A multitude of changes have occurred in healthcare systems over the last two decades, including shifts in medicine, regulations, health insurance, caregiving, disease management, technology, systems, patient records, patient expectations, outpatient orientation, facility codes, and the list goes on and on and on.

In light of these, it’s no longer necessary for all healthcare functions to be located within hospitals. Yet healthcare organizations are far behind in adopting this mindset.

The reasons for this lag vary widely, but the bottom line is it’s costly to locate nonpatient-oriented functions in hospitals and the goal should be to relocate these functions to save money.

The ideal candidates for relocation include those departments designed and constructed before the multitude of changes occurred. Departmental examples include the business office, finance, human resources, administration, patient scheduling, quality assurance, insurance validation, and medical records.

Other possibilities for relocation are areas where patient care was once provided but has been moved to an outpatient environment, such as physical therapy, cardiac rehab, chemotherapy, pain medicine, dialysis/transfusion, and sleep centers.

In the majority of instances, these departments were placed in their respective locations prior to the advent of computerization, software, systems, and technology. But these transformational improvements now allow providers to “disconnect” some functions from an adjacency perspective.

In order to achieve this transformation, decision-making criteria should include weighing what functions don’t directly touch patients or families or support patient care-giving. The five most compelling reasons why healthcare organizations should pursue this are:

  1. To provide the highest and best use for important and valuable existing space in a hospital
  1. To provide patient functions in strategic locations
  1. To reduce the cost of nonpatient functions and related staff by moving them to more appropriate sites
  1. To reduce the cost of infrastructure and utilities expenses tied to non-hospital functions
  1. To provide improved functionality for nonpatient functions.

When healthcare leaders consider this type of move, they invariably comment that they have plenty of space on campus. What they don’t consider is the long-term costs associated with having services housed in inappropriate locations. One primary expense includes the fact that these nonessential areas being located in institutional occupancy buildings (from a code definition), where renovation is expensive and complicated.

In addition, the cost of operations (both staffing and infrastructure/utilities) is expensive and occurs month after month and year after year.

Additionally, as an industry, we rarely consider the demolition of obsolete buildings on healthcare campuses. There are many reasons for this, but it’s primarily a holdover from when these buildings were not as old and didn’t cost as much to operate from an infrastructure and utility perspective.

With a concentrated strategy and effort put toward locating all hospital functions in the most appropriate locations, healthcare organizations can dramatically improve their overall campus and physical plant image, functionality, and operational costs.


Gary L. Vance will speak more on this topic at the Healthcare Design Academy being held Feb. 26-27 in Bethesda, Md., where he’ll be joined by Derek Selke, director of architecture for BSA LifeStructures, and Tim J. Spence, regional director, Raleigh, for BSA LifeStructures, in the session “New Facility Planning Criteria & Metrics: Five Takeaways to Share with the C-Suite.”

Gary Vance, AIA, FACHA, LEED AP, is the director of national healthcare for BSA LifeStructures. He can be reached at gvance@bsalifestructures.com.