While there are numerous things that contribute to creating a successful ambulatory healthcare...
Finding the right location for a healthcare facility involves much more than negotiating favorable lease terms or identifying a highly visible site. Medical offices, ambulatory surgery centers, imaging facilities, and specialty practices place unique demands on buildings that many commercial properties, particularly older ones, were never designed to accommodate.
We've seen projects where an otherwise attractive location became prohibitively expensive, operationally compromised, or even infeasible once the realities of the building's infrastructure were understood. Many of these issues are difficult, or impossible, to correct after a lease has been signed.
The best healthcare projects begin long before design. Before committing to a space, owners should perform a healthcare-specific feasibility study and develop a preliminary fit plan to determine whether the building can realistically support their program. That relatively small investment in due diligence can prevent costly surprises later.
Make Sure the Space Will Fit Your Program
One of the most common misconceptions in commercial leasing is confusing rentable square footage with usable square footage. Rentable area includes a tenant's proportionate share of common areas such as corridors, lobbies, restrooms, and building service spaces. Usable area is the actual space within the leased premises where your facility must function.
That difference can be significant. A healthcare program that appears to fit comfortably within the advertised rentable area may simply not fit within the usable space. Discovering this after signing a lease often forces compromises in workflow, patient experience, or clinical capacity.
A preliminary healthcare fit plan verifies that the proposed program can be accommodated before lease execution. It is one of the simplest and most valuable planning tools available to prospective tenants.
Evaluate the Building Infrastructure
Commercial office buildings are designed for very different loads and infrastructure requirements than healthcare facilities. Existing systems should be evaluated carefully before committing to a space.
Structurally, consider whether the building can support heavy medical equipment such as MRI or CT scanners, fixed fluoroscopy equipment, ceiling-mounted booms, or rooftop mechanical equipment. When introducing surgical microscopes, vibration is a factor. Floor loading, structural deflection, roof capacity, and the ability to reinforce existing construction all deserve careful review. In renovation projects, even seemingly straightforward tasks such as coring reinforced concrete floors or cutting new slab openings can become major structural exercises.
Mechanical systems present another common challenge. Many buildings simply do not provide sufficient heating, cooling, outside air, or ventilation for healthcare occupancies. Older mechanical systems may already be operating at capacity, requiring substantial upgrades or complete replacement. Supplemental rooftop equipment may be necessary, making rooftop rights, structural capacity, shaft space, and available equipment locations important considerations. The performance of the building envelope should also be evaluated, as poor insulation or excessive air leakage can increase operating costs and reduce occupant comfort.
Electrical infrastructure deserves equal attention. Medical facilities often require substantially greater electrical capacity than conventional office tenants. Available utility service, panel capacity, electrical room space, routing of new feeders, emergency lighting, and generator requirements should all be reviewed early. Older electrical distribution systems may require extensive upgrades that significantly affect project budgets.
Plumbing systems can present similar obstacles. Domestic water pressure and flow, the location of incoming water service, sanitary piping capacity, and the ability to install properly sloped drainage piping should all be confirmed. Healthcare projects frequently require access to ceiling spaces below for new piping, which may not be available if other tenant spaces occupy the floor beneath.
Understanding these infrastructure limitations before signing a lease allows owners to make informed decisions before construction costs begin to escalate.
Consider Equipment Access Early
Sophisticated medical equipment often represents one of the largest investments in a new healthcare facility. Yet surprisingly little attention is sometimes given to how that equipment will actually reach its final location.
Loading areas, service corridors, door openings, elevator dimensions, weight capacities, and turning clearances should all be evaluated before equipment is purchased or construction begins. Imaging equipment, sterilizers, and other large medical devices occasionally require temporary removal of walls or windows simply to move them into the building.
Planning equipment access early avoids expensive surprises and unnecessary delays during construction.
Don't Overlook Ceiling Space and Building Geometry
The space above the ceiling is one of the most valuable, and frequently overlooked, resources in a healthcare renovation.
Within that limited space must fit HVAC ductwork, plumbing, medical gas piping, electrical conduit, lighting, sprinklers, structural supports for equipment, and sometimes imaging infrastructure. Low floor-to-floor heights, closely spaced columns, brace frames, and shear walls can significantly limit design flexibility and complicate construction.
Although these conditions are rarely visible during an initial walkthrough, they often become major drivers of both project cost and layout.
Review Building Code and Life Safety Requirements
Healthcare occupancies introduce code requirements that differ substantially from traditional office buildings. Occupancy classification, exit capacity, travel distances, corridor widths, elevator size, emergency power requirements, and stretcher movement should all be considered during site evaluation. Existing tenant and fire rated separations that affect the new use should also be checked.
Older buildings often contain conditions that complied with the codes in effect when they were constructed but are difficult to adapt for healthcare use today. For example, elevators in older office buildings sometimes discharge directly into exit enclosures, a configuration that generally does not comply with current Life Safety Code requirements and can be costly or impractical to correct.
Identifying these issues early helps determine whether a building is a good candidate for healthcare occupancy before substantial design effort has been invested.
Evaluate Site and Landlord Constraints
Even when the building itself appears suitable, landlord restrictions and site limitations can affect project feasibility.
Before signing a lease, confirm that adequate space exists for generators, bulk gas storage where required, supplemental HVAC equipment, and exterior condensers. Determine who owns and meters utilities, who is responsible for utility costs, and whether adequate utility capacity exists to support the proposed use.
Review lease restrictions carefully. Some landlords limit rooftop access, restrict exterior signage, prohibit modifications to common areas, or limit patient use of shared entrances and lobbies. If patients cannot enter through the primary building entrance, verify that an alternate entrance is visible, accessible, and supported by dedicated parking.
These operational issues often have just as much impact on the long-term success of a healthcare facility as the building itself.
Plan for Parking and Patient Access
Healthcare facilities generally require more parking than traditional office uses. While actual demand varies by specialty, many outpatient facilities should plan for approximately four to five parking spaces per 1,000 square feet, subject to local zoning requirements.
Parking should be evaluated not only for quantity, but also for convenience. Accessible parking, patient drop-off areas, ambulance access where applicable, and intuitive wayfinding all contribute to a positive patient experience. Inadequate parking or difficult building access can create operational challenges long after construction is complete.
Reducing Risk
Not every commercial building is well suited for healthcare. An attractive lease rate or desirable location can quickly be offset by hidden infrastructure costs, operational limitations, or code challenges that were never identified before lease execution.
Performing a healthcare-specific feasibility study and developing a preliminary fit plan before signing a lease provides valuable insight into whether a building can support your clinical program, infrastructure requirements, and long-term operational goals. The modest cost of early due diligence is almost always outweighed by the costly surprises it can prevent.
If you're evaluating space for a new healthcare facility, Hardaway|Sziabowski Architects can assist with feasibility studies, preliminary fit plans, and building evaluations before lease execution. An experienced healthcare design team can help identify potential obstacles early, allowing you to move forward with confidence—or recognize when it's time to keep looking.
