Rethinking Deferred Maintenance and Master Planning in Healthcare

Healthcare leaders today know that the conversation around deferred maintenance isn’t new. But it is becoming more urgent.  

Aging infrastructure, shrinking budgets, and rising demands have led facility managers and executives to reconsider their approaches to capital planning and how they are using operational data to guide investment decisions. 

Deferred maintenance is frequently treated as something to be addressed “later.” But this often results in project delays, cost overruns, and – in some cases – serious disruptions to patient care.  

Instead of viewing existing infrastructure maintenance as an afterthought, leaders might actually find it more beneficial to bring it into the core of their master planning and strategic decision-making. Let’s discuss why.  

The disconnect between planning and reality 

One of the most common problems in healthcare planning is the disconnect between new construction and existing infrastructure. Many executives see master planning only as an exercise in building bed towers or new outpatient facilities. But ignoring what is happening in their aging buildings can lead to surprises, once renovation begins, that delay projects and drive costs beyond expectations. 

On the flip side, facilities leaders often see firsthand how existing assets can threaten continuity. From outdated air handlers serving critical spaces to fire alarms that are no longer supported by their manufacturer, risks like these accumulate quietly until they reach a tipping point. Bridging the gap between these two perspectives requires both objective data and a compelling story. 

A strong plan doesn’t just consider data for five or ten years out, it also addresses short-term realities like:  

• What service lines are shifting?
• How is telehealth impacting space usage?
• What technology investments will be required to stay competitive? 

This means making deferred maintenance a key part of the conversation. Creating a comprehensive and effective master plan requires evaluating whether existing facilities can meet community and service line needs, or whether reinvestment is justified.  

By combining strong financial stewardship, regulatory compliance, sustainability, and infrastructure renewal into a singular roadmap, healthcare organizations can make more informed capital decisions that avoid potential disruptions in the future. 

What the data tells us 

Data on deferred maintenance tells a sobering story. Across thousands of healthcare facilities and more than 90,000 tracked assets, roughly 56% have exceeded their expected useful life. Before the pandemic, the number was closer to 42%.  

That shift represents a sign of accumulating risk. Life safety systems like generators, fire alarms, and transfer switches show nearly the same levels of deferral as less critical assets. HVAC equipment is even higher, with more than 60% of systems exceeding their expected useful life. Many of these assets are directly tied to patient safety and revenue continuity, yet they are still slipping past renewal windows. 

So, what can be done?  

Communicating deferred maintenance effectively requires objectivity and consistency. Simply asking financial leaders for “$20 million to fix the backlog” isn’t going to resonate. Decision-makers require transparency and reasoning to justify investments.  

Instead, facilities leaders should frame the issue around strategies that executives already prioritize, like: 

• Financial outcomes: Lost revenue from unplanned shutdowns can reach tens of millions in a matter of weeks.
• Growth and strategy: Assets underpin service lines, patient experience, and compliance.
• Risk management: Every asset installed in a building serves a defined purpose. Framing conversations around risk to patient care and liability changes the dialogue from optional to essential. 

Transparency is equally important. Financial leaders frequently respond to clear distinctions between what must be addressed now, what can be managed over time, and what does not require immediate investment. That transparency builds trust and positions facilities teams as partners in the larger mission. 

But numbers and transparency alone are not enough. To gain traction, facilities leaders must connect the data to a compelling story that makes the risks and impacts of deferred maintenance real for decision-makers. 

Turning data into action and resilience 

Numbers on a spreadsheet rarely create urgency on their own. Translating those figures into context – such as what failure would mean for patient care, revenue, or community trust – can make it easier for executives to see deferred maintenance as more than a technical problem.  

For example, showing that a fire pump was installed “when John F. Kennedy was president” creates a much more vivid picture of asset age and risk that just saying, “it’s outdated.” Taking administrators on tours of mechanical rooms or critical spaces helps them connect the dots between infrastructure and patient outcomes and show the breadth of responsibility carried by facilities teams. 

Deferred maintenance, however, should never be treated as a facilities department burden alone. It is a strategic issue that touches finance, operations, compliance, and clinical care. The most effective organizations approach it through collaboration, with facilities leaders, executives, clinicians, and vendor partners working together. When these groups share a common understanding, deferred maintenance becomes a proactive strategy instead of a reactive scramble. 

Conclusion 

The backlog is real, and financial pressures make securing capital difficult. But the situation is not unmanageable. By combining transparent communication, objective data, risk-based prioritization, and collaborative planning, organizations can shift from a cycle of delay to one of resilience.  

The goal is not to eliminate deferred maintenance overnight. Instead, focus on setting realistic targets, investing steadily, and ensuring that every dollar you spend strengthens your foundation for safe, reliable, and sustainable care delivery. 

I recently hosted a webinar with ASHE on Leveraging Operational Data to Inform Strategic Infrastructure Investments. You can click here to watch the full recording.  

Or check out a recent blog post I wrote on more ways to effectively present your asset management plans to healthcare leaders.