Marymount University Hospital and Hospice is the sole provider of specialist palliative and elderly care in Cork, Ireland. It provides high-quality health care services for people with life-limiting illnesses, helping them to live with dignity in the context of their illnesses. Today, Marymount serves a population of approximately 600,000 people in County Cork.

Since its founding in 1870, Marymount was housed in a traditional brick Victorian building located in an urban area north of Cork City. By the 1990s, however, an aging population and a national increase in cancer patients escalated the demand for palliative care across Ireland, and the existing facility was limiting the organization's ability to fulfill its patient-centric mission. Following a 2001 government report mandating an increase in the number of palliative beds required per geographic area each hospital served, Marymount began the process of planning a new capital project.

Marymount's initial plan was to expand within its existing site. However, a decision was made to move all of its services to a new facility in a greenfield site on the edge of Cork City. With support from the Health Service Executive (HSE) of Ireland, the Friends of Marymount, and The Atlantic Philanthropies, Marymount opened its new 63-bed elderly and 44-bed palliative care facility in 2011.

The capital project has had a dramatic, positive impact on Marymount's ability to fulfill its core mission. The building allowed Marymount to double the size of its palliative care services. The project's focus on patient-centric design resulted in high-quality private rooms and public spaces as well as increased access to natural landscapes and daylight -- transforming the health care experience for patients and family members. Furthermore, the building helped to establish Marymount as a national leader in hospice design and attracted attention from hospice leaders in Europe and the United States.

At the same time, the capital project has also contributed to financial strain for Marymount. The organization's decision to abandon its initial, more modest expansion plan in favor of a new site and facility (a decision encouraged by Atlantic) significantly expanded the scope of the project. Marymount began operating the new facility with debt incurred due to a variety of factors: the rise and fall of the Celtic Tiger economy; decreased financial support from the HSE; changes in government service contracts that carried new financial risks; overruns in construction expenses; higher than anticipated costs for ongoing facility operation and maintenance; and increased staffing needs. This financial strain has been partially alleviated through Friends of Marymount contributions and continued fundraising, but the organization is still struggling to balance patient care with its staffing model and operating costs. While the building in many ways successfully achieved its intended design goals, these factors have created financial and operational pressures that are inhibiting Marymount from amplifying its organizational mission to the full extent desired through this capital project.

This case study is based on research conducted by MASS Design Group in May 2015. Funded by The Atlantic Philanthropies, this case illustrates how a capital project can support staff in providing patient-centered, dignified, and compassionate care. It also demonstrates the importance of aligning expanded facilities with an organization's operating model.