Hospital expansions are vital strategic investments for hospitals across the U.S., addressing growing patient acuity demand, aligning nursing unit design with modern care delivery models, and enhancing operational efficiency.
When delivered successfully, they make a health system more marketable and appealing to the local population.
Based on the most recent national reporting from Becker’s Hospital Review and other sources (through late 2025), there are up to 20 major hospital tower projects currently in progress across the United States. These current expansions show how health systems are investing to meet future needs. Pictured above is Novant’s Forsyth Medical Center Critical Care Tower designed by McMillan Pazdan Smith, in association with Gresham Smith.
It takes a proven, experienced team to deliver a successful hospital expansion project. These projects are technically complex, and they impact a health system at every level. A successful hospital renovation or addition requires more than capital: it demands a structured process, on-going collaboration, operational foresight, disciplined scheduling, and cost management.
Here are some actionable tips used by McMillan Pazdan Smith to deliver a major healthcare expansion project.
1. A Strong Discovery and Healthcare Visioning Process
Healthcare visioning session.
Even before the first planning meeting, top-performing healthcare design firms spend significant time and effort understanding why an expansion or renovation is needed. This discovery, or visioning process, includes feedback and research to reveal a health system’s clinical strategy, capacity targets, campus growth plans, and nursing models and patient experience goals.
Sometimes, full-scale mockups can be staged to determine care team needs for the expanded space. These workshop sessions allow stakeholders to provide critical feedback based on the conceptual design.
A workshop session between McMillan Pazdan Smith’s team and a client often includes:
- Facilitated visioning exercises with key executives, clinicians, support staff and other stakeholders.
- Establishing project guiding principles and project goals.
- Early definition of design standards, adjacency priorities, aesthetics, and operational requirements.
- Defining the project scope
These sessions kick a project off successfully while building team rapport. Establishing alignment early between the project team and client stakeholders can also reveal hidden issues or concerns and underreported clinical needs.
Accelerating decision-making and identify critical cost and schedule impact while building consensus reduces changes later on and mitigates risks.
When a planning and design partner truly understands its client’s needs and goals, a positive momentum is created that sets the project off in the right direction. It also prevents projects from becoming over-programmed or misaligned with evolving organizational strategies.
2. Plan for Operational Continuity and Project Phasing
Patient room at CaroMont Critical Care Tower Expansion – Gastonia, designed by McMillan Pazdan Smith.
Healthcare facilities must stay open throughout construction. Experienced project teams work closely with clinical leaders to plan for:
- Phased construction that maintains patient care, life safety and safety for all.
- A defined Infection Risk Control Assessment and plan.
- Defined laydown and staging areas that are close to active zones yet isolated for safety.
- Secure and accessible routes for clinicians, patients, materials, and services to move freely.
- Infrastructure sequencing (such as mechanical and electrical upgrades) that is integrated with clinical operational hours.
This work requires clear, comprehensive communication and meticulous logistical planning.
3. Hire Designers with Lean Design, Evidence-Based, and Human-Centered Design Experience
While Lean may not be in the scope of every project, it is beneficial for healthcare leaders to consider, since it focuses on process efficiency and the elimination of waste.
Evidence-Based Design (EBD) has been shown to improve care outcomes and improve experience for patients, families, and staff.
When Lean-thinking is paired with EBD, the impactful result can be expressed in a formula that healthcare planner Sara Robinson, AIA, ACHA, EDAC, calls “Motion + Emotion = Experience.” Or, in other words, a thoughtful space planning strategy that supports safety, workflow, and patient experience.
For healthcare facility expansions Lean + EBD means:
- Designs that reduce travel distances and support modern workflows.
- Patient environments that reduce anxiety and support improved recovery times.
- Spatial adjacencies that enhance clinical and operational efficiencies.
Combining Lean with EBD in a harmonious strategy can be an incredible differentiator; one where operational imperatives and human experience are not at odds. This is a unique approach where MPS thrives.
Above: Floor plans outlining the proposed expansion for CaroMont Health, Critical Care – Gastonia based on Lean and EBD principles.
Hospital construction must provide useful life spans anywhere from 50 to 75 years. It is essential that the facility can adapt over that lifespan in ways not imaginable today. “Designing for flexibility” is a phrase that many design firms use, but what it translates to in practice might include:
- Shell space for future growth.
- Modular systems and open layouts that allow adjacencies and departments to shift, grow, shrink, or relocate over time without major renovation.
- Infrastructure support for future technologies.
- Right-sized floors that convert between functions as needs shift.
An intentional and thoughtful conversation between the health system leaders and the project team about adaptably and flexibility over time will go a long way towards maximizing the long-term usefulness of a hospital expansion.
4. Integrate Contractors and Trade Partners Early
Involving the General Contractor and key trade partners early, at the same time as the design team, accomplishes several beneficial outcomes:
- Allows the Contractor to understand and buy in to the project goals and guiding principles.
- Can provide real-time vs. interim milestone pricing.
- With real time cost data, design decisions can be made based on overall value within the context of the overall budget.
- Can reduce RFIs and change orders.
- Can enhance pricing and schedule accuracy.
- Aligns design intent with constructability.
- Mitigates risk and creates unified project accountability.
The goal of adopting an integrated approach early in the process is to minimize friction between conceptual design and construction execution.
An intentional and thoughtful conversation between the health system leaders and the project team about adaptably and flexibility over time will go a long way towards maximizing the long-term usefulness of a hospital expansion.
5. Make Budget Management Proactive
Project budgets include far more than bricks and mortar. A budget should include all the fixed and movable medical equipment, furniture, IT systems, signage, and other supporting equipment required to allow the building to function fully.
In addition, there are soft costs including professional fees, project materials testing and commissioning, and probably, costs associated with smaller enabling work. Of course, the fully burdened budget must also support the business case and strategy that informed the decision to move forward with a project.
Given the project budget’s importance, leveraging real-time cost data will provide a constant and clear picture of how the current design aligns with the budget. This allows design decisions to be made based on value provided within the full context of the budget, and to do so when the decision is made, not weeks or months later when traditional milestone estimates are provided.
6. Use BIM and Digital Tools to Reduce Conflict and Reduce Risk
When pushed beyond its base uses, BIM clash detection (pictured above) can be a valuable tool for avoiding construction conflicts and mitigating risks.
An experienced design team will push Building Information Modeling (BIM) beyond its base uses, to include clash detection in coordinated models and running sequencing and phasing simulations before construction begins.
The latest technology used in modern hospital projects allows project teams to predict and visualize building complexity long before anything goes vertical. This advantage becomes even more crucial when multiple wings and departments remain operational during the project.
7. Assemble the Right Partner Team for Expansion
The success of any hospital expansion really depends on who delivers it.
There are many experienced and qualified healthcare design firms, but the ideal partner for an expansion project will:
- Have a clear understanding of your health system’s culture, goals, and constraints.
- Bring deep and diverse healthcare expertise to the design, construction, and lifecycle performance of your project.
- Demonstrate impactful collaborative leadership, not just technical skill.
- Guide decision-makers through ambiguity and complexity with clarity and trust.
Hospital expansions are exciting because they are so transformative. They also demand strategic vision, operational continuity planning, collaborative pre-design work, knowledge of Lean and evidence-based methodologies, disciplined budgeting, and integrated delivery.
Leveraging a well-structured, thoughtful process, rather than one that is reactive to challenges as they arise — positions your health system to deliver healing facilities that not only meet current needs but elevate care for decades to come.
The healthcare landscape isn’t just expanding; advancements in the future of care are being presented, one vertical foot at a time.
