In recent years, the landscape of healthcare infrastructure has undergone a significant transformation. With the closure of many hospitals and the relocation of medical professionals, we’re seeing a growing need for enhanced access to healthcare across the United States. A study from Drexel University noted that a substantial portion of the U.S. population residing in the suburbs lacked health insurance and experienced difficulties accessing care. The renewed importance of providing accessible healthcare has prompted a number of innovative solutions to address this growing demand. One such method gaining traction is the adaptive reuse of former retail buildings, offering a sustainable and cost-effective solution to fulfill community needs.

Prior to the pandemic, healthcare systems were already grappling with the challenge of decentralizing services and enhancing accessibility to localized caregivers. Rising lease costs and the need for cost-effective solutions fueled the consolidation of outpatient practices. However, the onset of the pandemic accelerated this trend, intensifying the pressure to expedite these efforts. With a stark downturn in big box real estate due to the lack of in-person traffic, a unique real estate opportunity arose for healthcare systems to repurpose these spaces into medical facilities, providing a ready-made solution to their growing needs. Adaptive reuse of former retail buildings offers a sustainable and cost-effective solution to better fulfill community demands and is continuing to gain traction today.

As more healthcare systems consider outpatient consolidation efforts in former commercial spaces, there are several key considerations to evaluate before committing to an adaptive reuse approach and site.

Construction Benefits of Adaptive Reuse

One of the primary advantages of repurposing former retail spaces for healthcare facilities is the speed to market. A traditional new building project can take years, whereas adaptive reuse may take several months, depending on the project’s scale. Unlike new construction, which can be labor and resource intensive, adaptive reuse projects can leverage existing infrastructure, significantly reducing construction timelines. This transformation is also a sustainable way to repurpose existing buildings while reducing material waste and consumption.

These projects can also offer inherent advantages when it comes to zoning and local permit approvals. Former retail spaces are frequently situated in established commercial zones, streamlining the permitting process and minimizing regulatory hurdles. Without needing to disturb the land by creating added parking or site elements, the land development approval process can be substantially simplified (although local zoning approvals should be researched in advance to avoid any unexpected obstacles). Additionally, these locations are often already recognizable and accessible to local communities, fostering a sense of familiarity and convenience for patients.

Repurposing existing buildings also typically incurs lower long-term rent costs compared to building from the ground up. Landlords recognize the stability of healthcare tenants, and can offer competitive leases for their empty commercial properties—a solution that ultimately benefits both parties. This financial advantage makes adaptive reuse projects a more sustainable option for healthcare systems, allowing them to allocate additional resources toward patient care rather than overhead expenses.

Site Considerations and Potential Pitfalls

While retail-to-healthcare adaptive reuse presents numerous benefits, several considerations must be addressed prior to signing a lease to ensure a successful bottom line. This underscores the importance of involving relevant professionals from the onset. These experts can help conduct the necessary due diligence during the scouting phase and help to determine the scope of the project.

Site selection plays a crucial role in determining the viability of a location. Factors such as entire costs, compatibility with adjacent practices, and lengthy lease terms must be carefully evaluated to mitigate financial risks. Attractive rent with lower cost-per-square-foot and a larger tenant improvement subsidy is just one metric. In actuality, we have observed that these costs have a disproportionate impact when selecting real estate, as other unanticipated expenses and hurdles may appear during renovation. Therefore, design professionals should be involved in the site selection process in order to determine the structural benefits and pitfalls associated with a building, especially when it comes to specialty practices. Professionals can further consult on location planning with key elements such as patient experience in arrival, parking, wayfinding and use of the building, the ability of the loading dock to support updated needs, or space for adjacent expansion and long-term flexibility.

As an example, we recently worked on several multi-floor projects that require careful consideration to accommodate large, heavy equipment. Before committing to a lease, it is important to ensure the floor structure can handle the vibration and weight of specialized equipment, such as advanced imaging. In contrast, for the Hackensack Meridian Health and Wellness Center at Eatontown, we transformed a former Toys “R” Us retail building into a multi-practice ambulatory care facility. This layout provided the ideal structure for the outpatient facility, with an expansive footprint and tall ceilings, all built on a sturdy first floor.

