Micro Hospitals, Macro Impact: Leading Change in Construction for Rural Healthcare

Summary 

In this episode of Activating Curiosity | Leading Change in the Construction Industry, Ryan Ware explores how micro hospitals are expanding access to healthcare in rural communities—and what this shift reveals about leading change in complex construction environments.

Ryan is joined by Peter Nicholson, Co-Founder and CEO of Modern Clinical Planning, for an insightful conversation focused on healthcare infrastructure, construction leadership development, and construction innovation. Together, they discuss best practices in construction change management, including standardized design, modular construction, and technology-enabled planning, showcasing how these approaches reduce costs, accelerate delivery, and effectively scale facilities in resource-constrained rural settings.

The discussion also highlights key leadership behaviors necessary for managing change resistance and guiding teams through uncertainty in the AEC industry. Listeners will gain valuable insights on construction change management best practices, leadership for change in healthcare projects, and the broader impact of construction leadership on community health, talent attraction, and operational resilience.

Whether you’re a construction executive, project manager, or change coach within the AEC industry, this episode offers actionable perspectives on leading change with clarity, curiosity, and purpose, helping you master the complexities of construction leadership and industry challenges.

Chapters

01:17 – Framing the Rural Healthcare Access Problem
03:44 – Hospitals as Products, Not One-Off Projects
07:45 – Accessibility, Affordability, and Smart Technology
11:09 – A New Delivery Model for Rural Healthcare Construction
18:27 – Capital, Mindset, and Resistance to Change
51:39 – Redefining Success: Wellness Over Profit

Guest

Peter Nicholson is a healthcare planner with over 35 years of experience designing and delivering hospitals and life science facilities worldwide. He specializes in integrating advanced medical technologies and has led projects for Harvard teaching hospitals, Cleveland Clinic Abu Dhabi, and other global healthcare systems. He is currently the CEO of a startup offering pre-designed, fully equipped micro hospitals as a scalable product to improve the affordability and accessibility of healthcare delivery. 

https://www.modernclinicalplanning.com/

Connective Consulting Group
Helping construction leaders simplify change, strengthen trust, and move forward with clarity.

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Transcript

Peter: 0:00

We can make it better, but I think that if things aren't deployed quickly, things are going to fall apart for many people, that they're not going to have good quality health care and access to it, that they are only they're going to have to travel hours and miles and miles in order to get health care. And that's difficult for people as they get older. So we have to bring health care to them. That's that's the point. If we don't bring health care to them, we have a more serious problem.

Ryan: 1:16

And that revolves around access to healthcare and healthcare facilities that are, you know, not only within large cities, but also within rural areas and how we go about planning them with healthcare systems, but also how we design and build them. So today I have with me Peter Nicholson, and he is the co-founder and CEO and managing partner with Modern Clinical Planning. So hey Peter, how are you? I'm doing well. Thank you for having me. Yeah. Well, I'm looking forward to the conversation. I know we haven't had a lot of time to kind of connect personally, but your your post and the things that you were working on really started to catch my attention. Um and most people listening know that I have had a career in architecture and construction, but something always kind of piques my curiosity. And I thought, hey, this might be something that listeners might want to listen to as well. So I'm glad you're willing to be a part of the show. And why don't we kick off? Just tell a little bit about yourself, what you've done in your career and then your past, and then we'll kind of dive into activating curiosity.

Peter: 2:24

Yeah, well, I well, I help uh really design and build hospitals. I've been doing that most of my career. Uh I have skills integrating advanced medical technologies. I've worked uh and managed clinical projects for Harvard Medical School, the Cleveland Clinic, and others. I've worked not only in the Boston area, but also in uh Abu Dhabi and in Riyadh and in places in the Gulf. Sometimes people call it the Middle East, but really the Gulf, uh, building hospitals there. And uh in doing so, I've come up to the conclusion that hospitals have become too complex. And we've tried to develop a model that would make hospitals more affordable, uh, easy to build, and which would make them accessible for people in underserved areas.

Ryan: 3:20

Yeah, I think it's, you know, as you just described, healthcare and building a hospital. I think most people will understand it, especially as you drive around and watch one be built. They don't see the backstory of how long it took to like plan that, not only from the owner's side, but but the architects and everybody involved. So they just kind of see it going up and there's just a huge amount of time that that spans, right?

Peter: 3:44

And what we try to do is we try to uh, well, our products are pre-designed. So from that point of view, we really use the word product, uh, saying that our micro hospital is a product that someone can build, they can customize, uh, they can brand it, but we do the heavy lifting behind the scenes. It's a turnkey idea. So this is a lower acuity hospital, not a high acuity hospital, but we think it has a real role uh to play in healthcare delivery.

Ryan: 4:15

So you're you've gone through your career, you've spent your career not only in the States, you've done some work, like you said, um throughout the world with the Cleveland Clinic and others. Was it was it that initial problem that you were aiming to solve? Like, was it geared towards, hey, this planning process is is broken, or whether you thought it was broken or not, it just that's the biggest thing that we need to figure out. Um, or were there other little things that you just kept kind of seeing come up as you were designing and planning? Like, yeah, we're not addressing this. A number of them, a number of them.

