In collaboration with the architectural firm, Kaplan McLaughlin Diaz, HealthWorks completed a strategic and facility planning project for a major academic medical center in the Northeast. The medical center had employed a strategy of constraining capital resources for facilities. With strong services and an excellent reputation, the organization had grown volume and gained market share for 7 years. As a result it was now operating with a high level of utilization. The significant economic benefits obtained—operating efficiencies and contained capital amortization costs—were documented by HealthWorks analysis; however, we also made a finding that surprised hospital management: The medical center was operating so close to full capacity that for 3 years it had begun to lose market share, leaving significant volume potential “on the table,” in effect, turned over to competitors. The loss was so significant that its economic value was greater than the benefits of efficiency and capital preservation. The hospital had, without knowing it, employed a sub-optimal strategy. The plan that HealthWorks and KMD developed rectified the strategic problem and provided for increased capacity and improved net financial performance.