Amanda Wilde (Host): Welcome to the Healthcare Executive Podcast, providing you with insightful commentary and developments in the world of healthcare leadership. To learn more, visit ache.org. I'm your host, Amanda Wilde. In this podcast episode, we are joined by Carey Sealy. Carey is Managing Director ATG Enterprise at JLL Healthcare.

JLL is one of ACHE's Premier Corporate Partners. Our Premier Corporate Partners support ACHE'S vision and mission to advance healthcare leadership excellence. Carey is here with practical strategies for transforming healthcare operations in these challenging times. That's a lot for you to cover Carey. Welcome and thank you for being here.

Carey Sealy: Thanks very much for having me.

Host: Can you tell us kind of how you got here, just a little bit about your background and then role at JLL?

Carey Sealy: Absolutely. So I've been with JLL for a little bit over seven years. I came to JLL then to lead what we called our Corporate Solutions Transformation group, and I've spent really the last seven years leading our work dynamics operational excellence group that has been focused on improving service delivery to our clients, bringing best practices and really driving the technology landscape across our client base.

So it's been a focus of mine for over 30 years to really drive operational excellence in operations. So this podcast is a real near and dear to my heart.

Host: Well, what do you see as the most critical operational challenges that are facing healthcare executives in today's complex environment?

Carey Sealy: Healthcare leaders today are facing one of the most complex operating environments since the Affordable Care Act. Policy changes like the rollout of One Big Beautiful Bill Act, are creating what I'd call a perfect storm. You've got Medicaid funding cuts, declining patient volumes and a rising number of uninsured patients.

This is like a triple threat reshaping the healthcare corporate real estate environment, in many ways. The ripple effects are that rural hospitals are facing permanent closures. Urban markets are experiencing more pressure from rising uninsured rates and healthcare portfolios are requiring strategic repositioning.

And then on top of all that, financial pressures are mounting. We've got declining reimbursements, escalating labor costs, especially in nursing, where we've got massive shortages and rising supply chain and energy expenses are all starting to compress margins and leading to a lot of financial instability.

We've got escalating labor costs are driving premium pays, supply chain disruptions and inflation driving up costs for medical supplies and hospitals, they're high energy consumers. So energy costs consume anywhere from one to 3% of a typical healthcare facilities operating budget, and that can represent an estimated 1% or more profits.

So every percentage point saved on energy costs can be redirected toward patient care.

There is really a growing need for operational efficiency as traditional revenue streams face pressure from value-based care transitions. And, you know, I can give you a few examples of what I'm seeing.

There's a rural hospital I work with in the Midwest; declining reimbursements and increasing costs, forced its closure. It stripped the whole community of its critical emergency services. And then we're seeing the workforce. There's chronic labor shortages that are exacerbated by an aging patient population, making it difficult to maintain adequate staffing levels and really ensure high quality care.

I was astounded over the weekend to find out that 43 million additional healthcare workers are needed to cover the health workers shortage around the globe. That's not just in the US but globally. So that's a big number.

Host: So let's talk about how you address these hospital closures and staff shortages and still maintain quality patient care while you try to optimize real estate assets and streamline operations at the same time. And you're trying to enhance margins. You said it was more important than ever looking at how your operational costs are structured. So let's take those things one by one. How can healthcare leaders transform real estate from cost center to actually into a strategic asset?

Carey Sealy: So that's a great question. So real estate is actually the third largest expense category for most health systems, and it usually accounts for about 15 to 20% of operating budgets. But rather than seeing that as just overhead, our forward-looking leaders are using data and partners to make data-driven portfolio optimization decisions.

This means using data to identify underutilized space, make evidence-based location decisions, and benchmark performance across sites. It also involves aligning the real estate strategy to the clinical priorities, making sure that like facilities are positioned where patients actually are and designed to enhance both staff and patient experience.

I can give you an example. There's one health system in Texas that realized that one of their outpatient clinics was only 40% utilized during the week. So by consolidating services and repurposing that unused space for urgent care; they not only cut costs, but also created a new revenue stream. And so we're seeing a lot more of these cases. Another one, energy efficiency is also a huge lever. So like I said before, hospitals are high energy consumers, so prioritizing investments like smart building automation, renewable energy, deferred maintenance planning. All of these can reduce costs while meeting sustainability requirements.

So energy assessments; you can identify various measures to reduce energy consumption from installing LED lighting to major investments like replacing HVAC systems. Many times, depending on the complexity, larger projects can not only reduce operational costs, but also potentially enable rebates on energy efficiency equipment.

A Midwestern system invested in energy efficiency upgrades, smart lighting, HVAC automation, and even onsite solar panels. And you know what, that was a 22% reduction in energy costs, and that frees up millions of dollars annually for patient care initiatives. So you can create market differentiation through sustainability initiatives.

Host: Well, you kind of just already touched on this, about how healthcare systems can leverage technology to drive both operational efficiencies and cost savings in facility management.

Carey Sealy: Yeah, and I think, technology is a game changer in healthcare. It's already transforming healthcare facility management, and I've really seen various ways that technology can really drive a differentiation. And this is everything from asset management to predictive maintenance, to energy like we just talked about.

But one of the other big trends that I see is one around compliance and then two is around healthcare data analytics. And I'll talk a little bit about those. But really what I see is the most successful healthcare organizations are implementing unified technology platforms that span the entire real estate lifecycle.

They're creating smart building systems that communicate seamlessly with clinical operations. So it's really building that optimal facility condition for both operational efficiency and patient care. So those silos are being broken down between technology, facilities and clinical functions. Leveraging the right tech data and insights is also a trend I see as a best practice.