Peter: 4:52

Um what in building, I think there's a place for large hospitals, first and foremost. I do think that with people with multiple diseases and or complications, they need to go to a sophisticated hospital. But I don't think that that's the way that most people need care delivered. Um we, you know, I in building large hospitals, I saw the complexity, I saw the uh the waste that went along with them, that people were doing the same thing to get an outcome more than once. So they were always rebuilding and rehashing something because it was complex and people did not understand it, or it wasn't in the right sequence of con construction. So, you know, but we what we saw is that, you know, hospitals were taking four years to deliver. Uh, and that's after the design. And in that amount of time, things can change. Certainly, technology changes and and has to be revamped, uh, but we don't see it as being a good way to deliver care to people. We have a hospital that we believe we can deliver in two years' time. So from the point that we have building permits that we get in the ground, we will have a hospital fully built for people ready for activation. And and that made a difference. Now, we try not to we try not to make it a complex hospital. We're not competing with the major hospital we're complementing. So we we are looking for 80% of those patients, that percent, can be, can be served by these hospitals. For that 20% that can't be people that have serious or more serious issues, they can be treated and transferred. So again, we see that as making health care accessible to people in their own local community. I always joke that, you know, if you're at one of our hospitals, somebody might come see you.

Ryan: 7:02

Yeah. I mean, I, you know, the word accessible is something I was thinking about as you were talking and just being able to say it is like one, I think about how many people have to drive hours and hours staying overnight to go to go get the care. You know, maybe as you're saying, that would fit into that 80%. So it's about also enhancing individuals' lives, saving money also in their pocket of travel to to healthcare. So there's all these extra costs that humans feel, especially here in the States, that that are healthcare related, but unrelated to actual the healthcare services that you're going to receive by by being in a hospital.

Peter: 7:44

Yeah, I mean, accessibility, I think, is tied directly to affordability, first off. We also, I think, as as a society in general, aren't really using available technologies very well. And everybody thinks about AI nowadays, and and I'm all for it. I think that that can be helpful. But there are so many existing technologies that, if deployed, can help with the efficiency of hospitals, especially smaller hospitals, allow them to run efficiently and serve the people in the community. I this is really where we think we've made a bit of a breakthrough. And it's not using, you know, abracadabra kind of technologies. These are these are easily found technologies that, if properly integrated in the hospital, they make uh a big difference for, you know, for second opinions, remote diagnostics, for people um that, you know, uh need that second opinion, for uh OR integration systems where a doctor that's remote can actually see almost everything that's going on in real time in an OR or in a procedure that's going on, so that they can either mentor or support uh what's going on, and that makes a big difference. I mean, there there are many places where people in the United States are underserved. There are many places where a phrase that's been used uh most recently, healthcare deserts, where people really need to travel, I don't know, 45 minutes to get to a hospital. Well, we all know without being in the healthcare industry that time matters if you have a serious condition. If you're hurt, injured, or if you're having maybe a heart attack or something, you know, time is of the essence. And 45 minutes is a long time. For a small hospital that's affordable, that can be placed in a local community, it's a resource. It's a major resource to that community's well-being. And it can make a difference. We think of our hospitals as being fully deployed with equipment, with over $7 million worth of advanced equipment for $32 million complete in two years. I think that we're seeing this as a delivery method.

Ryan: 10:13

There's so much that you just said that, you know, I think a lot of directions that we could go. Um, but very intrigued by, well, one, okay, so if we just back up and say we need to get healthcare more accessible to the patients, right? So it is a better patient experience. Two, the affordability side to get, you know, to get the healthcare system, these hospitals constructed in a timely manner gives them accessibility, not only a distance away from where they are, but quicker, right? Quicker to market so that you're taking care of of the patients. Now you you just mentioned, so okay, those things are sort of the problems. That's what you were aiming to solve. And now you just mentioned the delivery model. So talk a little bit about how your delivery model is different.

Peter: 11:09

Well, first and foremost, we see it as a product. Again, it's pre-designed, it's fully equipped, it's built on a turnkey basis, so that really the buyer of the hospital just has to make selections on possible options. They don't even need to take options if they don't want. There is a stock hospital that is functional that they can buy for the standard price. Once we know the options that they'd like in the hospital, we're ready to build. So I think that's the unique. There are a lot of uh healthcare systems that do deploy micro hospitals, but they do so as a proprietary uh facility that they've paid an architect and or engineer to develop specifically for them. They don't sell it to others. Ours is a non-proprietary product. And as you mentioned, the timeline. In other words, it it can't be accessible unless it's built, right? Oftentimes a hospital is built, that the the shell and core of the hospital is built, and then the equipment is installed. And that's a lot of times where things go awry. We installed the equipment as part of the construction process because we know how to do it. Right. Not only that, but these are relatively speaking, in the complexity of hospitals, these are relatively simple hospitals. And that's the the the value of them because that's what keeps also the cost reasonably low. We don't operate hospitals, we sell them. Right? We sell and build them. But in the operability point is that there's not that many healthcare workers. There's always uh a dearth of them in in these rural communities where they just don't have people to operate. By using technologies, we can minimize the number of staff and still maintain high quality standards.