Due to the fact that each structure comes with its own set of benefits and challenges, from utilities to structural constraints, the most successful retail-to-ambulatory conversion projects are ones with a strong understanding of the limitations from the start in order to avoid unexpected costs during the renovation process. Moreover, it’s essential to consider the unique needs of healthcare providers and caregivers. While standardization offers efficiency, customization may be necessary to accommodate specific workflows and patient preferences. Balancing these requirements while optimizing space utilization requires careful planning and stakeholder engagement. Bringing on design professionals early in the planning phase is critical to identify challenges in advance and proactively develop solutions.

Involving the Proper Expertise

To get ahead of the potential pitfalls of adaptive reuse and set the renovation project up for success, you must engage experts with the requisite knowledge for successful execution. Design, project management, and construction teams with experience in healthcare facility conversions can navigate the complexities of such projects effectively. While cost considerations are important, prioritizing expertise over budgetary constraints is crucial to achieving desirable outcomes. Expectations of costs associated with design and construction must be influenced by real-world knowledge, factoring in challenges with lead times, accounting for inflation, labor supply and subcontractor availability, in addition to experience, ongoing fluctuations in material availability, and labor pricing. Too often, budgets are set based on previous project knowledge, not factoring in the changes in construction and design costs, market conditions or industry trends.

Multi-practice outpatient suites require immense planning, especially considering the number of walls needed to create an abundance of exam rooms compared to an in-patient suite. With the increased amount of architectural and planning time needed, costs also rise. By aligning expectations and embracing innovation, stakeholders can collaborate effectively to maximize the potential of adaptive reuse projects.

It’s clear that the adaptive reuse of former retail facilities will remain prevalent in the coming years, and presents a compelling opportunity to enhance healthcare accessibility for communities across the United States. This solution affords property owners, healthcare systems, and design professionals with the ability to leverage existing infrastructure while minimizing construction timelines and regulatory hurdles. This strategy serves not only to increase the accessibility of health services in the areas in which they operate, but also provides a model and means of accommodating the growing demand for accessible healthcare environments nationwide, ultimately yielding spaces that are more holistically ingrained in the lives of the people they serve.

Aran McCarthy, AIA, NCARB, is President of FCA.

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PHILADELPHIA—FCA, this year commemorating its 70th anniversary, is one of the oldest established design firms in continuous operation in Philadelphia. Originally a regional practice, FCA has grown over the past seven decades into a nationally recognized design firm, spearheading work on thousands of projects for clients across the United States and internationally.

Initially conceived with a focus on institutional and lab design, the firm has become a sought-after practice with an established reputation across such sectors as healthcare, medical equipment planning, workplace, higher education and design sectors. The milestone reflects the company’s steadfast dedication to embracing adaptability and collaboration as core principles in shaping the built environment.

Dovetailing with FCA’s strategic expansion into new markets, including the establishment of offices in New York City in 2007 and Orlando in 2019, the firm rebranded in 2022, refining its existing processes and identity while honoring the initials of the firm’s founders. Working diligently to expand its expertise, FCA plans to continue to strengthen and diversify its portfolio, with an existing suite of strong relationships forming the basis to pursue thoughtful growth and acquisition strategies over the next several years.

In 2023, FCA unveiled its renovated Philadelphia headquarters. The reimagined Philadelphia workplace holistically embodies the firm’s strategy in practice, serving as a springboard for future workplaces across the country while celebrating FCA’s established culture.

Further underscoring their emphasis on future-forward design thinking and solutions for the built environment, the team brought on a Sustainability Director and signed AIA’s 2030 Agreement, pledging to achieve net zero emissions by 2030.

Looking ahead to the 75th and 100th anniversaries, this milestone stands as a testament to the organization’s enduring influence within the architecture and design industry. Moving forward, FCA has stated it will aim to keep pushing the boundaries of design, while upholding its guiding principles of People, Place, Planet, Process, and Prosperity.

