Casey Burnside – Sanford Health

When people think of healthcare, they often picture doctors in white coats, nurses rushing between rooms, or advanced medical technology humming in the background. What most do not consider is the vast infrastructure required to support that care—buildings that never sleep, systems that must run flawlessly, and a team that ensures both the basics and the complexities of a modern hospital operate seamlessly. For Sanford Health, the largest rural health system in the United States, this work is essential, and it is where Facilities Manager Casey Burnside has built his career.

Burnside oversees an enormous footprint: Sanford’s Fargo campus alone spans 1 million square feet and serves as an 11-story level 1 trauma center with 380 beds, 28 operating rooms, and 51 emergency bays. Including additional sites across the region, he and his team manage nearly 5 million square feet of facilities.

“We’re not patient-facing, but the things we do are impacting the patient experience and life and death situations,” Burnside says. “If it wasn’t for these teams, there wouldn’t be a place to work and provide care to patients.”

Sanford Health, headquartered in Sioux Falls, South Dakota, is more than just a hospital network. With 56 medical centers, 288 clinics, 147 senior living centers, and five international World Clinic locations, the system touches the lives of over 2 million patients across 320,000 square miles of America’s heartland. Its 4,000 physicians and advanced practice providers are backed by a research enterprise with more than 1,500 active clinical trials.

This scale makes Sanford the largest rural health system in the country, committed to transforming the healthcare experience in communities where access can be a challenge. From Centers of Excellence in specialties like cardiology and cancer to senior care facilities that anchor small towns, Sanford’s reach is both broad and deep. For Burnside, this mission means ensuring that the buildings and systems behind patient care never become barriers.

“People spend a lot of time improving health and studying how the environment impacts the patient experience,” he explains. “Something as simple as a room being too cold or too hot can make a huge difference in recovery.”

From maintenance to leadership

Burnside didn’t set out to work in healthcare facilities, but his career path steadily prepared him for the role. Starting in industrial maintenance, he eventually moved into power engineering before joining Sanford Health a decade ago. He began as a power plant lead, progressed to supervisor, and eventually became a facility manager in his current role, overseeing facility operations.

Now at 42, Burnside leads teams responsible for maintenance, carpentry, plumbing, electrical, and interior finishing work. He emphasizes that their contributions are far more technical than the old label of “maintenance” might suggest.

“Maintenance is such a vague term—it doesn’t spotlight the work or the impact,” he says. “Facility engineering is what we’re trying to move back toward, because it reflects the expertise and importance of the role.”

The distinction matters not just for recognition but also for recruitment. In a competitive labor market, particularly in trades, Burnside has seen how titles and compensation influence who applies.

“Facility maintenance and facility engineering are basically the same thing, but there can be a substantial difference in pay and talent pool,” he explains. To fill roles, he often takes a ground-up approach, training new hires from scratch while advocating for better pay and positioning.

Recruiting and retaining talent remain among his greatest challenges. Burnside stresses education within the organization about the impact of facilities teams.

“It’s not just the plumber,” he says. “We try to do our best with educating and preaching about the impact our folks have on the organization.”

Crucial projects & infrastructure

Sanford’s Fargo campus is still relatively new—its main facility was built in 2017—but constant upgrades and capital projects are required to meet the demands of a level 1 trauma center. Burnside’s team has spearheaded several major initiatives that keep the hospital resilient, efficient, and safe.

One example is a $1.4 million cooling tower upgrade, a project vital for maintaining proper temperatures throughout the sprawling facility. A future redundant medical vacuum system, for $500,000, ensures critical systems have backups if primary systems fail. Another $450,000 proposal focuses on replacing outdated with modern building automation systems, improving energy efficiency and environmental conditions for patients.

Burnside is also assisting with a $1.2 million project to enhance redundant cooling capabilities further.

“We can’t shut down a hospital,” he says, noting the complexity of coordinating system upgrades while patient care continues uninterrupted. “That’s why relationships with vendors and contractors are everything.”

He points to partnerships with firms like MMC, whose regional manager he counts as one of his closest professional allies and friends. Together, they’ve navigated projects ranging from domestic water shutdowns for the entire campus, rerouting services to the trauma bays and isolating the steam system. Impacting not only heating, but also its sterile processing for surgical cases. These impacts are thought out, communicated, and a team effort across all groups. Meeting the demands of hospital operations, patient care and ensuring that timelines are strictly met. These relationships provide flexibility during emergencies when quick decisions are required.

“Sometimes there are emergencies, and you need these relationships to make sure patients keep getting the care they need,” Burnside says.

A culture of care behind the scenes

While Burnside’s team may not interact directly with patients, their work shapes every aspect of the healthcare experience. He recalls spending time early in his career studying patient experience research, understanding how environmental factors contribute to healing. That knowledge now informs how he leads his staff.

His responsibilities extend beyond the walls of the hospital. Groundskeeping, for instance, is part of his oversight.

“The grounds are the first thing you see when you walk in the door and the last thing you see when you leave,” Burnside explains. “Dead plants or poorly maintained entrances are unacceptable in a setting meant to inspire confidence.”

He’s candid about the turnover challenges in this area, but he views them as opportunities to rebuild and rebrand. His philosophy is that every detail—inside and out—communicates Sanford’s commitment to care.

“We’re having a lot of turnover and trying to revamp the wheel here,” he says, noting the importance of reinforcing pride in facilities work.

Technology also plays an increasing role. From electronic preventive maintenance and work order systems to building automation, digital tools help Burnside’s team manage complex facilities with precision. Even artificial intelligence assists in streamlining tasks like communication and documentation. Still, he admits documentation remains a major challenge. Keeping records of everything from system upgrades to routine maintenance is critical for compliance, efficiency, and planning future projects.

Building for tomorrow

Burnside sees the work of facilities not just as keeping the lights on but as laying the foundation for Sanford Health’s growth. Plans are underway to expand services on the Fargo campus. These ambitions require facilities that can adapt and scale.

Sustainability is another priority, though still in its early stages. Burnside acknowledges that Sanford is beginning to explore detailed plans for greener operations, with projects like building automation already pointing in that direction.

For Burnside, leadership is about aligning his team with Sanford’s mission while preparing for the challenges ahead. His approach is practical but people-centered, rooted in both technical expertise and a recognition of the human impact of his work. Outside of the hospital, his life is grounded in family—his kids take up most of his free time—but at work, his focus remains steady: ensuring Sanford’s facilities remain safe, reliable, and welcoming spaces for healing.

“We’re here to make sure the environment supports care,” Burnside says. “If we can get that right, everything else becomes possible.”