Essential Insights for Adaptive Reuse of Facilities for Healthcare

In today’s complex real estate landscape, it is increasingly popular and practical to convert existing structures like strip malls, office buildings and hotels into medical facilities.

This adaptive reuse can offer numerous advantages, including shorter construction times, significant cost savings and the ability to advance sustainability goals. But it also presents distinctive challenges.

Bringing in qualified engineers during the initial due diligence phase before a lease is signed or purchase agreement finalized can save healthcare organizations significant time, money and potential headaches. Engineering and design teams can assess project feasibility and identify hidden costs associated with infrastructure upgrades and code compliance. This is critical to setting realistic budgets and avoiding unforeseen expenses or project delays that can hinder a healthcare facility’s speed to market.

To avoid costly retrofits and project delays, here are three key questions healthcare decision-makers and stakeholders should ask engineers and designers before embarking on an adaptive reuse project.

What is involved with adapting this space to meet healthcare needs?

 Underestimating infrastructure requirements is a common pitfall in adaptive reuse projects.

Existing buildings, particularly older ones, often lack the robust mechanical, electrical and plumbing (MEP) systems needed to support the demands of a modern healthcare facility. Converting an existing space into a healthcare facility requires careful consideration to integrate exam rooms, additional bathrooms and plumbing, proper heating-ventilation-air conditioning (HVAC) systems and more.

Even a space with seemingly robust infrastructure requires careful testing to determine whether it is sufficient for healthcare use, what upgrades may be needed and how much the improvements will cost. Short-changing initial assessments can also compromise the user experience, from the look and feel of the space to staff workflow.

Consider a project that involved converting the second floor of a three-story building into a behavioral health facility. The plan ran into challenges when it was discovered that low floor-to-floor heights would require extensive workarounds to accommodate essential MEP systems within the limited space.

The result? Forced design compromises, such as incorporating soffits, negatively impacted the therapeutic environment. Preliminary engineering assessments could have identified the challenges and positioned the facility owner to make more informed decisions earlier in the planning process.

Another organization purchased an older building to adapt into a laboratory but did not consult with an engineer until assuming ownership. They discovered too late that the building lacked the structural integrity and MEP infrastructure needed for the intended use and would require extensive – and expensive – renovations. The discovery caused them to re-evaluate their financial plans and timelines, delaying lab development and impacting broader organizational priorities.

It is also helpful to assess long-term infrastructure needs, such as the potential for future expansion. One healthcare provider leased a fourth-floor open office space and converted it into a clinic with numerous exam rooms. At the outset, they would have benefitted from considering potential future expansion to the fifth floor. Doing so could have helped plan for the substantial increase in plumbing capacity. Now, expansion may require significant upgrades, system reconfiguration and space layout changes. 

How might this project be impacted by building codes and standards?

To ensure the health and safety of patients, staff and visitors, healthcare facilities must adhere to stringent building codes and standards, which can differ significantly from those governing other commercial spaces.

Seemingly minor differences in regulation can greatly impact the overall plans for conversion, since standards for healthcare drive the kinds of systems that are needed in the final space. In turn, these solutions also impact construction costs and timelines.

One Kansas City suburb recently adopted the 2021 International Energy Conservation Code (IECC), which is far more prescriptive than previous energy codes. Property owners looking to develop healthcare facilities in that area will need to understand the evolving requirements for commissioning and MEP systems.

Kansas City isn’t alone. Post-pandemic, jurisdictions across the U.S. are updating expectations for healthcare facilities. For example, this year the National Fire Protection Association rolled out a wide range of new requirements (NFPA 99 and NFPA 101) that impact everything from HVAC to the need for auxiliary connections for temporary or supplemental supply for medical gas and vacuum systems. Owners who collaborate with engineers to identify potential code compliance issues before buying or leasing a space can avoid unanticipated complications down the road.

What are the anticipated costs and potential challenges?

Engineers can identify potential hidden costs and timeframes associated with infrastructure upgrades and code compliance when evaluating an existing building for renovation, helping developers and healthcare organizations develop more realistic project budgets.

A critical first step is to conduct a facility condition assessment, a process that also can help existing healthcare facilities with MEP infrastructure upgrades as well as future planning.

For example, a major healthcare system in the Philadelphia region invested in a large-scale facility condition assessment to understand current infrastructure conditions. The assessment spanned 4,000,000 square feet of acute care hospital spaces and medical office buildings across six campuses. By understanding the condition and capacity of their existing infrastructure, the assessment allows the owner to proactively identify potential infrastructure limitations and incorporate these findings into future project budgets and schedules.

Particularly when planning to adapt an existing building for a different use, the cost of an assessment is small compared to the impacts of underestimating the engineering demands involved. Engineers can help provide cost estimates, review anticipated schedules and detail potential challenges, all of which can help organizations determine whether to proceed with a potential project.

Adaptive reuse projects offer a viable and often attractive path for expanding healthcare services into local communities. However, success hinges on recognizing and overcoming potentially hidden challenges.

By integrating engineering expertise into the initial planning stages, developers and owners can make informed decisions about site selection, avoid costly surprises and ensure that the final design meets the unique demands of healthcare facilities while providing an optimal experience for patients and staff.

The bottom line: involve engineers as early in the process as possible.