site to the focused “just tell us if this is the right site” engagement. Neither approach is necessarily better than another, but there should be consensus on the type of information desired from the master plan process (though not a pre-determination of the results and recommendations).
Challenge: Addressing strategic and scenario questions that might challenge the status quo of where and how care is delivered. A robust master plan will include ways of thinking about the things no one wants to think about. Hospitals struggled with COVID-19 in part because of a reluctance to heed the warnings made by many epidemiologists that another 1918-1919 flu was probable and because addressing the inherent issue of possible disruptions to JIT supply chains didn’t seem to merit attention.
A master plan typically consists of a mid-term (seven to ten years) framework for capital investment that delivers on the imperatives of a strategic plan (if there is one), and includes an analysis of the existing facilities, phasing implications, and projected cost estimates. Scope and square footage requirements should be driven by an understanding of the number of key rooms (e.g., patient rooms, operating rooms, etc.) which in turn should be driven by assumptions regarding utilization and operational models. In terms of future fit, a mentor of mine once said “design a mitten not a glove.” Master plans should have a basis for assumptions about future size requirements, but there should be allowances for wiggle room.
Opportunity: Assess possibilities of rethinking traditional departmental organization and operations with the aim of delivering higher quality care more efficiently.