July 11, 2018

Healthcare organizations have been shifting hospital-based services to less costly locations for quite some time, and this is expected to continue as long as health systems deal with decreasing reimbursements and increasing costs. Most organizations are ever more aggressive in their approach to moving or adding services off campus rather than at the “mothership” for patient convenience and to better manage the systems costs.

While new construction continues to be the default facility solution, adaptive reuse of existing buildings offers great potential for addressing the needs of healthcare systems. Repurposing space is an increasingly popular facility strategy for hospital systems expanding or shifting services away from their hospitals because it often requires less capital, and repurposed space can be made operational more quickly than new construction.

Most often, the inventory of existing buildings available for adaptive reuse were built for retail use. As conventional retail has been greatly disrupted, large numbers of buildings, conveniently located, now stand abandoned or underutilized. These spaces often have many characteristics that healthcare organizations desire—single floor at grade; large, open floor plates; ample floor-to-floor height; abundant parking; and good visibility from the street.

With these advantages, however, there are also design challenges associated with renovating existing buildings into spaces able to support new healthcare delivery. When evaluating existing buildings for healthcare use, there are many things to be considered. The following represent just a few:

 

Does It Support the Medical Center’s Strategy?

Facilities strategy should support the health system’s broader business strategy. While time and money may be saved by leveraging an existing building, it does not necessarily mean it is the best choice. The location and long-term growth potential of the building should be considered through the lens of the system’s strategic plan.

 

The Site

Zoning
Will the current zoning allow for healthcare uses or will variances be required?

 

 

Visibility/Accessibility
The site should have good visibility, easy street access and ample parking. As patients are often stressed by the mere act of visiting a doctor, it is essential that site circulation is intuitive and simple. Finding the site, driving in and parking all set the baseline for patient satisfaction well before they arrive at the front door.

 

 

Approach to the Entrance/Accessibility
Unlike shoppers, patients often require covered drop-off zones at the front door, usually not provided in a retail setting. Larger quantities of accessible parking also may be required due to the healthcare use.

 

The Building

Building Codes
Bringing the existing structure up to code for use as a healthcare facility can consume a sizable chunk of the budget. Worst-case scenario, it can render the project financially impractical.

Envelope Construction
The condition of the building envelope is critical. Is it watertight? Well insulated? Any mold/mildew issues?

Structural Capacity
Although bar joist structures are common in retail, they may be too “bouncy” for healthcare purposes. Also, should the structure require fireproofing, it may prove costly. Seismic loading and vibration should also be considered when evaluating structural capacity.

 

 

Floor-to-Floor, Floor-to-Deck Height
The 10- or 11-foot ceiling heights common to commercial office buildings and strip-mall retail centers often do not work for healthcare facilities. Conversely, high, single-story spaces found in “big-box” stores present difficulties constructing interior partitions.

 

 

Partition Construction/Fire Ratings
Early identification of the required wall fire ratings is essential. High floor-to-floor heights will result in more expensive interior partitions, especially those requiring a fire rating.

Vertical Circulation
Elevators in multifloor buildings designed as retail space may not be adequate to transport the volume of patients seen in a healthcare facility. Additionally, the elevators may not be located conveniently for clinical use, and the cabs often lack ample room for stretchers.

 

 

HVAC
Mechanical systems intended for retail are drastically different from those supporting healthcare spaces. Retail HVAC systems are designed for large, open spaces that are often not zoned especially well. Healthcare uses will require new systems or strategies for zoning and controls, and will increase airflow and cooling.

Plumbing
While typical retail spaces have a few toilets for staff and visitors, healthcare facilities have significantly greater requirements. With separate restroom facilities for public, staff and patients, even small facilities have three to four times the number of fixtures seen in a retail space the same size. All these additional fixtures may require new water and sanitary services.

 

 

Electrical
The high density of use and equipment loads in healthcare facilities increase the requirements on the electrical system far beyond what a retail system affords. Emergency power systems, if available, will almost certainly not be adequate for new clinical requirements.

Flexibility
How might the facility change and grow over time? Healthcare is ever changing.

 

 

Despite the numerous challenges commonly seen in these adaptive reuse projects, with careful selection of the right property, a healthcare system may significantly reduce construction time, bringing services to market faster, while saving 20 to 30 percent of the cost of construction.

Executive Vice President of Gresham Smith’s Corporate + Urban Design market, Steve Johnson, AIA, NCARB, also contributed to this post.