The development of healthcare megaprojects—those topping out at more than 1 million square feet and 1,000 beds— is continuing to grow globally, especially in Asia and the Middle East. This can offer significant opportunities for U.S. design firms, as American healthcare design and planning remains a gold standard throughout the world and is greatly desired in emerging economies.

But there are plenty of challenges in working overseas and on megaprojects, specifically.

Planning and design
Planners and designers must first understand the cultural differences and healthcare delivery models of various countries. This is coupled with building a client relationship: A U.S. firm’s involvement is usually “one and done” and isn’t likely to bridge many years or projects.

There may also be the feeling of “designing in a vacuum,” as oftentimes there are ill-defined functional space programs since staff likely hasn’t yet been contracted nor have operations been defined. 

Many countries have limited strategic planning, too, with project size derived rudimentarily and subject to change. For example, on one Middle Eastern project, the bed count grew from 1,000 to 1,500 while the contract was negotiated.

Despite these challenges, there’s more of an opportunity to introduce best practices and innovative design ideas with this blank-slate approach.

Operations and logistics
The size of healthcare megaprojects means early analysis at an urban planning scale, and the efficient circulation of people and materials is key. Wayfinding is extremely important given the amount of staff, patients, family, and destinations. The logistics of moving supplies throughout massive footprints can include robotics, high-speed supply lifts, and large-scale pneumatic tube systems.

In isolated locations, operations must be sustainable, requiring long-term storage of supplies and replacement materials contrary to the “just-in-time” approaches often used in the U.S. To support the overall healthcare enterprise, a “medical city” may be formed and include housing for staff, transportation systems, teaching facilities, hotels for visitors, and other amenities.

Constructability is also affected by remoteness and access to materials. Imported materials can be costly and limited by the local distributor’s network. Research on indigenous materials must be done in advance, confirming availability.

Project management
To manage projects of this scale, project delivery best practices must be supported by digital systems, especially if work is divided over many time zones. Typically these megaprojects have super-aggressive project schedules and fees. Driving client approvals can be problematic, too, if decision-making responsibility is unclear. Defining contractual obligations is very important as well as detailed record-keeping of issues and decisions—there will literally be thousands of them to track.

Global healthcare megaprojects have many of the same issues as smaller projects in the U.S. but on an exponential scale. They require a well-structured, disciplined approach. Though not for the faint of heart, they offer enormous opportunities to flex design and planning muscles, and advance healthcare systems throughout the world through creative best practices.


This is the second part of Sheila Cahnman’s two-part blog on healthcare megaprojects. Read the first blog, "Healthcare Megaprojects: They Do Exist."