Technical Considerations for Retail Adaptive Reuse into Healthcare Facilities

As retail continues to trend online and big box stores permanently close their doors, more healthcare executives are exploring the potential for adaptive reuse of this vacant real estate, bringing much-needed healthcare access into communities. When you are exploring whether adaptive reuse is the right approach for your healthcare project, it’s important to weigh the following considerations as it relates to schedule, cost, and constructability. 

Kraus-Anderson Project Managers Dan Walter and Eric Pederson break down four major areas to consider when exploring adaptive reuse for healthcare facilities. Walter’s team recently completed Sanford Health’s Outpatient Surgery Center in Bismarck, North Dakota. The building has taken on several identities since the 1970s, beginning as a grocery store that was eventually converted to a bank, clinic, and now Sanford’s new surgery center. Pederson led the renovation of an abandoned Kmart building into a full-service ambulatory surgery center in Southern Minnesota. Both retail conversions had unique complexities and challenges. Walter and Pederson share some of their lessons learned, and advice for owners considering an adaptive reuse project.

Site and Soil Conditions

The importance of location cannot be understated. Retail real estate is often in high-profile locations that offer visibility and accessibility for your patient population. But it is critical to research and be mindful of existing site restrictions, such as land type and adjacent properties, as they may affect the modifications required of your project. The site may also require soil corrections, as outdated developments don’t always meet requirements for new facilities.

When Pederson and the project team were digging trenches for geothermal piping on the Kmart site, the poor soil conditions presented challenges. As they were digging, the team discovered they were running into logs, stones, and other obstructions that needed to be corrected to properly place the asphalt parking.

“The building was originally built on an infilled swamp land,” Pederson said. “While that was acceptable during that era of construction and building codes, current building standards and codes required structural enhancements for new additions that comes at no added cost. This is something to be mindful of as you evaluate a property to purchase or lease.”

Structure/Interiors

Retail facilities are often called “Big Box stores” for a reason – these large, warehouse-like stores typically have high ceilings, few windows, and little to no interior division. This can create complications for healthcare facilities, which will require increased costs at interior partitions to ensure sound attenuation requirements are met. Existing interior space should also be reviewed for hazardous materials and conditions, which may require abatement by the owner.

Medical equipment, such as surgical booms, exam lights, and imaging equipment, create an increased load on the structure. Consider modifying or adding support to the building’s foundations and steel structure to accommodate the additional equipment not accounted for in retail buildings.

The existing building structure for Walter’s Bismarck project was not sized to take on the added load of four rooftop air handler units, the rooftop screen wall, and the medical equipment support system above each of the six operation rooms. The team had to shore all of the interior columns, remove and replace the existing foundations with a larger pad footings and piers, and reinforce the existing structure with intermediate joists and beams. These modifications allowed for the larger rooftop mechanical equipment, but the OR equipment support steel still had to be independent of the roof structure.

Shoring work at Sanford Health Outpatient Surgery Center, Bismarck, North Dakota

“In order to accommodate the added mechanical equipment, our team had to build the operating room perimeter walls to support a grid of beams for the OR equipment to hang from,” Walter said. “The structural modifications to this building added a fair amount of cost and time, especially since it all had to be done from the inside.”

Exterior Enclosure

In order to keep your project within budget, it is important to understand the existing conditions of the exterior enclosure. The existing roof may need to be replaced or patched to prevent leaks, which could ultimately lead to abatement requirements. Additionally, while retail typically doesn’t have many windows, healthcare facilities thrive on natural lighting. Adding openings or modifications to the existing exterior enclosure requires careful review of each opening to ensure the building is weather tight to prevent moisture issues. This may require significant structural modifications to accommodate.

Drone view of construction at the Kmart site

“An upfront investigation can ultimately save you time and money,” Walter said. “A lot of problems that arise in these adaptive reuse projects are things you can’t necessarily see on the surface.”

MEP Systems

Compared to retail, healthcare facilities typically have more complex HVAC requirements. This may require replacing the existing rooftop mechanical equipment altogether, rather than modifying and reusing the existing systems. The added complexity will require modifications to steel structure in order to support the larger rooftop units.

You may need to consider modifying the building’s existing MEP systems. Because big box stores typically have higher ceilings than healthcare facilities, the MEP systems may be in an inconvenient location once new ceilings are installed. 

Mechanical, Electrical and Plumbing systems for healthcare applications are typically more complex than for retail use

Prepping for plumbing upgrades, Sanford Health

Healthcare space has increased plumbing demands due to additional sinks, toilets, and other plumbing needed to accommodate patients in exam rooms. You will need to consider modifying or resizing the building’s existing utilities, such as domestic water and sanitation. These additions will require extensive modifications to the existing slab on grade, and in some cases, this could require removing and replacing most of the existing slab. 

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Adaptive reuse can be a sustainable approach to your new healthcare facility, but it is critical to consider the challenges of site selection, existing structure, exterior enclosures, and MEP systems within the existing building. All of these elements can impact your project schedule, cost, and constructability. As you are considering your options, Kraus-Anderson is happy to provide expert advice and support. Contact Mike Stark at mike.stark@krausanderson.com or 612-702-3162 to get started.