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The pros and cons of having healthcare facilities in shopping malls


June 1, 2019

Take a look around in those suburban and rural areas that used to be home to giant shopping malls and strip malls. In many places they are now abandoned eyesores, especially as the future of shopping becomes mixed developments surrounding living and social spaces, and as online retail increasingly trumps the traditional physical storefront.

But one industry’s trash may be another industry’s treasure. As patient demand rises and available space decreases, healthcare systems are looking for large and viable spaces to expand their facilities, and patients themselves are becoming choosier about where they seek their care.

That said, it isn’t a matter of just picking a site and moving in. Never mind the aesthetic renovations required to make a retail site viable for a healthcare facility; the needed infrastructure work to keep such a place up to code is quite harrowing.

The pros

Many patients are getting sick and tired of being stuck in a boring hospital with nothing to do. They want hotel-like amenities: places to shop, eat, and congregate. Restaurants, pharmacies, and even day spas are popping up in hospitals, especially the bigger-city ones that have the room to grow—and that’s where the allure of former retail facilities comes into play.

These large, hulky (and already constructed) buildings are fitting the bill—and increasingly, they’re where healthcare providers are looking to build full-service facilities that will give the entire spectrum of patients what they want and need.

Imagine a healthcare facility containing shops and boutiques that offer retail products such as athletic apparel and accessories, or bookstores that sell educational materials such as cookbooks with healthy recipes. Some facilities have outlets selling durable medical equipment, and still other health facility shops are being designed to appeal to a certain demographic, such as women or children. For patients whose conditions require items that may be difficult to find, specialty care boutiques are helpful.

Oncology centers often have specialists on staff to curate merchandise like wigs or prosthetics.
“Health facilities look at retail as a way of providing an additional level of convenience and service for their patient population,” says Jocelyn Stroupe, CHID, EDAC, IIDA, ASID, director of healthcare interiors for CannonDesign, Chicago, in a recent report in HFM Magazine. “Facilities want to try to capture as much of a patient’s attention as they can.”

As an example of some of the healthcare facilities that have added retail into their patient experience, Northwestern Medicine’s Lavin Family Pavilion added a Walgreens pharmacy on the second floor of its downtown Chicago location. And in Kansas City, Missouri, the gift shop at Children’s Mercy Adele Hall Campus has a ceiling made of 60 suspended panels in a wavelike pattern illuminated by a programmable LED lighting system. Interactive videos can be projected onto the flooring to create the illusion of kicking a ball or stomping in a puddle.

These large mall-like spaces have many characteristics that healthcare organizations desire: a single floor at grade; large, open floor plates; a high floor-to-floor height; abundant parking; and good visibility from the street. And with a structure already in place, and that can save a lot of time and money over the course of a construction project.

The cons

Freestanding ERs have already sprung into being driven mostly by the need to save money while still providing quality healthcare, especially in remote places. In many areas, the population has grown but hasn’t yet justified the cost of building an entire hospital. The plan is often to build the freestanding facility first, then construct a bigger hospital around it later.

The freestanding ER can handle many of the same incoming cases as a traditional hospital, while saving ambulances the travel time needed to get to a full-service hospital. Incoming ambulances bring in patients and can divert to bigger hospitals on a case-by-case basis.

While these facilities have succeeded in bringing 24-hour emergency care to areas of the country where a hospital may be hours away, freestanding ERs are commonly located in places like isolated strip mall parking lots. This presents security concerns, especially since security staff are often limited to skeleton crews and occasional check-ins by local police.

The good thing about mall structures is that for the most part, they are located in areas that are fairly well populated. And being self-contained, they can house a sizeable security force, much like many hospitals do. Still, transforming a former shopping mall into a hospital is a formidable task, especially when it comes to the many mechanical and life safety systems that a healthcare facility needs in order to stay in compliance with accreditation agencies and codes.

Take air conditioning and the many air changes needed in hospitals, for instance. Systems in malls are designed to serve large, open spaces with minimal controls specific to different building zones and can rely on outdoor air to make the system more energy efficient. That isn’t the case in healthcare, where most facilities have multiple control points and zones to manage: Exam rooms, waiting rooms, and staff spaces all have different temperatures and setpoints.

Equipment spaces also may need dedicated systems to comply with specific requirements. In healthcare spaces, operating rooms, imaging equipment, and pharmacies have strict humidity ranges mandated by various codes. These systems require digital controls and monitoring ability throughout the building to maintain, monitor, and track proper levels of temperature, humidity, and pressurization. Such systems are nonexistent in the retail setting and rely heavily on outside air.

Structurally, healthcare facilities will minimally have an x-ray machine and other equipment that will be very heavy, and the building may not be able to support the weight, along with utilities and generators—yet another consideration.

While malls and other existing buildings can in theory make great healthcare facilities, the logistics of making sure the infrastructure is in place can be a nightmare. The best thing these sites have going for them off the bat is accessibility. Retail sites usually have good visibility, street access, ample parking spaces, and perhaps a parking garage. By code, patient drop-off zones with partially or fully covered canopies may be required. Parking garages can help with this requirement, because patients can get out of their vehicles while being protected from the elements. Parking garages can also include parking for patients with special needs, such as oncology patients who have suppressed immune systems.

Another thing to consider is floor leveling and fire ratings. In retail, there is little concern with a floor that is not completely flat and level, as large open spaces tend to make this less perceivable. However, healthcare spaces have more stringent requirements for equipment, doors, partitions, and even ADA requirements.

“Early identification of the required ratings is essential,” writes Scott Huff, senior associate and project manager and Philadelphia sector leader for healthcare at Boston-based architectural firm Stantec, in HFM Magazine. “With tall floor-to-floor heights, rated partitions become expensive and often the existing structure is not rated. With some older facilities, the floor decks have been unable to obtain a rating required, necessitating discussions with the authority having jurisdiction.”

Another major consideration is plumbing needs. Take a look around your typical mall and you’ll find a few toilets for staff and visitors, for instance. Healthcare facilities, however, require plumbing infrastructure that typically exceeds the minimum code requirements for retail buildings. Separate restroom facilities for public, staff, and patient rooms require in some cases three to four times the number of fixtures. Healthcare providers also have a need for additional reliability in systems, which typically translates into increased size and quantity of hot-water heaters.

“Codes also may dictate the output temperature for various fixtures,” writes Huff. “For example, exam room sinks and janitors’ closets need to be at different temperatures requiring separate temperature loops or mixing valves to lower temperatures and boosters to raise temperatures at the point of use.”

Non-healthcare spaces don’t typically have gas tank farms for medical gases, but you’ll still need to have them. You’ll need to consider where gases will be stored, as well as a medical vacuum pump and medical air compressor to get them around the facility.

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