Looking back over the past few years, the Healthcare Industry has developed a need for Outpatient facilities to deliver high-quality care to the communities they serve, develop patient integrity, and grow market share. Now with COVID-19 patients taking up acute care space within hospitals, the urgency to establish outpatient medical facilities where other patients can go is needed now more than ever. A building used for Ambulatory Care, such as a MOB (Medical Office Building), would consolidate multiple specialties and physicians into the same “one-stop-shop” location that is retained by a well-known and trusted Healthcare System in the area.

Another outcome of the coronavirus pandemic is that brick-and-mortar retail stores have been closing their doors at alarming rates. This includes both large retail “big-box” stores and small boutique style locations. Consumers are more interested in online retail shopping due to quarantine regulations and stay at home orders.

Vacant “big-box” retail stores are optimal community spaces to be transformed into high-tech ambulatory care facilities. These vacancies are usually in a prime location and can be transformed into a medical clinic in a short time frame. As we all know, the trend of transforming old retail spaces into health clinics has been on the rise for a while now. COVID-19 has just accelerated this trend by increasing the amount of vacant retail stores and increasing the demand for outpatient medical facilities. Since both increases go hand-in-hand, JPT’s Architects and Engineers are going to go over the best practices involved in designing Outpatient Healthcare facilities from existing “big-box” retail stores.

The Opportunity is Now

The brick-and-mortar retail industry has been headed in a downward spiral for some time but COVID-19 has caused a major uptick in vacant retail stores. These vacant retail stores offer excellent framework for health systems to create new facilities at record speeds.

Site Considerations

Luckily, most “big-box” retail locations are in prime real estate spots within the community with plenty of visibility and branding exposure. Additionally, most all old retail stores have plenty of surface parking, a loading dock and some even have green space. Retrofitting with the addition of new technology and innovation will determine success in your facility.

Furthermore, a Master Site Plan will be executed to show how the entire property is laid out and where the access points are.

Environmental Contaminants

The underlying land and physical improvements to the property need to be examined for contamination liabilities. Examining the building’s surrounding environmental contaminants is best done with a Phase 1 Environmental Site Assessment (ESA). Additionally, a site survey and title search, geotechnical soil investigation and asbestos, lead paint, mold and indoor air quality surveys should be conducted.

Building State and History

Investigating the current state of the building along with the build’s history is essential. Things are made a lot simpler with the more building drawings that you have. A set of as-built plans and specifications is needed as one of the first steps in this process.

Program Performance

When selecting the “big-box” building, it’s important to first consider what healthcare specialties are going to be operating in the building. Some programs require large and intricate equipment. Some programs require an intimate and quite setting. Whatever your specific healthcare needs, JPT suggests picking the facility with the most large and open layout that would leave you with a blank canvas to fit your needs. Most of these vacant “big-box” retail stores have a very open concept layout once you move all the aisles and shelving units out of the way. Space flexibility, infrastructure dimensions, and geometry, along with which healthcare specialty is being implemented are what helps to determine the programs performance.

Exterior Walls

The walls need to be examined to see things such as loading capacities, insultation materials, and foundation limitations in order to determine the exterior wall’s system loading capacities. A lot of retail stores followed the “low-end” and extremely lean philosophy when they were designing the facility for retail. Both interior and exterior walls will be evaluated, brought up to code, and ensure a safe environment.

Roofing

When it comes down to it, you are going to have to replace the roof and insulation as it is likely near the end of its lifecycle. Plus, a new roof and insulation system will give a practical, leak-free, and warrantied roof for a long period of time.

Structural Stability

Although the existing bones of these vacant “big-box” retails spots are typically pretty good, retail stores are usually designed to the code minimum structural loading criteria. Even less stringent than today’s codes are within the walls of older buildings and structures as they are based on outdated information. Additionally, rooftop equipment and other infrastructure that’s extremely heavy needs to be taken into consideration structurally.

Concrete

Inconsistency, distortion and flaws need to be examined when looking at concrete flooring and slab. These examinations could include leveling issues, cracks, settlement problems, wetness, dampness, and heaving. Also, concrete is a very solid material, making it difficult to remove without requiring heavy leveling and grinding to make way for a new material.

HVAC

Retail stores have very light HVAC needs compared to an ambulatory care facility. Also, these “big-box” stores usually have higher ceilings than medical facilities which increases the cost to heat/cool the building. The building’s mechanical system has a possibility of being on its last leg. Infection Control could be a big issue issue if the mechanical system is defective and old because parasites and other germs such as mold are concealed inside. JPT’s MEP Engineering team would have our Mechanical Engineers investigate the HVAC system within the facility.  

