Master planning is a process that is comprehensive (if conducted properly), time-consuming, and requires soul-searching in determining a “vision” for the future of a hospital or a multihospital organization. It is also a process that has been undergoing significant change in recent years, as the healthcare marketplace evolves. To comprehend that change, let's compare the “old” master planning process with the “new.”

Financial Reality

Older master planning did not usually address financial concerns until after the overall facility solutions had been generated. Then, either budgeting or fund-raising plans were adjusted accordingly, or the master plan was squeezed and shoved into accordance with available resources. With the cash flow difficulties experienced by many hospitals these days, though, master planning efforts have begun to prioritize those healthcare services likely to generate cash flow the quickest, within the context of overall facility solutions. As a result, in recent years master planning has been conducted in collaboration with financial consultants, who review the fiscal viability of both present and proposed services. In line with this, the expedited preparation of proposed service expansion pro formas is useful. Cost-flow analysis can provide a timely “go/no-go” decision tool during the master planning process. Financial planners also can assess the impact of proposed new capital projects on the bottom line and can assist in phasing in projects based on projected revenue production and return on investment.

Formulating a “Vision”

Traditionally, facility master planning focused on the perpetuation of the “same old-same old” service array. Not surprisingly, the entire process was fairly oblivious to a guiding “vision” or desired long-range goal. Factors evaluated in the new master planning include:

  • A review of the entire array of services offered in the context of utilization, market share, staffing (physician and other), financial performance, technology, and “fit” within the organization's strategy.

  • Analysis of physician availability on a per-population basis and in the context of present and proposed services.

  • The unbundling of services to address ambulatory care service delivery in multiple locations, to enhance patient convenience.

  • An assessment of available “growth zones” to allow facility expansion that will accommodate new services; this includes developing the real estate strategy necessary to obtain property beyond the existing campus boundaries; a review of present zoning to develop a strategy for dealing with city or county zoning boards, if necessary; and consultation with local government officials to head off chronic and costly problems, such as parking shortfalls and traffic flow difficulties.

  • Public input into the selection and potential location of new healthcare services. This includes an analysis of patient satisfaction surveys and unsolicited complaints.

  • A review of the organization's historical cash flow, equipment acquisition plan, and current bond rating.

  • Encouragement of local group practices or medical faculty members to share their future practice plans, so that redundant resources are not developed. This is a prime opportunity, as well, to discuss joint venturing of some services.

  • A review of all computer-based technology needs as they affect future staffing and infrastructure requirements. Computer-related areas that could influence building design include: security, medical records, nurse-call systems, patient-tracking systems, pharmacy dispensing, and digital archiving of images. Other technology-related considerations include the potential use of robotics in the pharmacy, clinical labs, and operating suites.

All of these, and perhaps other factors unique to the organization, must be addressed candidly, with appropriate direction provided, before letting a building solution direct future growth.

Allowing for Contingencies

There is no question that older master planners dealt with change. Few fields, however, have ever matched healthcare in the pace and depth of their evolution. New master planners must accommodate this truth more than ever. Although master planning has sometimes been construed as taking a “snapshot,” most healthcare systems are far too dynamic for this. No one expects planners to perform crystal-ball-type forecasting, but today's master plan needs to offer at least a rough approximation of future developments in terms of service delivery, financial and demographic trends, and technologic development. Broad, in-depth knowledge of current trends is highly important.


It is clear that, today, the healthcare organization's vision and future growth scenarios should be developed prior to master planning. Conducting these activities after the planners are retained and deep into their work might ultimately slow the project and will almost certainly increase costs. Diligent efforts aimed at identifying who you are and who you want to be will greatly facilitate the master planning process and keep it relevant. HD

William Jackson is an associate with The Innova Group.