And so I can talk to you a little bit about predictive maintenance. We see more systems using IOT sensors and analytics to be able to predict equipment failures before they happen, and that really starts to extend the asset life. We also see smart building automation where hospital systems are deploying integrated systems that automatically optimize HVAC, lighting and energy based off of occupancy.

So case in point, a hospital in California used integrated controls for lighting and HVAC that automatically adjusted based off of occupancy, and within a year they were able to cut their utility bills by almost 25%. And that's not just cost savings. So that's sustainability and market differentiation.

And then, you know, I would be remiss if I didn't talk a little bit about AI. I mean, AI is, you hear that all over now, and I think adoption in this space, while it's still early, the potential is absolutely enormous. If I can imagine, AI that helps forecast patient demand and automatically adjust facility operations like staffing or energy use to match. That's really where we're headed.

Host: So you're always finding ways to use technology to its fullest potential.

Carey Sealy: Absolutely. I mean, and we have to now, it's the only way.

Host: Right. It's the only way to survive now, as you said. What best practices from other sectors can healthcare executives apply to their operations?

Carey Sealy: Healthcare executives can learn a lot from other sectors, by adapting strategies from commercial, from retail and from hospitality real estate, healthcare executives can improve operational efficiency, enhance patient experience, and also create more valuable and resilient assets. So from a commercial perspective, take things like asset monetization.

Commercial real estate often uses sale leasebacks and other monetization strategies to free up capital. Healthcare systems can sell non-core assets. Or even enter into partnerships with third party developers to unlock capital that can be reinvested into their core mission of patient care. On the retail side, the retailization of healthcare is a growing trend. Healthcare providers are increasingly treating patients as consumers, and real estate strategies are starting to reflect that shift. And you can see this in everything from site selection to creating a more welcoming environment and also multi-tenancy and co-location.

So from a hospitality perspective, we also see that the industry, because hospitality is centered around the guest experience, healthcare leaders can also learn from this by prioritizing patient satisfaction in every aspect of a facility's design and its operation. And we can see this in everything from enhanced patient care, seamless technology integration like we were just talking about, and also flexible and adaptable designs.

So if you think about your hotel experience, those spaces are designed for different feelings and different emotions. Healthcare facilities can also incorporate those similar modular designs that can be adapted to patient care models as well. So really, by adopting best practices from different industries, healthcare real estate executives can move beyond traditional facilities management and build more strategic efficient and patient-centered portfolios that are better aligned with the evolving demands of the healthcare industry.

Host: Now integrated into all this is the constantly changing regulatory landscape. How should leaders approach that landscape with limited resources?

Carey Sealy: Well, there's one thing that is constant and that's change. With the constant regulatory changes, the key is really transitioning to what I call always-on compliance, and that's really shifting from episodic cycles to continuous readiness. And here, data and automation are our biggest allies. So I have a few recommendations that healthcare facility executives can consider.

So one, implementing digital compliance solutions that align with regulatory frameworks. Two, developing transition timelines based on specific survey windows to prevent those last minute compliance challenges. And then three, leveraging subject matter experts for guidance through transition periods that are really starting to look across departments to reduce burden on lean teams.

Really to me the big focus here is around digital tools and distributed responsibility that can make compliance less of a fire drill and more of a built in strength and a continuous value driver. There is a new joint commission change, a major restructuring of its accreditation and survey processes that are taking place in January of 2026.

And it's a significant shift to a more streamlined, transparent and outcome focused accreditation process. So really it's important to start planning now on how your organization will start to manage this change.

Host: And it sounds like you have those tools to create that framework.

Carey Sealy: We certainly do.

Host: And finally, Carey, looking forward to the future, how do you see operational excellence evolving for healthcare organizations and, just as you were alluding to, how can leaders prepare now for the future?

Carey Sealy: I believe we're moving towards a more fully integrated model where facilities, clinical operations, technology, and finance are no longer separate silos, but really deeply connected and part of a single unified strategy. Hospitals of the future aren't going to be just buildings. They'll be dynamic, they'll be intelligent environments that contribute to both patient outcomes and financial sustainability; through predictive analytics, experience centered design that responds to changing patient and workforce needs. So the traditional boundaries between cost centers and value drivers will really start to dissipate as healthcare organizations adopt real-time intelligent platforms and they'll be connecting previously siloed functions.

So imagine a hospital where a building itself contributes to patient care, smart rooms that adjust temperature and lighting to patient preferences. It's coming. Predictive analytics that anticipate patient surges and adjust capacities in advance and compliance systems that self-audit continuously back to that always-on compliance.

So leaders who are preparing for that future today, are going to gain a competitive advantage. So I recommend three critical steps. First, implement an always-on compliance and operations monitoring system. Second, develop cross-functional teams that blend clinical expertise with facilities management, technology, and financial.

Just break down those traditional barriers. And then third and final, embrace data driven decision making by investing in that analytics platform.

Host: So we have the tools to create fully integrated and dynamic and sustainable models, which is a very hopeful note. Thank you so much for this information, the very specific strategies. This has been such an enlightening conversation. Thank you for sharing your expertise and insights Carey.

Carey Sealy: Thank you for having me.

Amanda Wilde (Host): Carey Sealy is Managing Director at JLL Healthcare. JLL is one of ACHE's Premier Corporate Partners. Our Premier Corporate Partners support ACHE's vision and mission to advance healthcare leadership excellence.

For more information and further discussions, visit healthcareexecutive.org. This is Healthcare Executive Podcast from ACHE, the American College of Healthcare Executives.