Common Challenges in Hospital Planning

Posted on 02-April-2020 at 02:31 PM

Strategic plans that align everyone under the same mission, vision and values are critical for hospitals to succeed in today's challenging healthcare environment. Strategic plans help hospitals prioritize their goals and rally everyone's efforts toward reaching specific outcomes. Many hospitals, however, fail to create a strong strategic plan that unifies the organization.

1. Loosing sight of the mission.

Many hospitals attempt to develop a strategic plan without examining their mission statement. This is a critical first step because the mission begets the vision, which informs the strategic plan. Some signs of weak mission statements include the following:

• They don't elicit an emotional, motivational response in hospital staff.

• They are not easily understood or transferable into individual action every day.

• They are not firmly rooted in the competitive environment in which they operate.

2. Creating a plan that is short-sighted and non-positional. Strategic plans should include strategies for differentiating the hospitals from competition.

3. Not aligning operations and people. For strategy to be effective it must be aligned and integrated with the organizational structure, operations, culture and people.

4. Failing to include key stakeholders. hospitals should create a committee of people that includes representatives of key stakeholder groups, such as primary care physicians, faculty, employees and the board of directors. These representatives can then lead subcommittees that focus on specific strategies. This will provide a more comprehensive view of the institution and create a sense of ownership,

5. Relying on one's own perceptions. The objectives and tactics in a strategic plan are valuable only if they are based on reality. Hospitals need to ground their strategies and goals in data from impartial market analyses and not rely on their own perceptions

6. Not translating the strategy to specific tactics with measurable goals and timelines. Strategies are broad approaches to meeting a goal, while tactics are specific actions needed to reach the goals. A strategic plan without tactics makes it more difficult to implement the plan and achieve its goals. "Tactics and milestones define accountability and provide support for each person charged with moving the strategy forward,"

7. Forgetting about culture. The idiom "Culture trumps strategy any day" is true in healthcare. Hospitals should provide reward and recognition systems that support a culture that is needed for the strategic plan to be successful. "Unless the leadership clearly demonstrates the specific values it wants to promote, then culture will not change,"


1. Solve systems, not problems.

a. Adding space solves a problem temporarily; the return is better when the system is fixed permanently.

b. Communication and collaboration with the actual facility users is essential; the wisdom and buy-in of the human capital can make or break the plan.

2. Focus on real population needs, not perceived needs.

a. Avoid the “field of dreams” mentality, because they may not come.

b. New facilities will not change the usage rates of current populations.

c. Use data and sensitivity analyses to determine ultimate facility requirements.

3. Be accurate, not precise.

a. Data is great, but it can be distracting.

b. Facility and space requirements are not the same as financial reporting. Beds typically fill the overall space provided in blocks that are accurate ± 30, so a projection of 280 beds versus 300 beds will likely result in the same yield in the end.

4. Room size doesn’t matter, but quantity does.

a. There is a temptation to focus on reducing the size of rooms to save on capital costs; however the number of rooms drives the costs of equipping those rooms.

b. The quantity of rooms is based on critical forecast and through-put assumptions.

5. Focus on function over preference.

a. The plan should be driven by the goals and critical success factors of the organization. Keep those uppermost in the planning process and communications.

b. Use the critical success factors to audit the layout options.


1. Designing safety from the very beginning

Existing facilities have persistent problems that must be recognized and mitigated through data-driven design. These include safety issues, hospital-acquired infection, and worker fatigue. New hospitals will increasingly serve elderly patients who will require facilities designed to safely accommodate them.

Additionally, threats to patient safety such as medication errors, falls, and transfer errors can also be minimized through strategic planning that increases lighting, reduces noise, provides visibility of patients to the nursing staff.

2. The lessons of the flat world phenomena In the global economy, people travel more; the supply chain is global; the media provide awareness of global disasters. The flat world lends itself to the global spread of disease, to the assistance in recovery of disasters, and to the potential disruption of pharmaceutical supply chains. Hospitals require planning for expansion and reduction of capacity within the physical environment to accommodate the flattened world.

3. Embracing Flexibility The manufacturing sector is building flexibility into its operational processes. Hospitals must likewise be build in flexibility. However, unlike in the manufacturing environment, such flexibility comes through standardization of rooms, equipment, and processes. Such design reduces the costs of disruptions by providing a consistent context for varying process pieces to occur in varying and often unpredictable sequences and frequencies.

4. Safety is equally important for hospital employees as for patients and families. Facilities should be designed to move supplies closer to their intended usages to reduce travel and walk time for care givers. Use ergonomic technologies to reduce heavy lifting, transporting, and turning of patients. Beyond increasing safety, such designs contribute to a culture of safety that benefits all those who enter the facility.

5. Design for sustainability and healthy living spaces. Historically, hospitals have not been environmentally friendly. Chemicals have been used in hospital building supplies and medical supplies; hospital emissions have created toxic spaces for patients and health care workers.

In addition, hospitals should be designed to be energy efficient with low carbon footprints and high percentages of recycled materials.

Food served should promote wellness using healthy ingredients that are local, humane, and environmentally protective.


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