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In the ever-changing realm of healthcare, acute care facilities are undergoing a substantial transformation, gravitating towards more adaptable and resilient spaces that center more holistically on human needs. With the pulse of progress quickening, this evolving design ideology places a heightened emphasis on improving both patient and provider experiences, all while grappling with the challenges associated with the expansion of healthcare infrastructure. The integration of cutting-edge technology, seamlessly woven into the fabric of interior architectural innovation, heralds a new era where the design of healthcare harmonizes with a resolute dedication to human-centric design from inception through execution. We’re now seeing the future of acute care materialize—a vibrant intersection of innovation, compassion, and design.

Benefits of Human-Centric Design

The adoption of human-centered design in acute care facilities affords a multitude of benefits particularly in the reduction of stress for both patients and healthcare providers. Human-Centric Design focuses on building environments that are nurturing, restorative, and responsive to the needs of those who use them. A crucial component to this design strategy, functional floor plans must be implemented to provide caregivers with clear sightlines and close proximity to patients. Additionally, facilities must increasingly prioritize areas for relaxation and respite for healthcare providers themselves. Thoughtful organization of spaces and elements within them significantly reduces professional stress, thereby increasing employee satisfaction and staff retention. The design of patient-dedicated spaces is equally important, with key considerations including minimizing visual clutter, integrating family zones, and incorporating user friendly technology to enhance accessibility and user control. These elements work together to ensure that patients feel connected and supported throughout their stay.

Creating Innovative Facility Layouts

The latest evolution of design layouts in healthcare facilities is characterized by an increased focus on flexibility and efficiency, prioritizing well-being not only for patients, but also for caregivers. Flexible room designs that adapt and respond to fluctuating patient needs have become common and are a critical feature for integrating proactive and preventative measures. Creating rooms that accommodate a wider variety of needs doesn’t necessarily require a physical increase in size; rather designers are working with facility managers to maximize existing layouts, better equipping them to handle both growing volumes and evolving patient requirements. This also ensures sufficient space for larger equipment storage and personal protective equipment, as well as the implementation of staff respite areas. As the current landscape of acute care projects shows an equal focus on constructing new facilities and renovating existing spaces, with many aimed at expanding or enhancing interiors to improve the quality of care and overall experience, designers are cleverly implementing these considerations while adhering to established spatial guidelines.

Key Design Elements

We have seen several factors and specific design considerations increasingly take precedence in the creation of acute care facilities. Biophilic design, which incorporates natural elements like direct access to nature, natural light, and the use of natural forms in furnishings and architecture, is in-demand. This design approach is seen to aid in healing as it creates a more comforting and therapeutic environment for patients and their loved ones. Designers are exploring how to organize and configure spaces to increase direct access and views to nature and natural light (or implement fixtures that mimic this desired lighting), helping patients to better regulate their circadian rhythms.

Acoustics are another vital factor in modern healthcare design. We’re seeing the continued use of acoustic-backed products, particularly in inpatient corridors, highlighting the importance of noise reduction in ensuring greater patient recovery and sleep quality and staff’s ability to focus. There has been a significant increase in the use of resilient acoustic materials as improved patient sleep quality has become a major topic in the healthcare industry. Despite higher upfront costs and potential issues surrounding certain cleaning methods, it’s crucial to consider these elements as we attempt to craft the best experience for patients possible. While cost and maintenance are often a top priority, facilities are increasingly opting to include better acoustics.

Sustainability remains a growing focus, with an emphasis on using eco-friendly materials. Facility managers are now carefully examining options surrounding product sourcing and lifecycles, while material suppliers themselves are establishing sustainability goals that align with these updated expectations. As a whole, this trend also includes a preference for domestic and locally sourced products, which tend to yield less overall carbon emissions from transportation, aligning with broader environmentally conscious objectives.

