Every facility director is running the same arithmetic this budget season. Capital is constrained, construction costs are up, patient volumes won’t sit still — and somewhere in the portfolio, aging infrastructure is competing with growth for the same dollars. A session at the IFHE 2026 World Congress took that arithmetic as its subject, with a health-system construction chief and an engineering principal working the problem from the two chairs that usually argue it.
The session. “Healthcare at the Crossroads: Capital Pressure and the Future of Facility Investment” ran Monday, October 19, 2026, on the IFHE Stage in New Orleans. As listed in the official program, the speakers were Rahul Tikekar, Principal and Senior Vice President at Loring Consulting Engineers, and Barry Zuckerman, Vice President of Design and Construction at Northwell Health; the program notes the session’s sponsorship by Loring Consulting Engineers and lists the moderator as to be determined.
The conditions, as the program states them
Three pressures, named plainly. Per the program, capital constraints, rising construction costs, and uncertain volumes are reshaping how health systems think about facility investment. None of the three is a surprise to anyone holding a capital plan — but together they change the planning problem. It is no longer “what do we build, in what order” but “what do we fund at all, and what do we consciously defer.”
What the session worked on
Frameworks for prioritizing projects. Per the program, the session explored frameworks for prioritizing projects under those conditions. Prioritization is where capital pressure becomes visible: a framework decides, in advance and in the open, what renewal work outranks growth work — or the loudest project decides instead.
Aligning stakeholders. The program pairs prioritization with stakeholder alignment, which is the honest acknowledgment that a framework alone settles nothing. The clinical, financial, and facilities cases for a project are made in different languages; aligning them is work, and the program treats it as part of the discipline.
Renewal against growth. Per the program, the session addressed balancing renewal with new growth, with lessons from recent projects and strategies for disciplined, future-focused decisions under pressure. Renewal is the unglamorous half of the portfolio — roofs, plant, and infrastructure with no ribbon-cutting — and under capital pressure it is the half most easily deferred and most expensively recovered.
The facility director’s version
Deferred renewal is a decision, whether or not it was made as one. The session’s value for operators is the framing: under constraint, the choice is not between spending and saving but between deciding the deferral list deliberately, with eyes open about the risk it carries, or discovering it later as failures. A prioritization framework a facility team can show its CFO — tested against renewal needs, not just growth ambitions — is the working tool this session was built around.
Related reading
- Norwegian Hospitals Run One Platform From Construction to Asset Management. Here’s What That Buys.
- From Strategy to Performance: The IFHE Session on Operational Readiness
Session record
- Session: Healthcare at the Crossroads: Capital Pressure and the Future of Facility Investment
- Event: IFHE 2026 World Congress (29th), co-located with HCD Conference + Expo, October 17–20, 2026, New Orleans
- Slot: Monday, October 19, 2026, 3:45–4:15 p.m., IFHE Stage
- Speakers, as listed in the official program: Rahul Tikekar (Loring Consulting Engineers) · Barry Zuckerman (Northwell Health); moderator listed as TBD
- Sponsorship: The program notes sponsorship by Loring Consulting Engineers
- Source: IFHE 2026 World Congress official agenda
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