Ryan: 13:09

Yeah, so you're you know, not only getting the built environment taken care of, but providing a path thinking about the future labor force, right? Because I I think we all know that labor force is changing across all industries, and there is, you know, we talk about the shortage of labor not only within the construction side and that future labor force, but also in healthcare. The other area that you're talking about is hey, you're outside of a city and now you're in a rural area where there may not be either that that talent area or development where someone just doesn't want to live in in a rural area. Um that can do a lot of these things, right?

Peter: 13:51

A lot of changing demographics. There are a lot of changing demographics, no question about it. And I believe that one in seven people in America get their health care in a rural setting. That's a lot of people. I think it's something, you know, we're talking about, you know, uh 25 million people, something like that. I but it's something like one in seven. They the phrase healthcare deserts starts to come into play. And and you know, it's not only a rural solution. There are plenty of places in cities and towns where there are underserved communities. And and these can be, you know, we use a phrase about uh a hub in spokes. So really the major hospital is the hub, and they can share so many of these technologies that they have at a fractional cost, you know, whether it's electronic medical records, whether or not it's a packed system for digital uh uh X-rays and other images, whether or not it's a laboratory information system, whether it's those OR integration and other systems, even AI, telemedicine, these things can be shared at fractional cost. That extra person on the medical records, that's that's costing nothing. That extra person that's you know sitting in a uh laboratory or looking at these images, you know, they don't have to be in the micro hospital where it's located. They can be remote and it can function very efficiently in that way.

Ryan: 15:29

I mean, it you know, when you say it, it it makes total sense, right? Like we, you know, healthcare systems to to the doctors, like what everybody would want is that affordable, accessible healthcare in a timely manner. And, you know, hearing you say it, I I can hear having practice in architecture to being in construction, to working for fabricators, to think even working with healthcare systems, right? Healthcare systems. So I hear having an area of standardization that makes it easier for the healthcare system to go through and design things. And I know there was, you know, I've had an opportunity to work with Kaiser and talk to even HCA and SCA and Dignity or Common Spirits, and like a lot of them wanted to do what you were saying, which was build MOBs to repetitive, sort of, you know, smaller facilities, uh hospitals. But they are proprietary in some instances, which doesn't answer the question I think you're you're aiming to solve, doesn't provide it to everybody, because that's there's those are some healthcare systems. So while this isn't, you know, new, there are things that are have really changed the way we need to think about healthcare design recently. And I always tell the story about uh the Ohio State University building their major tower here in early 2000s, right? Well, it took, I I think it was nearly 10 years to go through planning. Well, there's one thing that didn't exist when planning started and did when it ended, and that's the iPhone. So by the time they got into the building, as you just described, it's like the building was designed to be something else than where the world was by the time it got in, but everything was designed in a way that didn't allow for flexibility or adaptability as things were changing. Sure.

Peter: 17:30

So much changes in the decade. It's amazing. It's amazing.

Ryan: 17:34

Yeah. So what now you're talking about like being able to have these pre-designed kind of uh concepts for the hospitals, you you're changing sort of procurement path and relationships of some of those systems, you know, that that not only probably tied to the building and the building automation systems or other things, but also to how doctors will be performing work inside the building. So you're you're beginning to change that entire delivery process through design, procurement, and construction. So I'm sure you are, you know, this is a mindset shift. So I'm sure you're hearing obstacles to every barrier put up in front of you. So I'm just, you know, curious what some of those are that you're hearing.

Peter: 18:26

Well, yeah, I I think that again, uh there, we're not the proof of concept is already out there. In other words, you mentioned one group uh healthcare system, dignity health. They they have their own proprietary micro hospital and they've deployed it successfully. Um and another one, Baylor Scott, and white, they have uh deployed these proprietary themselves. So we're the proof of concept is there. What we have to prove to people is that MCP can scale, that we can ramp up uh quickly enough to be building multiple hospitals simultaneously. So the issues that we are faced with are really capital issues. Uh and this is not my this is not my bailiwick, so to speak. Um I'm learning. Uh, but access to capital, uh, because each hospital, so a hospital is $32 million. Even though we consider that to be a very affordable price, it's still a lot of money, right? And the deposits on things, we have great partners. Our partners are Phillips and uh Gettinger and Amico from Canada and and other Ida from Ireland and other groups. But like any business, they expect us to give them deposits and they give us favorable terms. Well, if one can do simple math, it said 15% on seven and a half million dollars. Well, that's well over that's 1.1 million. Million dollars just in deposits. So each hospital needs working capital. And our buyers, you know, they expect to buy a hospital as a product. And that's fair and reasonable. We need to make sure that we can always have enough working capital in order to build multiple hospitals simultaneously. So that's been one entry barrier that we've had. It's an expensive business. And so we're playing with large entities. And we kind of say, look at the people that are partnering with us, because they see that we have a really a viable option to change healthcare delivery. So they are intended to be simple hospitals. In a complex world, it's a simple hospital. So that's a barrier. You know, getting people to speak with us, you know, um, and getting to the point where we have funding to make sure that people know we exist. That's that's why this podcast is so important to me, that it may help people know that modern clinical planning has a solution that's available to them. So there are a couple of the entry barriers and the uh challenges that we need to overcome.

