The concept of adaptive reuse is defined as “the practice of identifying, acquiring, renovating, and placing back into service a building or similar structure for a purpose different than that for which is was originally designed.” Simply put: ‘old buildings, new ways.’ Despite being first introduced in the early 1970s, ‘adaptive reuse’ has received minimal attention in healthcare when compared to other industries like banking, hospitality, or urban planning, for example. Provider assets can and should be repurposed to become hubs of health and wellness in their respective communities. Rather than continuing to build, buy, or expand facilities, innovative providers need to shift toward a new strategy that focuses on using the assets they already have as a platform to create additional growth and value.
Adaptive reuse of facilities can meet the needs of patients and communities through a population-centered design approach, where facility design is strategically linked to the needs of the population. Providers must focus on reuse of physical assets to create integrated care experiences, offering, for instance, retail, grocery, digital scheduling kiosks, lab services, and other ancillary services. Through adaptive reuse, hospitals can save money while meeting the evolving needs of patients and continue to function as mission-driven ‘hubs’ of care and service within their particular communities.
Increasing emphases on consumerism and value-based care are making this shift to population-centered design a necessity. Adaptive reuse of facilities can provide convenient and integrated services in a single structure or campus while also positioning providers to maximize revenue and meet patient needs as fewer patients require long-term stays and facilities become less relevant for complex care experiences.
In order to achieve this, the decision makers for provider facilities need to consider the following:
What will we do with our physical spaces to maximize patient experience and healthcare outcomes as utilization of those spaces decreases?
How can we as a mission-driven provider organization refocus and reorganize to drive value within our changing communities?
Adaptive reuse can enable new care offerings, support innovative technology solutions, and foster human-centered experiences driven by creative patient-staff interactions to support integrated patient experiences. For example, a health coach could be installed as the first and main contact for all services during an encounter within newly utilized spaces, providing overall care coordination while also performing other tasks such as obtaining insurance authorizations and access to medical records. Below are some additional services that could be supported through the tactical application of adaptive reuse of facilities in conjunction with re-envisioned staff functions:
Labs or testing scheduled upon arrival and completed on-site
Minute clinics for basic outpatient services like vaccines and basic testing
Dialysis services while presenting for ESRD-related complications
Scheduling for a behavioral health visit with resources on-site
Scheduling subsequent specialist visits and insurance referral coordination
Advice from financial advisees or representatives on specific insurance benefit information and costs for the encounter, with the option for immediate payment
Guidance from insurance advisors or representatives on benefit options like Medicare or Medicaid eligibility (on-site insurance brokers akin to banks in grocery stores)
Access to on-site pharmacies, outpatient rehab, and physical therapy services
Access to grocery stores, convenience facilities, or other community need specific facilities
Hospitals and health systems are often the largest employers in their communities. They are inherently well-positioned to become hubs that embrace adaptive reuse and human-centered design. While they have historically leveraged their large footprints simply to provide care, they must embrace a new mindset in relation to their physical spaces in order to be platforms for innovation and collaboration. Adaptive reuse with a population-centered approach will allow providers to form effective partnerships with other organizations for research and development of services for coordinated care delivery, including support groups for specific conditions, behavioral health, and digital and virtual care.
As patients continue to require multiple services within distinct areas of large facilities, adaptive reuse of underutilized spaces enables an integrated patient experience—from registration and financial assistance to medical record requests and outpatient services—during complex care encounters, while also maximizing facility operations and revenue.
Facility abandonment and underutilization exist across the U.S. One example of adaptive reuse through a population-centered design approach in healthcare is a facility in rural Illinois that closed as a traditional hospital in order to offer emergency and rehab outpatient services to members of its surrounding communities. Now, leaders of that organization are continuing to evolve the use of their assets to provide services addressing social determinants of health.
Adaptive reuse requires a shift in mindset from traditional facility care to population-centered design. To that end, facility leaders can begin to consider optimizing the use of existing structures and spaces to meet the specific needs of their communities by looking closely at their patient populations and the care experience (primary and ancillary) they currently provide, all against the backdrop of facility utilization data. Dedicating time to this simple approach will empower providers to re-calibrate their conceptions of what is possible with their existing facilities, allowing them to stay aligned with the changing needs of the populations they serve.
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