Focus

Hospitals are complex systems. Our focus is on the physical infrastructure that supports every aspect of care.

A Foundation Built For A Different Era

The modern hospital infrastructure landscape was shaped by two landmark pieces of legislation: the Hospital Survey and Construction Act of 1946, commonly known as the Hill-Burton Act, and the Medicare and Medicaid Act of 1965.

Many hospitals operating today were built or significantly expanded during the postwar expansion era. That history helps explain why so much healthcare infrastructure now faces simultaneous pressure from age, demand, modernization, and workforce continuity.

Source areas for review: Hill-Burton history, Medicare and Medicaid historical materials, ASHE infrastructure publications, AHA capital and hospital field resources, rural healthcare infrastructure research.

1946Hill-Burton Act

Federal investment expands hospital construction and modernization.

1965Medicare & Medicaid

Expanded coverage increases demand for care and supporting infrastructure.

1946–1975Expansion Era

Many community hospitals are built, expanded, or reshaped during this period.

TodayAdapting & Sustaining

Facilities teams keep aging systems operating while modernization needs compound.

Why Healthcare Infrastructure?

Patient care cannot happen without reliable buildings, utilities, environmental controls, emergency power, water, steam, medical gas, controls, maintenance, and skilled people who understand how these systems behave under pressure.

Infrastructure failures are often invisible until they become emergencies. Just The Bones exists to help bring visibility, practical support, and long-term thinking to the systems that keep healthcare operational.

Current State→The Gap→Path Forward

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The Current State

Modern healthcare facilities depend on highly complex infrastructure systems operating continuously under demanding conditions.

Facility teams maintain exceptional reliability through the work of engineers, technicians, operators, and support staff, even as infrastructure ages and complexity increases.

Deferred maintenance backlogs
Aging utility infrastructure
Rising operational complexity
Modernization costs
Resilience and reliability requirements
Energy and efficiency demands

Source Areas

ASHE, AHA, FEMA, DOE, GAO, rural healthcare infrastructure research.

View Current State →

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The Gap

Infrastructure competes with immediate clinical needs for limited resources, even though clinical care depends on those systems remaining functional.

Operational infrastructure often remains invisible to patients, donors, and the public until a failure occurs.

Capital constraints
Long replacement cycles
Low public visibility
Competing clinical priorities
Funding and reimbursement challenges
Fragmented responsibility and planning

Source Areas

Hospital capital trend reports, rural health research, GAO reports, healthcare facilities planning resources.

View The Gap →

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A Path Forward

Hospitals can build stronger, more resilient infrastructure through prioritized investment, planning, modernization, and workforce continuity.

Just The Bones intends to begin with small, practical proof-of-model projects and grow from lessons learned in the field.

Lifecycle planning and asset management
Infrastructure modernization
Electrification and decarbonization readiness
Energy efficiency and sustainability
Workforce development and retention
Institutional knowledge preservation

Source Areas

ASHE guidance, DOE Better Buildings, FEMA resilience resources, healthcare energy and sustainability programs.

View Path Forward →

Examples Already Underway

Healthcare organizations across the country are already investing in modernization, resilience, energy efficiency, electrification, and workforce development. These efforts show that the path forward exists, but support is uneven and many smaller facilities face greater constraints.

Just The Bones is not attempting to reinvent this work. The goal is to understand where gaps remain and where additional support, awareness, partnership, or resources may provide meaningful value.

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Just The Bones exists to bring visibility to the infrastructure behind healthcare and help build support systems for a stronger, more resilient future.

Healthcare depends on what you don’t see.

Info@justthebones.org

Currently seeking conversation, perspective, and mentorship from experienced nonprofit, healthcare, infrastructure, and workforce leaders.