In comparison with the rapid progress (and often unpredictable changes) in clinical technologies and models of care, hospital capital planning has remained remarkably conventional and mostly unresponsive over time. Progress in this field has tended to be slow-paced and incremental in nature. Hospital design (with a few distinctive exceptions) has tended not to display the bravura concepts of change commonly associated with contemporary medicine. This is both a paradox and a threat to progress in healthcare. Capital consumes a large amount of healthcare resource and through its fixed nature can sediment services in place given the opportunity cost of change. Capital investment is often justified on the grounds of improving cost and throughput performance targets and can be stultified through the various financing methods adopted. It is rare to see capital business plans describe how the investment will (in measurable terms) contribute to improvement in clinical outcomes or better population health status, yet these two dimensions of healthcare provide its rationale. Recent evidence emerging from a pan-European study of new capital projects demonstrates that green shoots of change in capital thinking are emerging. One of the catalysts is undoubtedly the recognition of care pathways as the new foundation for capital planning and design. Care pathways (within hospital and spanning whole systems) provide a template and a language that can unite clinicians, nurses, managers, planners, architects and financiers in the common purpose of creating a stronger and more effective interface between the service and capital elements of healthcare. There is strong evidence in a number of leading edge examples (case studies) to suggest that a range of critical success factors can now be identified as providing a basis for generic application in the wider field of health capital infrastructure. These include designing in new concepts of functional adaptability, improving the synergies between the workforce and the buildings they occupy, improving patient safety (including reducing the risks associated with new opportunistic diseases) and responding more adequately to patients and citizens needs. The axiom that improved quality leads to improved cost effectiveness in capital provision can now also be demonstrated through the adoption of care pathway principles in the planning and design of new hospitals healthcare infrastructure.

University of Durham United Kingdom