Healthcare facility design and construction encompasses the planning, engineering, and building of hospitals, clinics, and related infrastructure that enable the delivery of safe, efficient, and patient-centered care. For the Indian Health Service (IHS), which invests billions of dollars annually in these projects, facility design is not simply about bricks and mortar—it is central to reducing health disparities, advancing public health goals, and strengthening the readiness of the healthcare system. Despite these high stakes, providers and engineers often enter the process with limited understanding of each other’s priorities. This disconnect can lead to miscommunication, inefficiencies, and facilities that fall short of fully supporting patient care. The consequences of this limited understanding are tangible. IT rooms, for example, are often designed without sufficient clinical input, resulting in inadequate space for equipment. The outcome is costly retrofits, project delays, and disruptions to care delivery. In Rapid City, exam room planning revealed that providers and engineers “visualize space differently.” Without early collaboration, layouts risked increasing patient transfer distances, slowing the pace of care, and adding stress for both patients and staff. Elevator design in another project underscored the importance of having “the right people at the right time.” Without interdisciplinary input, accessibility and workflow would have been compromised, requiring expensive redesigns. At Fort Yuma Clinic, the placement of sharps containers highlighted how seemingly minor decisions can have direct implications for infection control and staff safety. These case studies make clear that communication failures directly affect patient safety, operational efficiency, and long-term sustainability. The Whiteriver Hospital project in Arizona serves as a central case study because of its scope, complexity, and community significance. Whiteriver demanded deep collaboration between engineers, clinical leaders, and community stakeholders across multiple design phases. Lessons learned—including the use of mockups and site tours to build shared understanding, co-development of functional narratives to translate patient experiences into technical requirements, and structured interdisciplinary design reviews to maintain accountability—illustrate how candid dialogue and collaborative problem-solving produce facilities that truly serve their communities. These lessons extend across the Federal Health Enterprise, which AMSUS convenes. Whether within IHS, the Department of Veterans Affairs, or the Department of Defense, federal health agencies face common challenges: long project timelines, complex stakeholder environments, and the imperative to align facilities with both patient care and public health objectives. Best practices such as integrated project teams, consistent communication tools, and early provider engagement are transferable strategies that strengthen facility outcomes and improve the return on federal investments. This session will equip participants with practical strategies to bridge provider–engineer divides, foster trust, and ensure that design and construction efforts maximize impact, efficiency, and sustainability. Grounded in real-world lessons, participants will leave with tools to reduce health disparities and contribute to facilities that are safer, more efficient, and better aligned with mission readiness across the Federal Health Enterprise.