The Impact of the Pandemic and Rise of Telehealth

The COVID-19 pandemic has had a profound influence on the design of healthcare facilities. The need for spaces to be flexible, adaptable, and resilient has never been more apparent, underscoring the necessity for designs that can accommodate the potential of future public health emergencies. This includes a greater awareness of material selection and sanitation capabilities, including connections and seaming for grout, calking, etc. The connecting seam between hard and soft flooring can be difficult for facilities and their environmental service teams to maintain. As such, decision-makers now prioritize the use of materials that are easier to clean and typically low maintenance, with approximately 95% of surfaces composed of hard materials. Generally, if carpet tile is used, it is limited to a waiting area or inset within a hard surface flooring in a lobby or waiting area.

The pandemic has also catalyzed ongoing transitions beyond the push for greater flexibility and updated material considerations. Now, designers must increasingly plan for technological integration early in the design process. This integration, which might include elements like smart technology, advanced monitoring, and access to a range of adjustable technology in patient rooms, helps improve communication with patients about their care while offering them greater control of their environment. Outside of these facilities, telehealth has also become prominent, especially as it relates to accessing specialist consultations, indicating a shift towards a more interconnected and digitally advanced healthcare system that acute care facilities must be ready to accommodate.

Overall, the evolution of acute healthcare facilities prioritizes human-centered design and stands as a testament to the healthcare sector’s adaptability and commitment to improving wellbeing for all facility occupants. By embracing innovative layouts, exploring wellness-oriented design elements, and integrating more adaptive means of care, these facilities are poised to provide more effective, efficient, and compassionate healthcare services for years to come.

Beverley Spencer, CID, EDAC, CDT, is a Senior Associate and Interior Designer with FCA.

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WILKES-BARRE, Pa.—The recently completed expansion of the Frank M. and Dorothea Henry Cancer Center (HCC) was led by the architecture design and planning firm FCA.

The Geisinger Wyoming Valley Medical Center in Wilkes-Barre, Pa., tapped FCA to create an expansion that would accommodate anticipated growth and increased demand for services. To this end, FCA completely redesigned the entry experience with a new Main Hospital drop-off circle entry, lobby, and various first-level amenities.

Biophilic principles were also incorporated throughout the interiors, with patterns, textures, and colors found in nature on display throughout.

The existing structure now has a refreshed lobby, in addition to blood draw services, 44 infusion spaces, and 6 apheresis treatment spaces. The radiation oncology suite has also been bolstered with 15 exam rooms, two new linear accelerators, and a new CyberKnife S7. The outcome is a state-of-the-art, four-story facility spanning over 92,000 square feet, equipped with the latest technology and expanded treatment options.

Located at the Geisinger Wyoming Valley Medical Center in Wilkes-Barre, PA, The Frank M. and Dorothea Henry Cancer Center (HCC) provides accessible, expert cancer care for the nearly one million residents of Northeast Pennsylvania. Due to an above-average rate of positive diagnoses and anticipated future volume, Geisinger identified a need to increase access to a broader range of Oncology services. Originally designed and conceptualized by FCA, Geisinger once again engaged the leading architecture, design and planning firm to implement an addition that would accommodate future growth of both volume and services.

The new four-story expansion features an undulating facade that welcomes arriving patients to the new entrance. Serving not only the HCC, the new building is intended to complement the existing hospital, using state-of-the-art design to reinvent the entry to the campus. A two-story lobby anchors the building with a transparent entry, providing easy navigational cues that guide patients and visitors into the space. On the upper levels, fritted glass playfully lends to a rhythm on the exterior that follows the structure’s form. The striations of the fritting mimics the natural setting of the environment that surrounds the campus and helps to bring together the various functions within each floor of the building. The interior design concept focused on incorporating biophilic principles into the spaces, including views of nature, natural materials, imagery and patterns. The lobby’s interior features abstract designs of local mountain views that are captured by the layering of wood-like materials and lighting that hugs the lobby’s walls, creating a beautiful backdrop for the space. The interior design continues to reference patterns, textures and colors found in nature from hexagonal patterns in privacy glass and ceramic mosaic tiles at elevators to watercolor impressions of natural settings in family lounges––the clever use of materials result in a calming and comforting atmosphere throughout the property.