Ryan: 21:26

So, Peter, I thanks for sharing that because I think you know, humans we're we're skeptical, we see fear, like we run from it. And then a lot of things that you were talking about are very common with new innovation, especially in the construction industry, because of the way we build. And when we think about, like you mentioned, capital, it's that cash flow through a project. And I think of I think of the part of the industry around prefabrication and you know, as we're shifting into a lot heavier modular construction, um, not just in healthcare, but in housing and everything else, well, the funding structure changes and where the capital has to enter and get to before, you know, you're so far down the line, like that's not new either. Um and, you know, just curious, like what other, you know, this is healthcare. So I guess one of my questions would then be well, if this solution doesn't happen in some of those rural areas, what is the answer from the healthcare systems to address it?

Peter: 22:38

Yeah, it's only part of the answer, first off, right? There are the staffing issues that we spoke about before. That's that's clearly an issue. Um we are part of a solution. I think that it can only we can make it better. Micro hospitals can bring hospital care to people. And we look at bring healthcare services to people in their local community, and that can be in a city. That can be in an underserved area of the city. So, you know, there are a lot of applications, but really we're trying to focus on underserved communities. We have to deliver. We have to deliver if we want to serve the people of this country.

Ryan: 23:24

Yeah, I mean, it's such an important subject to try to get those solutions to individuals, which always comes back to, like you said, the capital. So, you know, I guess it's the barrier seems to be you you brought it up probably more than mindset in this case, the capital, but I think the capital mindset shift is even part of the process here because if the health it getting them to the rural area and the capital has to change where you're they're buying a product, you're the way you're approaching it then, right? The healthcare system, describe that a little more just to try to, you know, so listeners as well as myself kind of understand it. Is it that they're expecting that you're just getting it done in two years? There's some deposits that have to happen, but it's not a normal construction sort of progress pay application, or what makes it more, I guess, unique, a product versus you know, that traditional method of delivering construction?

Peter: 24:29

So there's a distinction between the buyer, who's not typically an investor, right? So the the buyer wants to buy a product and they're not investing in the operational part of it. We are the capital issue rests with investment banks, investment uh arms, with community investment resources, where that's where we need to raise that capital. Two things. Two things. One is that a buyer and the problem of rural health in part is that it's not profitable. And why is it not profitable? There's a whole host of reasons. There there are, you know, low numbers of patients going to specialties, and so therefore, there's not enough throughput, and so therefore, it's not profitable. Many, many of these hospitals in rural America are older infrastructure. It's harder to renovate them. It's a good question about whether or not a renovation should take place or if a replacement hospital should be sought. We can be that replacement hospital. But, you know, it's it comes down to the affordability. So we're not going to be able to solve every problem, but we are able to say that we have an affordable, efficient, modern hospital that's available to a community. And that may be much better than dealing with that 30 or 40-bed hospital where people have a hard time maintaining occupancy, for example, in the hospital. That if you don't have enough patients, they the right scale, you know, it's important to it's not to say it's like a hotel, but a little bit like a hotel. You want to keep your occupancy levels high, but you also want to keep your turnover, something that they call the average length of stay. You want to have a turnover of your patients so that they're staying, you know, three to four days kind of maximum. And and that's how a hospital is profitable. If nothing else, a smaller hospital is easier to manage. It's obviously easier to manage, and it's easier to maintain patient volume. These larger hospitals that are inefficient and older structures, well, they they really buildings, as you know, as an architect, buildings get used up. There's times when they're no longer viable. Um, and and we see that when we look at major cities and that the demolition industry is almost as big as the construction industry, right? Right. So there can be a point where that rural hospital really has served its purpose and no longer can. And we think that these hospitals that are modern, efficient, and sustainable, right? That they become those replacements. Rural health has these staffing issues. It has the issues of declining populations, but a smaller hospital sits better with those. The buyer, the hospital chain, the hospital system. Well, why aren't they participating? Because they're afraid they're going to lose money. Uh, they don't want to lose money, and so therefore, they they don't participate. We're giving them an opportunity to participate because we believe that these hospitals can work. And if they're not, they're not gonna be amazingly profitable because they're not amazingly big. But they have to get out of that mindset. You're not going to lose money. You're going to make a decent margin on these hospitals operating them. And if you have multiple ones, then you can make a bigger margin. But each one of these, as much as they won't make a lot of money, they won't lose a lot of money.

