Building a new hospital “from the ground up” is one of the largest investments that a health system can make; here’s how early strategic thinking will determine financial success long before design begins.
Health systems considering a greenfield hospital are embarking on a critical market strategy.
Whether entering a new area, responding to rapid population growth, or establishing a regional hub, a greenfield hospital becomes the physical expression of an organization’s brand, as well as, its meeting long-term clinical, financial, and operational goals.
And while excellence in healthcare design can overcome many obstacles, it cannot compensate for poor strategy, or market opportunities that were not fully leveraged.
The most successful greenfield projects are the ones where the facility is the physical embodiment of the strategy.”
– Heather Hayes, MHA / Senior Advisor, McMillan Pazdan Smith
A greenfield hospital will typically be in service 30 years or longer. With the right approach, it should create value over that lifespan.
Planning Should Be Informed by a Comprehensive Market Strategy, Not Just Today’s Service Lines
Healthcare systems should not begin planning a new hospital by listing departments and estimating square footage. A more effective and ultimately successful approach begins with a deep understanding of the market.
A greenfield hospital in a new market must answer questions that extend well beyond programming:
- Which patient populations are underserved?
- How will this location operationally relate to other care sites?
- How will the system of care be optimized for patients?
- Which competitors currently own high-value service lines?
- What referral patterns already exist?
- Which specialties should anchor this market entry? Which ones can grow over time?
Successful advisory planning anticipates how a health system can best serve this community and stay relevant decades into the future.
When facility planning follows market strategy, we can ensure the facility is right-sized and the service mix is curated to meet the needs of the community.”
– Sara Robinson, AIA, ACHA, EDAC / Sr. Healthcare Planner, McMillan Pazdan Smith
Design for Every User Group, Because Each Defines Success Differently
Hospitals serve far more than patients.
A successful planning process considers every group interacting with the campus and recognizes that each experiences value differently.
- Patients seek competence, simplicity, dignity, and convenience.
- Families value intuitive navigation, comfort, visibility, and clear communication throughout the care journey.
- Physicians prioritize clinical adjacencies, operational efficiency, flexibility, and opportunities for collaboration.
- Nurses and caregivers need environments that reduce unnecessary travel, improve visibility, minimize stress and fatigue, and support recruitment and retention.
- Operations and facilities teams require infrastructure that can be maintained, expanded, and adapted with minimal disruption.
- Community stakeholders evaluate accessibility, economic impact, environmental stewardship, and long-term investment.
When all these perspectives are considered comprehensively, not sequentially, design decisions become significantly more resilient and impactful.
Healthcare planning should help address and resolve all of these priorities efficiently and harmoniously.
Treat Sustainability as an Operational Investment — Not a Compliance Exercise
MUSC’s Shawn Jenkins Children’s Hospital and Pearl Tourville Women’s Pavilion is a greenfield hospital in the heart of downtown Charleston, SC that combines advanced design with disaster resilience in a location prone to hurricanes. (In association with Perkins&Will).
Too often, sustainability conversations focus on Green Globes, LEED certifications, or environmental goals alone.
Forward-thinking health systems evaluate sustainability through the lens that executives understand best: operational resilience and total lifecycle value. Strategic sustainability can produce measurable returns by reducing:
- Utility costs
- Deferred maintenance
- Equipment replacement cycles
- Operational disruptions
- Environmental risk exposure
Resilient infrastructure supports continuity during power interruptions, severe weather events, and future climate-related challenges.
Natural daylight, high-performance building envelopes, efficient mechanical systems, adaptable utilities, and thoughtful site planning all contribute to lower operating costs while improving the patient and staff experience.
At MPS, we don’t frame a sustainability conversation around: “What does sustainability cost?” We work with clients to determine: “What risks does sustainability help you avoid?”
Viewed from this data-driven standpoint, sustainable design becomes part of essential, long-term financial planning, not only environmental stewardship.
Design Clinical Ecosystems Instead of Isolated Departments
Healthcare delivery continues to evolve around coordinated care rather than independent service lines.
Planning should reflect how patients actually move through diagnosis, treatment, recovery, and ongoing care, as opposed to how departments appear on an organizational chart.
When Sara Robinson, a Senior Healthcare Planner at McMillan Pazdan Smith, became a long-term patient herself — she developed an original approach to planning health spaces. And when planners can apply integrated solutions, such as Sara’s “emotion + motion = outcomes” framework, opportunities can be identified where clinical programs naturally reinforce one another.
By optimizing the patient journey, ecosystems reduce duplication, improve staff utilization, simplify patient movement, and create greater operational flexibility as volumes change.
Success Should Be Measured By Adaptability
Every hospital is designed for uncertainty.
Technology changes. Clinical delivery evolves. Patient expectations shift. Reimbursement models continue to change. The question is not whether the hospital will evolve; the question is whether the building allows it to evolve efficiently.
Planning for adaptability includes:
- Site planning that preserves future development opportunities
- Structural systems capable of future expansion
- Universal clinical spaces
- Capacity beyond immediate needs
- Flexible diagnostic and procedural zones
- Digital infrastructure capable of supporting future care models
Getting these decisions right can eliminate significant renovation costs over the facility’s lifespan. The highest-performing hospitals are rarely those that were designed for opening day. They are the facilities designed to perform successfully through decades of change.
Why Well-Planned Greenfield Hospitals Succeed
A new hospital investment succeeds when planning moves beyond architecture into enterprise strategy.
Organizations that can align market insights, operational priorities, financial stewardship, clinical integration, and future adaptability provide facilities that remain valuable long after construction is complete and the first patients are treated.
MUSC Black River Medical Center pictured above, is a greenfield hospital designed by McMillan Pazdan Smith.
A hospital is not just a collection of departments; it is a powerful driver of internal and external development and growth. For health systems entering new markets, that distinction matters.
A new healthcare facility planned with the right strategy behind it should continue creating value for generations. After all, the building you open in 2029 must still be clinically and financially viable in 2060.
Questions Every Healthcare Executive Team Should Answer Before Design Begins
Is your leadership aligned around these five strategic questions?
- What role will this hospital play within our broader regional network?
- Which patient populations and clinical services will define long-term market success?
- How can today’s investment minimize tomorrow’s operational costs?
- How can the design enable greater collaboration across departments?
- How will this campus adapt as healthcare delivery changes over the next three decades?
Answering these questions early reduces operational silos, while improving patient flow, staff efficiency, and clinical outcomes; they can also create alignment among executive leadership, advisory consultants, clinical stakeholders, operations teams, and design professionals.
Learn More
Visit a few of our greenfield hospitals:
- CaroMont Regional Medical Center – Belmont Campus
- MUSC, Shawn Jenkins Children’s Hospital
- MUSC, Black River Medical Center