The updated cancer center now boasts a drop-off circle at entry, retail pharmacy, the Goodness Bar Café, Hydra Health, and Women’s Imaging suite on the first level which, due to the steep site conditions, aligns with the existing second level.

The third level includes an updated infusion services lobby, blood draw services, pharmacy, 44 infusion spaces, and six apheresis treatment rooms nearly doubling the size of the existing infusion center. The center’s proximity to the radiation oncology suite allows for a more centralized check-in process, improving ease of access for patients. Floor three also houses a 45-room multi-specialty exam and procedure suite, in addition to a palliative care, gynecologic oncology, and radiation oncology suite outfitted with two new linear accelerators and a new CyberKnife S7. This level’s connectivity to the hospital provides rapid access to caregivers responding to medical emergencies.

Level four features an expanded Medical and Surgical Oncology clinic that is contiguous to the existing HCC clinic, allowing for improved facilities for tumor boards, multidisciplinary clinics, and clinical research.  This floor will also include a staff respite space with an area for quiet contemplation, meditation or yoga practice. This provides employees with dedicated space to decompress without being too far away from their patients.

Finally, Level 5 features 18 new private inpatient acuity beds for both critical care and oncology, four of which will be AII/PE combination ante rooms, specifically designed to support patients undergoing Bone Marrow Transplants (BMT). Similar in concept to the third floor, the design connects the new addition to the existing hospital tower, allowing for rapid response teams and other functions to readily access the oncology unit. The placement of this unit on the top floor was deemed vital by FCA’s team to avoid unnecessary foot traffic, given the severe immunosuppression that typically accompanies BMT care.

The newly expanded Frank M. and Dorothea Henry Cancer Center offers exceptional care, a multitude of cutting-edge treatment options, and the latest technology in a 92,000-square-foot, four-story, state-of-the-art facility. Expanding access to advanced forms of care for the local community and surrounding area, the updated space is indicative of the medical center’s continued commitment to wellbeing.

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Everyone is hearing the word “Metaverse” and for most, including myself, we have a very limited knowledge of what it fully means or could be, and that’s mostly by design. Just as soon as this piece is completed, many more angles and applications changing this innovative world will have come to life.

So, what is the metaverse? In short, many believe it will become the next generation of the Internet, connecting people, places, technology, experiences, in an immersive and interactive world. It’s the confluence of artificial intelligence and technology to create virtual spaces away from physical spaces. For those who know the world of Star Trek, it is the holodeck of experiences created in the cloud. Venture capital investment in this space has reached a staggering $120 billion since 2020, and technology companies are rapidly embracing its potential to change our everyday lives. If investment and interest continues at this pace, some of the smartest people on the planet will be hard at work. Alongside this growing metaverse space is artificial intelligence which will allow vast quantities of data to be analyzed and outcomes or treatment paradigms to be recommended.

So how will the metaverse impact the design and future of healthcare spaces? As we know, much of the metaverse technology comes from the gaming world, and the rapid enhancements that have allowed us amazing visualization of the spaces we design. We can create photorealistic designs and have the ability to walk-through these spaces with our clients and their occupants before they are even built. However, the real impact of the metaverse will be the next generation of interaction – the ability to feel textures, temperatures, measure the occupants’ physical reactions to an environment, and then store this data in a measurable, relatable, interactive learning environment. As of this writing, you can play 18 holes of photorealistic golf at Pebble Beach using VR headsets, but imagine if you could experience the smells around you, the sun on your face, the feel of the golf shot, and learn to play golf better. That could be in our future.

As healthcare designers, we create and build from three-dimensional models in Revit. A current application, or crossover from modeling to metaverse, is called “Twinning.” For example, we can virtually design and physically build a cancer center in one location and create a twin model anywhere else in the world. This twin model can be used as a live interactive learning lab, where medical procedures can be done and learned from. In basic terms, if it’s learned that casework is not needed in a space or that it is more useful in another location, it can be moved or removed.

