I was reminded recently of one piece of the planning and design process that can make or break any healthcare project: community buy-in.

Just a couple of weeks ago, two stories were in the news that illustrate the weight that not only public opinion but the decisions of local officials can have on whether projects get the green light. In this case, the two projects in question saw two radically different outcomes.

In Brooklyn, N.Y., the news was good—for now—for New York Methodist Hospital, which is planning an expansion of its hospital in the Park Slope neighborhood of the city. However, the 300,000-square-foot Center for Community Health has had its fair share of resistance from community members who feel the project “has the potential to forever alter the essential character of Park Slope,” says one resident in a report from the New York Daily News.

Due to its location in the historic brownstone area, opponents say the eight-story building could overshadow nearby homes, while the expansion of services will likely bring more traffic. With the project making its way to the city’s board of appeals, members of that body voted unanimously to push it forward. However, a community opposition group is still eyeing up its options and looking to argue for the state to refuse New York Methodist’s certificate of need.

Meanwhile, not too far from Brooklyn, The Valley Hospital in Ridgewood, N.J., saw its eight-year attempt to expand struck down yet again due to community resistance, this time for its size. The hospital is asking to almost double its current 562,000 square feet in a residential neighborhood.

With the plan making it to the city planning board, members voted 5 to 2 against the expansion that was deemed “detrimental” to the community, according to a report from NorthJersey.com. Argued isn’t just the square footage (albeit, that’s a big piece of the squabble) but the construction process itself, with reports stating that residents object to the projected six-year schedule and in-and-out of workers and materials.

These types of scenarios are likely playing out all across the country. It’s important to keep in mind that no matter how great of a solution a healthcare provider and its design team have come up with to fulfill whatever needs have been identified, there’s always another party that has to be involved in the conversation.

And, luckily, there are plenty of great examples out there of organizations that have solved this particular challenge.

One that comes immediately to mind is Boston Medical Center’s Shapiro Ambulatory Care Center, which opened in 2011 in Boston’s historic South End neighborhood. And as you might have expected, local residents were pretty interested in how the new construction might impact the neighborhood, especially thanks to its nine stories rising above the predominantly low-rise area.

The design team used that resistance as inspiration for a building that today works well within the context of its brick row-house community, even introducing environmental graphics on the interiors that were drawn to depict neighboring structures. (Read more about the project here.)

And just today, I came across a news story from the Hamilton Spectator about the 42-year-old McMaster Hospital in Hamilton, Ontario, Canada, being given a landmark designation by the Ontario Association of Architects—a building that, too, saw its fair share of controversy back in the day. Construction of the building called for demolition of a garden as well as 90 nearby homes, with residents fighting the plan for years, one calling it a “monstrosity” and another deeming it “certainly no asset to the community,” the report reads.

But a few decades later, architect Ed Zeidler says in the article that the landmark designation shows that after some time, “you can find out that people really liked what you did.”

So what advice do you have for turning what might be seen as a monstrosity into what neighbors might someday herald as a good thing for their community?