A building with glass windows.

What do we do with underutilized or closed hospital infrastructure?

Research Project Name

The Hospital Left Behind

What We Did

We identified strategies for adaptive reuse and redevelopment opportunities for underutilized medical facilities, with a goal to benefit owners and users, as well as the communities the hospitals serve.

Our methods included interviews with hospital executives and other healthcare professionals, as well as architectural project teams; a review of historical events that directly impacted hospital facility growth and decline; and the identification of industry benchmarks to better understand key components for successful facility transitions.

We also gathered secondary research and case studies identifying the economic parameters that drive real estate decisions to repurpose or demolish buildings; and analyzed metrics from independent industry organizations such as the American Heart Association, The Advisory Board, DHG Healthcare, PwC, Kaufman Hall, among others. Using this information, we held roundtable discussions, design charettes, and think tanks with service providers, industry analysts, and design professionals to explore effective strategies that would later inform a speculative design project to illustrate our findings.

The Context

The healthcare market is undergoing a major transformation in how and where it delivers services. This is impacting service providers’ real estate strategies in profound ways. Just as patient care is shifting from a reactive, episodic service model to one of continuous wellness, healthcare facilities must adapt to this new continuum of care.

As a result, the U.S. is rife with shuttered or underutilized hospitals. These facilities vary in size, shape, design, context, and age, and have come to symbolize the state of the healthcare real estate market. Together these are the hospitals left behind, and the phenomenon only promises to grow. The question of what to do with underutilized or closed hospital buildings is of vital importance, not only to the buildings’ owners and operators, but to the patients and communities they were built to serve.

The Results

When facing the challenge of adapting legacy healthcare infrastructure for new purposes, it’s critical that stakeholders have a solid understanding of what works—and what doesn’t. More often than not, the real opportunities for hospital reuse reside slightly “off stage” and away from the glow of critical praise and preservation dialogue. The vast numbers of the hospital buildings left behind are not considered historic or iconic.

To understand when, and in what way, a building is worth reusing, we developed a process to identify the highest and best use for a given building. By exploring demographic and trend data specific to a building’s location, in context of the costs and opportunities for converting the building to different uses—whether workplace, residential, hotel, or other healthcare uses—the process helps clarify the options for redevelopment, and ultimately aids in making the final and best decision.

What This Means

The architectural options for hospital reuse are initially quite straightforward: you can either renovate, repurpose, or raze the building. However, the underlying factors that inform which path a client chooses are as nuanced and varied as the buildings themselves.

We ultimately identified eight critical factors our clients must consider when undertaking a hospital reuse project:

1. Curate your team. You’re not just picking a team of architects, planners, and facilities managers; you need the right people at the table to help calculate capital and operational expenditures, as well as analyze market need and opportunity.

2. Start the right conversation. Make the conversation strategic and informed, and have the right people in the room. The client side of the equation must include the C-suite, not just the facilities manager.

3. Know your community. This means understanding demographics, but also the nuances and personality of a community. Sustained and meaningful community engagement is tantamount to success.

4. Infrastructure always rules. Respect the bones of your building, and understand how it can—or cannot—be adapted to work for you. The opportunities, or limitations, of infrastructure may be the key factor in deciding whether a building can be saved.

5. Understand your options Learn how residential, hospitality, learning, workplace, and clinic programs work with legacy infrastructure. Paired with the needs of the local community, this will help you identify the best usage options.

6. Think sculpture, not surgery Don’t be afraid to make a big, inspirational move that goes beyond the pragmatic. The intervention should be a provocation, not an homage to the past.

7. Sometimes the smartest option is not to build. Sometimes you don’t need more space, just better use of space. Look for ways to make processes more efficient—embarking on a new project should be the last resort.

8. Know yourself. At the end of the day, it’s critical to understand your own risk profile. If it’s the right decision, as one source put it, “don’t be afraid of the wrecking ball.”

What’s Next?

We continue to share our findings within the industry, and help clients with underutilized facilities explore the best opportunities for their revival.

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Sarah Bader, Tim Jacobson, Caroline Brown, Raleigh Cohen, Mairen Foley, Whitney Fuessel, Chris Grosse, Randy Guillot, Michael Hanley, Russell Lacoursiere, Kathleen Margolis, Melissa Mayer, Chirag Patel, Jeremy Rodgers, LingYi Tseng, John Waller

Year Completed