Ryan: 28:36

Yeah, so there's, you know, the perspective from the healthcare area and the healthcare system of why would we make this investment if you know it's costing us? And on the other side, uh, it is costing humans something, right? We've been talking about that that affordability and accessibility as being that major problem that you're aiming, you know, to really address. So it, you know, it's an interesting dynamic, it would which all businesses have. Where do you spend the money, you know, to to provide for your clients or provide for, in this case, the patients? So, okay, so let's just say that they they keep looking at it from that standpoint. If they don't go this direction, how are they answering that question?

Peter: 29:25

They may not. They may not. They don't want to take over that old hospital that's in the town because it's not profitable. So they just demure. They they don't do anything. And then those places at some point in time lose money for some number of years in a row, and all of a sudden they're in the red and they can't, and they close their doors. And unless people are willing to use a tax base as a method, that's kind of the old method, you know, if you will, a hundred years ago in America, the the city hospital, right? That city hospital was supported by a tax base. Only if there's a rural community willing to use its tax revenues to maintain that hospital, that hospital probably is not going to be profitable and can't sustain losses for a long period of time without closing.

Ryan: 30:21

That's why I wanted to have the conversation. We all recognize it. You know, I've always kind of, since growing up, tried to get away from the rural areas because it's just me. I wanted to live in in cities and everything's been more accessible, but I have a lot of family that just lived hours from major metropolitan areas that had a healthcare system. I was lucky enough to grow up in one that had a pretty robust one and actually is now going out into other rural areas. I'm, you know, in saying that, it's just things that I'm recognizing, and I'm sure other listeners, you know, we all see it, but we get busy and we don't think about it. Well, part of it is like we just don't answer the question. Like you said, the healthcare systems just don't answer it. Doesn't solve the problem for anyone. Um, when you're coming and saying, hey, this is it's different, but not that different. It's not different enough in a sense of like, hey, we've never seen this before. It's still coming up with a delivery model which sounds more collaborative. You've packaged, you got all of these groups together and said, hey, we we see this as a problem. Technology pieces recognize it too, like the pain points that they have potentially coming into large healthcare projects and hospitals where they're too late. They're brought in too late, and the things designed and almost built, and they're probably able to give you, you know, feedback into what would work better, like you're saying, to deliver a better product, um, a better design, and a better solution, not only for the staff who's there, who is going to be there for a while and dealing with an acceleration of technology and advancement that needs to be able to be switched out and upgraded and continuing to evolve as the industry changes, but also to the patient as they're going through it. So, one one question I do have out of curiosity as well is you know, you're working with a lot of solution providers that go into hospitals. Talk a little bit about just that process of the design. You have pre-designed areas that they could just you know purchase as a product, like you're mentioning, but let's say they don't want to go to that area. What was the sort of North Star for you? Was there a delivery model? We've talked, I think, a little bit about prefabrication or even modular, but like what is it that you're and how you're aiming to build these in rural areas who don't may not even have the contractors in the subtrades to go build them? Yeah.

Peter: 33:08

So uh what we have is we have a project that has a lot of modular elements. So everything from the skin of the building, everybody's seen this, these aluminum panels that go, and that is a really durable skin of the building. We can literally have three containers full of this product for the side of the building. We have modular features in the hospital for the head walls, the foot walls that go in. We have modular ORs that are not used in America so much. Not sure why, but it's a modular OR. So it's a kit that in fact comes in and builds out the procedure rooms, the even the scrub areas and that sterile core. We in fact have modular features that are down in the head walls in the emergency department. We we provide a lot of things that are commonplace to a hospital on a smaller scale, nutrition services, the laboratory. And one of the things that we've used as a phrase before is a hospital in a box. Um many of the modular elements, it's a full hospital all the way down to pathology, a pharmacy, even you know, the receiving dock and everything else that goes with that. We've built and designed a hospital with my input, the input of uh Rob Glyke, who's one of the co-founders, uh, the input of others, about what are the proper adjacencies? What are the support services that we need? How do we fit this in to a uh a 30,000 square foot building? And and we've been able to do it, and we've been able to do it so that it's efficient, it's compartmentalized, it's safe, it meets accreditation standards. It was uh not an easy task at first to do, but you know, we we've accomplished it. We always say to people that if they want to buy a hospital, you know, I have no idea what their land looks like. So how do you want it oriented? Uh that's part of the process when a buyer has their land. You know, we say that we recommend two and a quarter to two and a half acres. That sounds like a lot of land, but there's a lot that goes on between the ambulance entrances, between staff parking, visitor parking, loading dock, roadways that go around and make the circulation work. So we say two and a quarter as a minimum, but uh recommend two and a half acres of land. Uh so you know, we it there is a lot of modular features. These modular features and these elements allow us to build it in two years. Plus, our partners, Phillips, Gettinger, Amico, they come in and they install with us during the construction. You know, we have to make sure things are plumbing square, but basically, they put in their head walls, they come in with their CT scanner, they come in with their radiology room and telemetry systems and other things that make the hospital work. So we work tantem with them. That's how we get to two years. The frame in the hospital typically is a reinforced concrete frame. I'd prefer doing it in steel, but this is an engineer's point of view. But at the same token, we can build anywhere in the world using reinforced concrete. And so that's how we've designed the building. It opens up if you do it with steel. You know that as an architect, you get better span and everything else. But we can build this anywhere in the world and then use modular elements in order to do it quickly, efficiently, and and you know, sustainably. If somebody buys an MCP micro hospital, they're not going to overbuild, right? They're not going to overbuild. And and that can be a problem. You know, if you overbuild and you don't have the the patients, you don't have the occupancy, then you're going to have a hard time with your operating car. So with MCP microhospitals, at least people will not be overbuilding.

