- According to Wold Architects & Engineers’ recent national research report, 92 percent of survey respondents are engaged in or preparing for facility planning, but 72 percent say they don’t feel well-equipped to lead capital improvement projects from planning through construction.
- Rural healthcare leaders are juggling aging facilities, workforce shortages, tight margins, and difficult funding pathways, which makes it hard to move long-term infrastructure priorities into implementation.
- The report shows rural organizations need a coordinated strategy across operations, funding, design, and community priorities—because there’s no one-size-fits-all care model, and reactive planning limits long-term success.
Josh Ripplinger (Photo: Courtesy of Wold Architects and Engineers)
Rural healthcare leaders understand the needs within their communities, recognize where access gaps exist, and are actively working to plan for the future, but many are struggling to move long-term priorities from planning discussions into implementation.
That reality became clear in Wold Architects & Engineers’ recent national research report, The State of Rural Health Planning in America, which surveyed hospital and health system executives serving rural and small communities across the country.
Published in March, the report’s findings reveal a healthcare landscape shaped by growing demand, financial pressure, and increasing operational complexity. More importantly, the findings point to a larger industry shift: Rural healthcare planning today requires far more than designing or expanding facilities. It requires early alignment between strategy, funding, operations, and long-term community priorities.
Among the most striking findings, 72 percent of rural healthcare leaders said they do not feel well-equipped to plan, design, and construct a capital improvement project. At the same time, 92 percent reported they are either currently engaged in strategic master facility planning or intend to begin soon.
Taken together, those numbers tell an important story. Rural healthcare organizations are not standing still. Leaders recognize the urgency of the moment and want to move projects forward. What many organizations lack is the internal capacity and coordinated planning structure to confidently translate priorities into implementation.
Why healthcare projects stall before construction even begins
That disconnect is becoming increasingly difficult to navigate as healthcare systems face mounting pressure from every direction.
Tu-Anh Bui Johnson (Photo: Courtesy of Wold Architects and Engineers)
Aging infrastructure, workforce shortages, operational strain, and evolving care models are forcing organizations to make intricate decisions while continuing to deliver essential services day-to-day.
Nearly two-thirds of surveyed leaders reported operating margins under pressure, while more than half cited cost, planning complexity, and funding navigation as major barriers to advancing capital projects.
In many rural systems, the same leaders responsible for operational oversight are also expected to guide long-term infrastructure strategy, funding coordination, and community planning. That fragmentation often slows momentum before projects ever reach design or construction.
There’s no one-size-fits-all model
At the same time, the research revealed that rural healthcare leaders are thinking more strategically about what care delivery should look like moving forward. While 52 percent of respondents prioritized hospitals as the cornerstone of essential access, nearly as many emphasized the role of smaller, specialized facilities.
That near-even split reflects the broader industry reality that there’s no universal model for rural healthcare delivery. Every community faces different demographic trends, workforce realities, geographic barriers, and care priorities. For some organizations, expanding outpatient access or behavioral health services may be the immediate need.
Others may need to modernize aging inpatient infrastructure, strengthen emergency services, or rethink senior-focused care delivery closer to home.
Rural healthcare planning is less about choosing between facility types and more about developing a coordinated approach that reflects long-term operational goals and community priorities.
How can early planning help navigate funding sources for rural healthcare projects?
Too often, planning conversations begin only after funding is identified or a facility need becomes urgent. By then, organizations are frequently forced into reactive decision-making that limits flexibility, compresses timelines, and creates additional operational strain. However, early, integrated planning enables a different path forward.
When strategic planning, operational evaluation, funding guidance, and stakeholder alignment happen early on, organizations gain greater clarity around priorities and long-term feasibility. Decisions become less reactive and more intentional. Facility investments can then support not only immediate demands but broader organizational goals tied to workforce retention, financial sustainability, and community health outcomes.
This integrated approach is especially important as rural healthcare organizations navigate increasingly complicated funding environments. Seventy-five percent of surveyed leaders said they believe funding sources likely exist that they are currently unaware of.
Additionally, 73 percent said coordinated, multiparty funding structures, such as public-private partnerships and regional coalitions, are essential to securing capital.
Those findings reinforce the point that funding strategy can no longer operate independently from facility planning strategy. The organizations making the greatest progress are often the ones bringing together strategic planners, financial advisors, design teams, operational leaders, and community stakeholders early enough to build a phased, realistic roadmap before critical decisions are made.
Tools to help rural healthcare planning
That thinking ultimately informed Wold’s Rural Health Confidence Framework, developed as part of the report to help organizations connect desired outcomes with the partnerships and planning coordination needed to achieve them.
Rather than focusing solely on buildings, the framework encourages leaders to begin with broader questions around service gaps, operational priorities, funding alignment, and long-term resilience. At its core, the framework is intended to help organizations move forward with greater confidence in their long-term planning decisions.
Rural healthcare systems remain foundational to the health, stability, and economic vitality of their communities. Despite ongoing pressures, the research shows strong momentum across the industry and a clear willingness among leaders to plan proactively for the future.
The challenge ahead is not determining whether action is needed. Rural healthcare leaders already know that. The challenge is creating the alignment, partnerships, and planning structures necessary to move from intention to implementation with clarity and confidence.
Josh Ripplinger, AIA, ACHE, LEED AP, is the national healthcare practice leader at Wold Architects & Engineers (Minneapolis) and can be reached at [email protected]. Tu-Anh Bui Johnson, Assoc. AIA, NOMA, LEED AP BD+C, is a healthcare practice leader at Wold Architects & Engineers (Minneapolis) and can be reached at [email protected].
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