Healthcare systems across the country are rethinking how care is delivered. For years, the hospital campus served as the center of everything from specialty care and outpatient services to diagnostics and even routine visits. Now, that model is shifting.
In its place, a more distributed approach is emerging. Care is moving closer to patients through clinics, micro hospitals and specialty centers, while larger campuses are becoming more focused, efficient hubs for higher-acuity services.
It’s often framed as a choice: centralized or regionalized care? But for most healthcare leaders, the real challenge is more complicated than picking one model over another. Because, at the heart of the challenge, there isn’t a universal answer.
Several forces are pushing this shift at once. Outpatient care continues to grow. Large systems are expanding their footprints across regions. At the same time, there’s pressure to reduce hospital square footage, improve efficiency and meet patients where they are.
The result is a more distributed model of care. Central hubs support complex procedures and longer stays, while smaller facilities handle routine services closer to home. On paper, it makes sense. In practice, it raises a more important question – how do you decide what belongs where?
One of the biggest misconceptions in healthcare design is the idea that there’s a best practice that applies everywhere. What works in one system, or even one department, can fall apart in another. That’s because these decisions go beyond buildings and into how people work, how patients move through care and how systems operate daily.
In fact, Wold’s recent State of Rural Health Planning Report found an almost even split among healthcare leaders on whether centralized or specialized models are the right path forward. That divide reinforces the critical point that there is no consensus because there is no one-size-fits-all answer. Without alignment, even the most thoughtful design won’t hold.
So if the question isn’t “centralized or regionalized,” what is it? It starts with understanding the factors that shape care delivery in the first place.
Community needs often lead the conversation. Where are patients located? What services are most in demand? Are there gaps in access that could be addressed through a more distributed model?
Operational realities come next. Staffing constraints, existing workflows and organizational structure all influence what’s feasible. A system may want to decentralize services, but if staffing models can’t support it, the strategy may create more strain than relief.
Then there’s the facility itself. Existing infrastructure, space limitations and long-term capital planning all play a role in determining what can shift and what should stay.
Financial considerations tie everything together. Every decision carries cost implications, not just in construction but in long-term operations. Looking at these factors in isolation rarely leads to the right answer. It’s the intersection of market, operations and facilities that begins to clarify the path forward.
For many healthcare organizations, the hardest part is knowing how to both generate and evaluate ideas. That’s where Wold’s design and engineering team comes in. Instead of arriving with a predetermined solution, the focus shifts to guiding the conversation and helping clients define what matters most, testing ideas against real-world conditions and building alignment along the way.
Early discussions often center on defining goals and expectations. What does success look like for this organization? Is the priority patient access, operational efficiency, staff experience or something else entirely?
From there, ideas are explored in ways that are tangible and easy to understand. That might mean walking through comparable facilities, building full-scale mockups or using three-dimensional tools to simulate workflows. These approaches allow teams to experience a space before it’s built, revealing opportunities and challenges that wouldn’t surface in a set of drawings.
Equally important is learning from what already exists. Post-occupancy conversations, site visits and peer-to-peer discussions between healthcare organizations provide a level of insight that no single project can offer. What worked, what didn’t and why – it all feeds into better decisions moving forward.
“The beautiful thing I loved about working with Wold was that the team never came in and said, ‘This is what you need to do.’ Instead, they took the staff and me on a journey that started with identifying the need and the why before we ever tried to solve the problem. If you don’t define the problem, or define the right problem, then you can’t actually solve anything,” shared Jeff Mengenhausen, chief executive officer at Montrose Regional Health. “We worked from the bottom up by involving nurse leaders, staff and department teams as ‘owners’ during the process, and it became the caregivers’ plan. The people working on the floor every day have the strongest voice in shaping the right solutions, which created better alignment.”
At its core, the process is built on listening. Not just to leadership, but to the people who will use the space every day.
As healthcare systems continue to evolve, the pressure to “get it right” isn’t going away. Rather than searching for a universal solution, the focus should be on building a strategy that reflects the realities of your market.
That means understanding the nuances of a specific community, aligning design with operations and creating a plan that teams can realistically implement and sustain. It also means being willing to adapt, knowing that what works today may need to evolve tomorrow.
The most successful projects don’t come from choosing centralized or regionalized care. They come from asking the right questions, involving the right voices and building toward a solution that reflects how care is actually delivered. In the end, design is about creating environments that support the people inside them and giving healthcare leaders the confidence to move forward.
