Through planning and design, hospitals can position themselves to better accommodate their market areas' growing and shifting demographics.

The four major demographic shifts that can affect a hospital's strategic planning are:
• Population decline or growth
• The introduction of new cultures/ethnicities
• An increasing or decreasing level of affluence and education
• An aging or younger population

Forecasting growth and decline is the most common way that hospitals plan their facilities. Flexibility and scalability are key, since this will help hospitals maintain profitability during both growth and decline periods. Hospitals should also be selective in the services they offer; it may be better to master specific services than have a smorgasbord of mediocre departments. By determining which services will attract new or retain old patients, hospitals can weather changes more easily.

When a new ethnic group moves into a hospital's service area, adding multilingual forms, signs and staff members is just the beginning of the changes that should be made. Some cultures have large family units or differences in diet and eating habits, which can affect the design of patient rooms and dining facilities, as well as the services offered. If there are tolerance issues within the greater population area, hospital security may need to be increased to keep patients and their families safe.

Affluence and education are closely related. Educated customers will demand unique services, new technologies, enhanced convenience and improved ambience. This population also generally has more sophisticated tastes and will be aware of the benefits of amenities such as private beds and healing gardens. If a population's affluence is decreasing, however, value-oriented design is more acceptable.

For hospitals that serve a notable older or younger population, strategic facilities planning will be impacted differently. An aging population requires clear wayfinding and access, as well as a higher percentage of ADA-compliant rooms. Younger patients look for advanced technologies and departments such as obstetrics, pediatrics and plastic surgery. They also have higher expectations of design quality and desire private rooms, while older patients are more accepting of semi-private rooms.

One hospital that underwent in-depth strategic planning to examine each of these demographic shifts is the Del E. Webb Hospital (DEW) in Sun City West, Arizona. The hospital's service area has grown dramatically and is experiencing an influx of young families into the traditionally retirement-age community. Prior to its new strategic plan, the hospital had a low market share amongst these families, who may bypass DEW because of its reputation for servicing older patients. In addition, facilities that couldn't efficiently handle the population growth were discouraging patients who were coming to the emergency department, often the first encounter with a care provider for a newcomer.

A new patient tower was designed to attract younger patients and doctors to DEW. By examining the strategic opportunities and discerning the best use of funds, the hospital chose to include more private rooms, increased surgery capacity for orthopedics and cardiovascular, and a configuration that would facilitate use by a branded specialty service line.