Ryan: 37:34

So you've kind of gone through a process of defining a program of requirements, right, based off the most critical and common things that would be required for rural areas that don't have a hospital. You've you're utilizing what sounds like some design assist with specialty technology and equipment so that they're part of that design process and iteration, as well as some prefabrication components, uh kit of parts through assemblies. So you're utilizing um collaborative, even into design build almost approach into this, right? To get this constructed. It is a design. Well, design build that we've done the design, but it's a turnkey process of construction. Of construction. And and this isn't, again, like like it may feel new for healthcare, you know, and have been through these processes of creating programs. And and and a lot of it's been more MOB, right? That acuity level that you talked about early on. Like there is a difference. And but you're saying, like, hey, we're we're just aiming to solve like 80% of those things that normally would be solved in a space like this.

Peter: 38:51

Right. Um so you know what? A lot of the things that have been ambulatory, there's been already the revolution in ambulatory care, right? The clinics, the ambulatory surgical centers, all these ambulatory, the freestanding ED, you know, the urgent care facilities. These things are all good. These things are all great. But when they have a problem, they can't admit a patient. There's no admissions in a freestanding ED. There is no admission that can take place in an ambulatory surgical center. If they have a problem, they have to go to a hospital. That's the difference between a micro hospital and an ambulatory facility of any sort. We admit, we can admit patients. The most serious one we can treat and transfer, but we can admit patients. And not only, you know, I I've said this, I'm getting a little off topic here, but the repeater system to the major hospital for that cardiac thoracic surgery, for that, that major um hip replacement. No, we're not doing those in these hospitals per se, right? We're not doing cardiac thoracic surgeon. These are low to mid-acuity hospitals. Higher acuity is the major, and that's where these are feeder systems to them. But they also work the other way in the transitional care sense. That in a major hospital, after somebody's had this cardiac thoracic surgery, right? And they're out of the ICU, they can be then transferred back to the microhospital and be placed there at a lower cost, at a much lower than the downtown unit for transitional care. These hospitals are local and they can provide personal care for people that are coming back. And they come back to the microhospital and then they go home. So, you know, we see the economics of that working both ways.

Ryan: 40:54

Well, I mean, I you you said you said the joke, but that's the first thing I thought of. If you transfer somebody back, they'll be in their they'll be in the location where they're normally living and experiencing life and community. And now that community is there to help them recover quicker, opposed to being three hours away and maybe somebody you've seen in the last 10 years gets to come visit. So it does back to that human piece, because you know, coming from design and construction, like everything we do is for humanity. Like we building infrastructure is about the humans, it isn't about anything else, right?

Peter: 41:36

Right. I mean, you hospital care and and yeah, hospital when when people think about what if you're gonna build a town, right? You're gonna say, Well, I need a fire department, I need a police department, right? I need a hospital, right, right? I need schools. These are these are those resources, community resources that every community needs. Um you know, again, we are not the we are not a complete solution, but we're part of the solution to a problem that exists. And we think that again, if we can keep, if we can lower costs, then we can make of things accessible. We're going for and and that being said, appropriate, appropriate to a low to mid-acuity hospital. Right. All the hospital high-tech stuff that I did when I was working at Harvard hospitals or at the Cleveland Clinic and all that, very little of that goes into these hospitals. Those are for the high acuity hospitals. And there's a high-lo mix, and there should be a high-lo mix.

Ryan: 42:47

Yeah, absolutely. I mean, I don't I I think, I mean, yes, we all want like what we want, but like there has to be a solution that A, it's solving a problem, and is not necessarily to have all those things. And that's, you know, as I'm thinking through this, I think, okay, as a designer, we all want our fingerprint on something. We all want some impact. And what you're what you're addressing, it's like, okay, again, going back towards the problem exists, right? We know it exists, and it's getting worse and worse. And I think, you know, given a lot of the news that's out there, and I try to, you know, avoid politics, but like there are a lot of changes that are about to happen that may make this even worse for rural areas. Yeah.

Peter: 43:37

It's true. So it needs a standardized solution. Now, we'll allow people to customize it. I'll let you have, you know, remember, uh, I think it was uh Henry Ford said you can have any color you want as long as it's black. Well, we'll allow you to have any color you want within our palette of the hospital. And that's what you get to choose. And we'll allow you to choose your carpeting within our palette, within the carpet that goes in the area, the floor tile, the, you know, we'll allow you to brand this so that it looks like your hospital. But it's a standard hospital. I have had people ask me if we can change it dramatically. And I've said, no, we really can't. It's just not there. I can change some certain things and we can customize and we can brand it, but it's the value of it is that it's standardized, that it's deployable, it's repeatable, it's scalable. And and we can't get away from that. Because that ripeline of affordability and technology and scale is what makes hospital services accessible. That's what we think.