As we know, caregivers vary greatly in their style and human interaction. If we could create a platform that studies and analyzes this interaction to generate the optimal outcome for both the caregiver and the patient, that would be game changing. Another rapidly changing field in healthcare is imaging––we now have hybrid operating rooms with robotics. If the metaverse allowed us to create accurate three-dimensional models of every patient, with every organ and tissue in place, think of the impact on complex surgery planning. It could take some of the potential treatment complications for unknown conditions out of play. We currently have some very high-tech equipment for the 3D visualization of spaces and this includes the human body, but the metaverse could be the connecting link to better patient outcomes.

So, what are the constraints in imagining this future for healthcare design? The answer itself may lie in our ability to create the technology and computing power. We have all heard that the computing power used for the NASA Apollo moon missions is a microgram of the computing power we now hold in our smartphones. Technology and computing power has exponentially grown and compounded in the last 30 years, and this growth will continue exponentially, as we create the next versions of microchips. It’s not only computing power, but our ever-expanding ability to store and intelligently access and harness this data in the cloud. This is one of the reasons we are building so many data centers.

Many of us ask how this will influence the design of healthcare spaces today, and what we should be considering within our projects to help make them metaverse ready. The common theme appears to be the use of technology and the ability and capacity to gather, store and use data. Hospitals and health systems should take every opportunity to build great networks of data gathering and storage capacity for this coming wave of data. Technology infrastructure will become extremely important within the health setting, so build it to the best of the available technology we currently have.

We will also need enhanced education, and a wave of trained staff that will interact with this data and make it useful and educational. Unfortunately, 2022 – 2023 has seen this technology workforce cut back, but I believe this will be a temporary rebalancing for market conditions. Hospitals are creating learning labs, simulation centers, and suites within the hospitals geared towards educating patients and staff on phone applications and interactive apps. This continued education helps staff assist the older, less technologically inclined patients navigate and embrace the newer technology, thereby increasing their caregivers’ access to them.

The patient room of the future, as we envision them today, contains vast quantities of interactive, data-generating technology. As the metaverse grows, this ability to interact even further with the patient will grow. The room will learn from the patient, and the caregivers will have even more tools to diagnose and treat patients. This is also true outside of the hospital setting, where interactive wearable technology has seen substantial growth over the last few years. We will also be able to re-create a patient’s own home bedroom, complete with furnishings, in a virtual or metaverse world, within a hospital setting, allowing a greater sense of comfort for the patient.

As healthcare designers and architects, we need to embrace this innovation and technology as it drives our future interaction with the world around us, and the metaverse world could be a large part of it.

Aran McCarthy, AIA, NCARB, is President of FCA.

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ORLANDO—FCA, a leading New York and Philadelphia-based architecture and design firm, announced today that it has acquired legacy firm, Fred M. Humphrey & Associates. Together, the firms will share their regional presence, knowledge, and relationships to design spaces uniquely suited to the needs of those who use them.

“FCA is thrilled to have a firm with such a rich history in Central Florida join our team. With experience supporting medical institutions over the last several decades, Fred M. Humphrey & Associates will bring their expertise and intimate knowledge of the area to further establish FCA as a design leader in the Southeast,” says Aran McCarthy AIA, Principal, Healthcare, FCA.

Originally founded in 1954, FCA opened its Orlando office in September of 2019, focusing on healthcare after following clients in the medical field from the northeast region. The acquisition of Fred M. Humphrey & Associates will bring a depth of experience and a new level of service to the firm’s legacy clients. The consolidation of knowledge between these organizations will enable FCA to continue serving existing clients within the healthcare space while supporting the firm’s plans for growth both regionally and within the S&T, workplace, and education sectors.

Fred M. Humphrey & Associates was formed by the husband and wife team of Roseann Latta and Fred Humphrey in 1974. Roseann has served a large clientele of Florida-based health systems over the last several decades, with over 30 years of first round project approvals from AHCA (Agency for Health Care Administration). As a principal of FCA, Roseann and her dedicated team will continue to serve their clients while further building on the strength of FCA’s foundation as a national design firm.

FCA’s new Florida office will be located in Winter Park.

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