Bridging the Gap Between Strategy and Capital Planning in Healthcare

Capital planning conversations often start after key decisions have already been made. Leadership announces a bold new project, sometimes without a clear business case, budget, or input from facilities. Before you know it, design work is underway, and you're left trying to make the vision feasible after the fact.

At HealthSpaces, that disconnect set the stage for a candid discussion where Clayton Mitchell, SVP, Corporate Facilities & Real Estate, Yale New Haven Health, Kevin Vos, SVP, Facilities & Support Services, Corewell Health, and Molly Ironmonger, System Director of Planning and Preconstruction, Bon Secours Mercy Health, joined Donna Deckard, Director of Strategic Initiatives at the Center for Health Design, and leader of the Built Environment Network—a collaborative group of senior healthcare leaders focused on advancing strategy, design, and performance in the built environment.

The conversation focused on a challenge that continues to stall healthcare construction efforts: aligning capital planning with enterprise strategy. From governance gaps to underfunded infrastructure, the discussion unpacked how systems are bridging these disconnects.

Aligning Strategy and Structure

Vos described how Corewell, created from the merger of Beaumont and Spectrum, had to make an early decision: operate as a single system or remain a collection of parts. Leadership chose the former, launching a unified enterprise strategic facility plan.

Corewell's capital decisions are now guided by five facilities principles that tie directly to corporate goals: right-sizing scope, systemwide modernization, targeted growth, outpatient footprint stability, and localized care delivery. “It’s not about how much money you have,” Vos said. “It’s about how well your teams are aligned around a common vision.”

Smart Ideation: Early, Fast Filtering

Ironmonger, who supports planning across 10 markets and 46 hospitals, shared how her team vets ideas early using rapid cost modeling and historical data. “Here’s what $50 million gets you. Here’s what $10 million gets you. And if you’ve only got $5 million? We show that too.” That fast turnaround helps weed out emotion-driven requests before they get too far.

She also emphasized how capital discipline helped her system grow its infrastructure budget from $30 million to a projected $110 million, thanks to a hard commitment to “bucket integrity"—protecting infrastructure funding from being redirected to flashier projects.

Infrastructure Needs a Voice, Too

Vos was blunt: if infrastructure stays regional, it gets ignored. Corewell moved infrastructure planning to the corporate level to ensure it’s prioritized using data, not politics. Mitchell echoed this need for system-level thinking, pushing back on the common “build and burn” mentality.

Too many systems, he said, build new facilities and then run them into the ground. “We need a 100-year mindset.” He pointed to European hospitals still thriving centuries later thanks to long-term investment.

Ironmonger summed up the risk: “When a nun has to bless 1950s switchgear every morning, that’s not a strategy. That’s survival.”

Governance: Where Clarity Beats Chaos

Mitchell didn't mince words: the biggest failures happen long before a shovel hits the ground. “Execution isn't our problem. It's the lack of upstream clarity.”
His solution? Yale New Haven created the role of Chief Systems Design Officer to bridge gaps between planning, strategy, and operations. His team now evaluates capital projects before design even begins, ensuring rigor and alignment from the start.

What Health Systems Should Take Away

These leaders are proving that smarter capital planning isn't about having more money. It’s about putting structure around how ideas move forward, who gets a voice, and how decisions get made. For systems juggling mergers, deferred maintenance, and new growth demands, this isn’t optional—it’s survival.
Start with strategy. Build the governance. Protect the infrastructure. And invest in clarity before design ever begins. Because no one wants to make a $50 million mistake they saw coming from the start.

Watch the full discussion below…