Healthcare projects have become larger because healthcare itself has become more complex. Modern hospitals are treating higher acuity patients, supporting more technology, focusing on patient-centered campuses and designing for decades of service, not incremental growth. As a result, organizations are choosing fewer but bigger capital projects to support advanced care and positioning themselves strategically for the future. The goal of this presentation is to engage in a conversation with the leaders of three academic healthcare institutions who are currently designing and building mega healthcare projects to reflect on lessons learned and best practices when planning these types of projects. The discussion will focus on project management, budgeting, consultant selection, user group management, land use, master planning, and other relevant topics.