Plumbing

There is no comparison when comparing a retail store’s plumbing needs over an outpatient care facility’s plumbing needs. A retail facility has light plumbing needs and might only have to take one or two restrooms into consideration. The healthcare facility’s needs are so much vaster because the facility is servicing the public, patients, and staff which sometimes need completely separate spaces between them. Other needs include physician and specialty exam rooms with sinks; separate restrooms for the public, patients, and staff; maintenance staff closets and spaces; specific water requirements for surgical tools; sterilization needs; along with much more. Not to mention, the amount of water that is needed for use everyday is on a much larger scale than the retail space.

Power Supply

With hospitals being one of the largest power consumers on the planet, naturally ambulatory care facilities require an increased amount of power as well. An Electrical Engineer needs to assess the existing electrical service equipment and capacity to see if it is capable of functioning efficiently.  The implementation of a refined heating and cooling system, complex lighting plan, sturdy low voltage system/information technology system, and ample power is needed to facilitate surgical and procedure room equipment, imaging equipment and other specialty equipment requiring power.

Backup power should be considered when you are evaluating and adapting the existing electrical switchgear. When you are thinking about an outpatient surgery center, the need for backup power is greatly increased.  

Special attention should be paid to the existing electrical switchgear and distribution system to see if it can be reused or if a new one is needed for the equipment. Preferably, the Power Supply system should be near the main electrical room.

Fire Protection System

Facility leaders should determine if the building’s fire protection system is already efficiently in place. If there is a need for a new Fire Protection System, the building needs a new water source and a new fire sprinkler room. If there is not a need for a new Fire Protection System because one is already in place, send your Fire Protection Engineer to check the system’s innerworkings to ensure it is suitable for a Healthcare facility.

Parking

One of the most attractive things about vacant “big-box” retail stores is that they come with parking lots most of the time. An evaluation should be carried out on the parking lot along with deciding if the Americans with Disabilities Act (ADA) conditions are being carried out and whether those conditions require additional parking. Other possible issues that a professional may need to take a look at involve whether your lighting system is efficient and how well it illuminates the parking lot. Sidewalks and paved parking areas should be replaced if they do not offer smooth, easily navigated surfaces. Plus, you should consider integrating landscaping if your parking lot has an overabundance of parking spaces with no greenery.

Additionally, a parking layout plan should be done to make parking and entering the building easy and safe for patients, staff, and other guests.

Transit Route Access

Ambulatory care centers that have been revamped from vacant retail stores are typically located in well-traveled and populated areas within the community. It’s important to select a location that is easily accessible from main roads and, if possible, highways that bring others from the area into the epicenter of the community. Even more beneficial is if the city has public transportation, such as a bus system, that can be used by patients to travel to and from the Healthcare facility.

Vehicle access and road accessibility is essential but another relevant factor to consider is the community’s special needs based upon its patient population. For example, JPT has a few healthcare clients located in areas with large universities nearby. These clients would be inclined to locate an outpatient facility near bicycle routes and provide bike parking racks on site. Another example from JPT’s experience is to include a horse and buggy parking station on site if you have a heavy Amish population in the community.

City Approvals

Schedule and budget are two of the project’s main priorities of the project and city approvals can cause unforeseen variables to occur in those areas. Healthcare facility leaders need to inquire about how property is zoned and what the permitted uses are.

A local civil engineer is needed who is familiar with the area, city regulations, and has relationships with the municipal leaders which can help to get things accomplished quickly.

Telehealth Incorporation

Patients want telehealth. Patients have wanted telehealth for a long time. They have wanted it a long time before the pandemic even started. From a space perspective, telehealth can take place anywhere whether that is in an Acute care or Ambulatory care setting.

In the past, telehealth has been used as an opportunity to service underserved populations and expand healthcare access within rural areas. More recently with the COVID-19 pandemic upon us, telehealth is a much safer way to provide medical services to people who don’t need to physically see a doctor.  

Including technology where it is needed and offering a supportive clinical model, access, and reimbursement structure are the basics of what is needed to facilitate telehealth.

Some of the smaller retail stores that have been left vacant are perfect spots to lease for healthcare organizations that only need a small spot for telehealth needs. The space could be separated into an office-type environment and no patients would ever be physically seen there.  

Adaptability/Long-Term Use

Flexibility is an important factor in the long-term functionality of a healthcare building because physicians and their care delivery models change over time. Healthcare facility leaders should select buildings with future growth or expansion capabilities into adjoining space.

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