Leading Large Healthcare Projects: The Principal–Project Manager Partnership

Back To Articles

February 20, 2026

Knowledge

Healing

Leading Large Healthcare Projects: The Principal–Project Manager Partnership

On complex healthcare projects, success is never the result of a single role, but a product of strong leadership, clear communication, and alignment from vision to execution. At BSA, the partnership between Principal and Project Manager creates the foundation for that success, balancing big-picture strategy with day-to-day delivery. 

For leaders like Mike Ferment and Mitch Caldwell, this relationship is rooted in shared purposes: delivering environments that support healing, reducing stress, and improving the experiences of patients, families, and caregivers.

Vision First: Leadership at the Principal Level

When Mike steps into a project, his focus begins with understanding the deeper purpose behind it. 

“I want to understand ‘why’ before anything else,” he explains. “That clarity helps connect the design team to the users in a meaningful way, strengthens communication, and fosters collaboration. When everyone understands the mission, we move forward aligned and intentional.” 

Mike’s experience leading large, complex healthcare projects has shaped his ability to manage scale without losing sight of purpose. He approaches complexity through structure and organizes work into clear, manageable streams that keep scope, schedule, budget, and team alignment moving forward together. 

His communication style reflects the same clarity. He prioritizes direct, transparent, and solutions-oriented conversations that help clients understand options, risks, and implications so they can make confident decisions. 

For Mike, healthcare work is deeply personal. 

“I’m motivated by the impact healthcare environments have on people during critical moments in life. Thoughtful design can reduce stress and support healing, creating a dignified environment for patients, families, and caregivers.” 

Just as important as his individual experience is the strength of the firm behind him. 

“At BSA, we bring together expertise across architecture, engineering, interior design, and planning and design. That integrated knowledge allows us to support clients from vision through delivery, ensuring continuity, insight, and quality at every step.” 

Execution and Alignment: The Project Manager’s Role

While Mike sets up the strategic direction, Mitch focuses on building the operational framework that brings it to life. 

When beginning a project, Mitch starts with people. 

“I like to take time early on to learn how the client team prefers to communicate. Setting expectations upfront helps create clarity and consistency throughout the project.” 

This people-first mindset has been shaped by years of hands-on experience across projects ranging from 5,000 to 450,000 square feet and everything in between. Working across such a wide range of project scales has also helped Mitch understand what’s important and when. 

“When you break down a large project, it’s really a series of smaller projects combined into one, so experience across different sizes and types of work helps me manage more effectively and efficiently. I’ve also helped deliver an IPD project, worked on many IPD Lite projects, and applied the Target Value Delivery approach on others. Finding the right management style for the right project is paramount to its success.” 

Mitch approaches large projects as interconnected systems. 

“Breaking it down by floors, departments, and teams helps keep everyone aligned while still managing the bigger picture. It’s a constant balance between macro and micro thinking.” 

His experience in complex healthcare work, including long-term involvement on a major care tower project where he grew from a PA role into project leadership, has reinforced the importance of relationships and consistency. 

Over more than five years on that project, Mitch established trust with clients, users, and project partners while helping coordinate teams, manage expectations, and support ongoing renovations and backfill efforts. 

That progression is part of what makes him an effective Project Manager today. 

“My varied experience helps me understand what matters most at different moments in a project. And I’m surrounded by an incredible team. A manager is only as good as his team. The strength of our OneBSA model means I can draw on expertise across the firm to support our clients.” 

His connection to healthcare design runs deeper than project delivery. 

“As a North Carolina native from a rural community, I understand how important access to quality healthcare is. I got into architecture to do design that matters. Seeing patients and staff benefiting from a facility I helped deliver was a moment that reinforced why this work is important. That’s the perspective I bring into every project.” 

A Complementary Leadership Dynamic

Together, the Principal–Project Manager relationship creates a balance of perspective and precision. 

Mike helps define the vision, guide strategy, and ensure alignment with the client’s mission. Mitch translates that direction into action, coordinating teams, managing details, and maintaining momentum across every phase. 

It’s a leadership model built on trust, growth, and shared purpose. 

And on projects where every decision impacts patient care, staff efficiency, and community health, that partnership matters.

A modern hospital building labeled 'Greeley Hospital' with the 'UCHealth' logo, captured at dusk. The architecture features a combination of glass, metal, and stone materials, with a curved roof and large windows reflecting the sky. The entrance has a well-lit covered drop-off area supported by stone pillars. Three flagpoles stand in front of the building, displaying the American flag and other flags. The surrounding landscape includes neatly trimmed grass, small trees, and decorative lighting. This image shows BSA's expertise in healthcare architecture.

A digital rendering of an expansive hospital complex. The architecture is characterized by a six-story brick and glass rectangular center with different building additions extending from the main building. The surrounding environment includes trees, cars, two six-story parking garages, and pedestrians, giving a sense of activity. This image shows BSA's expertise in architecture design and rendering.

UNC Hospitals Hillsborough exterior featuring an all-glass design aside from brick pillars. This image showcases BSA's expertise in exterior architecture and blending different materials.

Modern hospital building, the MHP Medical Center, illuminated at dusk, showcasing sleek architecture the emergency department entrance. This image showcases BSA's expertise in architecture.

The image shows a modern healthcare facility, specifically a UNC Health Cancer Care center, photographed at dusk or early evening. The multi-story building features a contemporary architectural design with a combination of glass, stone, and metal elements. The front entrance has "CANCER CARE" prominently displayed and is covered by an extended overhang. The building has large windows that are illuminated from within, creating a warm glow against the deep blue evening sky. The landscaping includes a circular grass area in front of the entrance with curved walkways leading to the building. There's also a small directional sign visible in the foreground. The overall design blends functionality with a welcoming aesthetic appropriate for a medical facility.

A modern hospital building with a sleek glass exterior at dusk. This image showcases BSA's expertise in architecture.