Patient volumes shift. Care delivery evolves. New technologies emerge. Yet, one mistake continues to create unnecessary cost and operational headaches down the road: failing to plan for flexibility from the start.
Healthcare leaders face a difficult balancing act, designing facilities that meet today’s needs while preparing for an uncertain tomorrow.
Once a site is constrained — by buildings, parking, infrastructure or regulatory limitations — future growth becomes more complex, more expensive and sometimes impossible without major disruption. The solution isn’t predicting the future perfectly. It’s designing with enough foresight and flexibility to adapt when change inevitably comes.
There are some steps healthcare leaders can take to get it right. The most effective facility strategies begin at the highest level, understanding the full capacity of a site, not just what’s needed on day one.
Kevin Knue, executive vice president and partner, Bremner Healthcare Real Estate
A health system might plan for a 50,000-square-foot medical office building today. But what happens when the area’s population doubles? Can the site support expansion? Is there adequate space for additional parking? Will stormwater systems, utilities and access points accommodate future growth?
These aren’t questions to answer later. They should be addressed upfront through comprehensive site master planning, evaluating the maximum building footprint, parking ratios, infrastructure capacity and land constraints before the first shovel ever hits the ground.
Flexibility starts with the site itself. Parking, for example, is often treated as a static requirement, but it shouldn’t be. As facilities expand, so do parking needs, and that has a ripple effect on stormwater management and land use.
Smart planning considers multiple scenarios. Can the site accommodate additional surface parking? If not, is there a path to structured parking in the future? Is stormwater infrastructure sized and located to expand, or will it become a bottleneck?
There’s also a cost strategy at play. Some investments make sense on day one, especially those that are significantly more expensive to retrofit later. Upsizing utility lines, reserving space for future infrastructure or designing expandable systems can prevent costly rework down the line.
Flexibility doesn’t stop at the site. It must extend to the building itself.
Healthcare facilities should be designed with expansion in mind, both horizontally and vertically where appropriate. That starts with core elements such as structural grids, mechanical systems and utility infrastructure. Standardized structural layouts and scalable systems allow spaces to be reconfigured as care delivery models evolve.
Most important is the patient experience. Growth should feel seamless, not disruptive. Thoughtful placement of entrances, corridors, elevators and key departments ensures expansions enhance — not hinder — how patients access care.
For example, critical functions such as emergency departments should be positioned away from anticipated growth zones. Expanding through or around these areas is operationally challenging and costly. Strategic placement upfront avoids those constraints later.
On a project in Kalamazoo, Michigan, Bremner delivered a cancer center that initially supported medical oncology services, such as infusion therapy. However, the building was intentionally designed to accommodate a future expansion into a comprehensive cancer center with radiation oncology.
While that capability wasn’t needed on day one, the team planned for it — allocating space, designing infrastructure and positioning the building to grow without disrupting operations. As patient volumes increase and regulatory approvals are secured, that facility can evolve seamlessly, without requiring a costly redesign or relocation.
“We don’t know what the future holds” is a common pushback from healthcare leaders. That’s true. But uncertainty is not a reason to avoid planning — it’s the reason to plan more thoughtfully.
The goal isn’t to predict exact future needs. It’s to understand the site’s full potential and make informed decisions about where to invest today. If a relatively small upfront cost can prevent a much larger expense later, it’s worth serious consideration.
At the same time, not every future need requires immediate investment. The key is balance, building in the capacity for growth without overcommitting capital to equipment or infrastructure that may not be needed for years.
Ultimately, successful healthcare facility design is about creating a roadmap. That roadmap should outline how a campus can evolve over time — where new buildings can go, how infrastructure will scale and how patient flow will be maintained when the time comes.
This approach aligns both operational and strategic goals. For healthcare executives, it supports market growth and patient access. For facility and real estate teams, it ensures that expansion is feasible, efficient and cost-effective.
The healthcare landscape will continue to change. But with the right approach to site planning and facility design, organizations can adapt without starting over. The best projects aren’t just built for today — they’re designed to grow into tomorrow.
Kevin Knue is executive vice president and partner at Bremner Healthcare Real Estate. With more than 17 years of commercial real estate development and construction experience, Kevin has a wealth of knowledge and expertise including experience pursuing new opportunities and managing projects from conception to completion.