Ryan: 44:46

Yeah. Well, I you know, I'm enjoying the conversation because I think it's there's so many things that it can solve, right? That the rural areas, and I'll tell a story about you know, the one that was down, I grew up in Marietta, Ohio, and that is in the southeast, it's a small, small city, they have a healthcare system. Well, they constructed uh a new clinic. It wasn't a hospital per se in that case, but there's procedures that are done there, but they used all prefabrication, it's based in Athens. They use modular construction because there is no labor force to even build, you know, the facility. So, one, I think about you know, areas like within Texas and a lot of other, you know, regions within the middle part of our country where large cities are spread out, you know, far away, and but there's still people living there. And they're just, as you keep alluding to, is this healthcare desert. Like, one, we know the problems there, the healthcare systems know it's there, the the local states know these exist. And you said this before, but you know, what does it look like or what does it mean if we don't solve it? They may not answer that question.

Peter: 46:06

I again, I I think that people have a real right to healthcare access, you know, and I think that, you know, that means hospitals also. It's not just ambulatory care. And and part of that solution, again, is that we can say that we are not overbuilding, but healthcare systems also have to have their own targets of serving people. Their mission has to be to serve communities. You know, I think there has to be some certain things to offer uh nursing and physicians and clinical staff incentives to work in these areas. I mean, there's always been those initiatives where uh people, young people going to medical school, nursing school, that they would pay, the government used to pay a portion of their tuition, if not all of it, if they would then uh give three, four years to a rural health care program. MCP microhospitals will not contribute to the problem.

Ryan: 47:19

They will help sustain a solution for people for a long time. I think, I mean, there's again, there's a lot there to just kind of ponder and think about. I uh uh the mentioning of the program in the past of I think about even educators, right? Going to teach in a rural area. North Carolina, I lived there for a little while and they could not find teachers. They maybe still can't. So like we have this that's again, it's not uncommon that certain professions can't get the individuals to the location that's needed. But you mentioned again back to the well, that's capital and that's finance and everything we need. That's always going to be true. That is always going to be true for everything. And and we tend to build barriers up. Not just, I'm not saying you, I just mean as a society and as other humans, to just use that as the, you know, I get out of jail card, if you will, of I don't need to think about this anymore. Well, that's not solving the problem. And I think you've even said this isn't a silver bullet. So it doesn't mean it's for every location everywhere. We're not aiming to solve every single thing, but there is someone who is probably out there listening that's like, hey, my community could probably use something like this, right? Right. Um, and things like that. So I do think it's viable that could we rethink it. Like, what well, you could shift staffing. Like if they are located, people could be traveling a couple days a week. You know, there's all kinds of ways to solve it because we have to do it in construction. We have to do it with every every industry that we're in.

Peter: 48:59

We may want to make uh it may be that we have to make uh rural communities uh a place that younger people want to go. And and and why would they want to go there? They'd want to go there perhaps to have a family. And if they are going to have a family, they're going to want to have schools, they're going to want to have health care, they want to have jobs. You know, it's the human capital. We talked about financial capital, but it's the human capital. We have to attract younger people and and maybe give them incentives of housing, give them incentives to make sure that they can have viable jobs.

Ryan: 49:43

Mm-hmm. Yeah. I mean, there'll there'll be people who would say that's a better quality of life that they they want because I I can't suggest that what I want is what everybody wants, right? And I think in in all of us is from estates, and like we know affordability is a big conversation going on right now beyond healthcare. So yeah, I think there's a lot of ways to think about, and we are talking about building a hospital, but that's why they're so intertwined, because it's like it may be a hospital that has to be built. There are so many other things that go within our communities of the importance of solving this issue because if there is no infrastructure, if there is no housing, if there is no whatever, people can't go to that location. Um, anyway. So it is it is a deep conversation. I I mean I'm just thinking through it and it's what you're doing. Like I said, uh it's a unique model. It's packaging these things up in a way to solve a very real problem by utilizing things that we've all been doing and just coming up with a new sort of delivery to get it there quicker and address a lot of different things, a lot of different problems. Accessibility, affordability, all those things you mentioned before. Um we we threw up what those barriers can be. But Peter, um, kind of a final question I I have is around, you know, what do you think success looks like, not just from your standpoint, the modern clinical planning and and what you're aiming to do, but like if you achieved it or if we achieved it as a society, like what from the healthcare, like what does that success look like to you? I think success is affordable healthcare, right?

