By Don Procz, P.E., and Mindy Whisler, P.E., Contributing Writers

In today’s complex real estate landscape, it is increasingly popular to convert existing structures like strip malls, office buildings and hotels into medical facilities. This adaptive reuse can offer numerous advantages, from speed to cost savings to the ability to advance sustainability goals. But this approach 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. These benefits are critical to setting realistic budgets and avoiding unforeseen expenses and project delays that can hinder a healthcare facility’s speed to market. 

Infrastructure issues  

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 modern healthcare facilities Converting an existing space into a healthcare facility requires careful consideration to integrate exam rooms, additional bathrooms and plumbing and proper HVAC systems, among other considerations. 

Even spaces with a seemingly robust infrastructure require careful testing to determine whether the space is sufficient for healthcare use, as well as whether upgrades might be needed and their cost. With some projects, short-changing initial assessments can 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, that negatively impacted the therapeutic environment. Additional engineering assessments up front could have identified the challenge and positioned the facility owner to make more informed decisions earlier in the planning process. 

Related: Facility Condition Assessments Help Make Cases for Upgrades

Unforeseen infrastructure costs can be enough to halt a project altogether. One organization that bought an older building intended to use it for a laboratory. But they did not consult with an engineer until assuming ownership. Only later did they discover that the building lacked the structural integrity and MEP infrastructure needed for the intended use. 

They discovered too late that it would require extensive and expensive renovations to make it suitable for their intended use. The discovery caused them to re-evaluate their financial plans and timelines, delaying lab development and impacting broader organizational priorities. 

It also is helpful to assess long-term infrastructure needs, such as the potential for future expansion. 

One healthcare provider leased an open office space on the fourth floor and converted it into a clinic with numerous exam rooms. At the outset of the project, they would have benefitted from considering the potential future expansion to the fifth floor. Doing so could have helped plan for the substantial increase in plumbing capacity. If they expand now, it might require significant upgrades and reconfiguring systems and the layout of the space. 

Code considerations 

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. This also impacts construction costs and timelines. 

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

Kansas City is not alone. Since the pandemic, jurisdictions across the country have been updating expectations for healthcare facilities, as have organizations like the National Fire Protection Association (NFPA), which in 2024 rolled out a 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. Leaders who do not work with engineers to identify potential code compliance issues before buying or leasing a space can run into unanticipated complications down the road. 

Money matters 

Engineers also 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. 

One critical first step is to conduct a facility condition assessment, which also can help existing healthcare facilities with MEP infrastructure upgrades and future planning. 

For example, a large healthcare system in the Philadelphia region invested in a large-scale facility condition assessment to understand infrastructure conditions. The assessment spanned 4 million square feet of acute care hospital spaces and medical office buildings across six campuses. The owner helped the owner understand the condition and capacity of their existing infrastructure and helped 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. But the success of such projects hinges on recognizing and overcoming potentially hidden challenges. By integrating engineering expertise into the initial planning stages, developers and owners can make more informed decisions about site selection, avoid costly surprises and ensure the final design meets the unique demands of healthcare facilities while providing an optimal experience for patients and staff. The bottom line is to involve engineers as early in the process as possible. 

Don Procz, P.E., is senior vice president and healthcare sector practice leader with WSP, an engineering and professional services firm. Mindy Whisler, P.E., is vice president of property and buildings with the firm.