Peter: 51:39

Uh I think success is the well-being of people in their local community. You know, uh, I haven't used this phrase, but I've said it before. It's kind of the so-called Amazon model. We should be bringing it to you. You shouldn't have to go get it. Uh it's, you know, I think it's these small micro hospitals are the infrastructure that support healthcare delivery. Right. Uh you know, healthcare delivery is done by people, not by my building. But this is the infrastructure that supports that healthcare delivery. I think the wellness of our population, you know, that we see trends that go to people living longer, people not having as many issues of, you know, coronary artery disease, or people that have issues of diabetes that it's under control, or that kids with asthma are are able to be treated. That, you know, that people can have wellness. That's the goal. That's the goal of having any hospital or any healthcare facility, I would think. It's not to move money. So, yeah, I think the goal has to be the wellness and to provide care, but knowing that it has to be affordable and at least not a loss. And I think that it may even have external benefits. Again, we talked about you know, feeder systems and things like that. Right. That's viable. Yeah.

Ryan: 53:19

I appreciate you saying it because again, it goes, it's back to the human piece of it. The micro hospitals are a vessel for people to do what they need to do in order to make other individuals' lives better. And, you know, the food we we have food deserts, we have affordability of food, all it all ties back into our quality of life as humans, right? Everyone that's around us is going to have a higher quality of life when we could solve the basic fundamental needs that we have as humans. And you have seen a problem through your life and you said, hey, it is unaffordable. We're overdesigning. I think you've gotten to that. We didn't get into value engineering, right? But the way you've approached it is to say, like, we are right sizing these based off of things that we've learned, feedback that we've got, in order to make it affordable to construct in a timely manner to get microhospitals into regions that don't have it, to solve a high percentage of the things that we need as humans on on you know, routinely, where we don't have to travel long distance and making it harder to gain that access, like you said.

Peter: 54:35

So it's the comfort, and you use the right phrase. Uh, it's quality of life. It's quality of life, right?

Ryan: 54:42

Yeah, I think. I mean, hey, you're solving a problem I think we all can relate to. We've all talked about it. We've talked about it my entire life. Um, so ignoring it isn't working anymore. No, um, it isn't gonna make it go away. Yeah, it is never going to go away. Um, so the final thing then, you know, for you, Peter, someone's listening. What is something, a next step or an action item that you think they should take to not just learn more about you know what you're doing with um, you know, the modern clinical planning, but like looking and evaluating this problem deeper, or talking to people in their community. Like what do you think they could be doing?

Peter: 55:31

Well, you know, we've we've done, we tried to do a little bit of education. I've done a number of posts and uh that talked about the industry that talk about the rural health care crisis in America, that the that uh, you know, how Robert Kennedy Jr. uh is in fact made a proposal for funding rural health care initiatives. We'll see how that rolls out. Um I think that, yeah, oh please uh go to our website uh for modern clinical planning. You know, uh just research it a little bit and you'll see that that, you know, there's a lot of areas, and you brought it up a little bit, Ryan, where you said we're not so sure where things are going to be going in 2026. There are a fair number of uh cutbacks in in funding, and those cutbacks can affect the quality and affordability of care. Um so there are things we can do, and we can we can move forward in a reasonable fashion. And I think that's what we're trying to do with micro hospitals because again, I believe that they're the you know, they're the infrastructure that supports healthcare delivery.

Ryan: 57:00

Well, I really appreciate getting to have the discussion. It has definitely intrigued me, like I said, since I first saw what you were working on and knowing from my past a lot of the things that I was doing from construction side and and and prefabrication of like, hey, this is a unique model that is separate of, like you said, a proprietary solution that another healthcare system might be doing, but this could bridge a gap. So it I appreciate you sharing your story. I know you're fairly new in the journey from this side, you know, from you know the clinical planning side for your business, but you're not new to healthcare. So you're bringing a lot of experience and things that you've seen and continue to talk through. So I'm glad you were at this point in your career where you said, you know, I've done a lot, um, a lot of work, and I am willing to dive into solving this issue. So, Peter, thanks for being willing to be a uh a guest here uh on Activating Curiosity. You certainly um continue to spark mine with with a lot of the work you're doing. So thanks again for being on. Thank you so much. I appreciate being here. So that is the episode with Peter Nicholson with Modern Clinical Planning. And like I said on the episode, something struck me when I first saw some information come out on LinkedIn that he was posting that I knew I needed to have a conversation with him. And I'm hoping that all of you as listeners are as intrigued as I am, is that he is looking at how we design and procure and construct hospitals at a micro level in regions and areas and health systems where building a full facility would take multiple years beyond his planned solution. He is trying to take his experience and address part of the healthcare systems that most of us face. So he he is trying to say there is this space in between that needs a solution that is not only affordable from the healthcare side, but it is affordable for people to get to because they're not leaving the region and it is accessible. We identified potential obstacles that we probably all recognize and probably even think like, I don't know how to begin to address this. But that is why I wanted to have the conversation because you know, we still are human and need accessible health care when we need it. I hope you enjoyed this episode. I know it may have felt a little bit that we weren't talking as much about construction, but again, a lot of what we do in design and construction is. Is about the humans on the other side and the spaces that we design and build for them. And it is part of our responsibility to be helping solve those problems. So until next time, I hope you continue to look at some of those challenges that you feel internally. I want to be a part of it and I want to take that first action step towards solving it. I hope you're able to do that and continue to activate your curiosity as well as others and their curiosity.

Ryan : 1:00:32

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