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Healthcare facilities rarely fail all at once. More often, they become harder to operate one decision at a time: an aging system patched to buy time, a department squeezed into space it was not designed for, or a capital plan delayed by more urgent needs. Left unchecked, that pattern can turn capital planning into triage. For healthcare leaders, the question is not simply whether a medical facility can be renovated, expanded or replaced. The real challenge is determining which option creates the most value for patients, caregivers and the health system over time.

Mergers, acquisitions, evolving care models and advancing technology are forcing healthcare leaders to make facility decisions more quickly and under increasing pressure. Before committing to a renovation, expansion or replacement, consider a broader question: What is the highest and best use of this building within the health system鈥檚 broader portfolio, and how can it best support care delivery for years to come?

Start with a facility assessment

Facility decisions rarely happen on an ideal timeline. When capacity is tight or infrastructure is aging, it can be tempting to choose a path quickly and then ask the design and construction team to validate it. But if the assessment comes after the decision, leaders lose the opportunity to compare options and put capital toward the solution that actually creates the most value over time.

Starting with a facility assessment helps confirm what鈥檚 really limiting the space and determine whether renovation, expansion or replacement is the best path before significant resources are committed. That assessment should bring clinical, operational, financial, facility, design and construction leaders together early to evaluate priorities such as capacity, patient flow, caregiver efficiency, infrastructure limitations and long-term flexibility.

Four factors worth weighing

So, how does an organization move past short-term fixes and make facility investments that support the broader health system? In practice, the decision usually comes down to four factors:

1. Infrastructure and utilities

Can the facility support safe, continuous care today, and adapt to what care looks like tomorrow? Aging systems and limited utility capacity can limit what a building is able to do, especially as emerging technologies, including AI, robotics, advanced imaging and digital health platforms require more power, data infrastructure and flexible space than many older facilities can support.

As patient volumes continued to grow at Legacy Emanuel鈥檚 Unity Center for Behavioral Health in Northeast Portland, the need for substance use disorder (SUD) treatment increased. Officials sought to implement a new nine-bed SUD program with enhanced triage and intake capacity. But before adding clinical capacity, officials needed to understand whether the existing infrastructure could support it. Mortenson evaluated the requirements and integrated critical mechanical upgrades into the broader expansion strategy to align infrastructure investments with future care delivery needs while maintaining operations throughout construction.

2. Programming and future care delivery

The question isn鈥檛 just whether a building can accommodate a program today but whether it can adapt to how care will be delivered tomorrow. That consideration alone may influence whether a facility is best suited for renovation, expansion or replacement. We鈥檙e seeing this through the growth of acuity-adaptable patient rooms, integrated outpatient and specialty care centers, technology-enabled care environments and flexible clinical spaces designed to evolve as healthcare delivery changes.

Increasingly, health systems are rethinking facilities around care delivery models rather than individual departments, consolidating services to improve patient access, strengthen care coordination and create greater flexibility for future needs. Hennepin Healthcare in Minneapolis consolidated 26 outpatient and specialty clinics previously spread across nine buildings into a single integrated Clinic & Specialty Center. This improved connectivity across services while creating a more adaptable platform for future care delivery.

3. Seismic strength, code and compliance

Does renovation still make financial sense once seismic upgrades, code requirements and compliance considerations are factored in? In the Pacific Northwest, seismic and code requirements are, hands down, the top drivers of replacement decisions, particularly when aging buildings require substantial upgrades to meet modern standards. When the alternative is major construction inside an active hospital, healthcare leaders must weigh not only the cost of compliance, but also the operational impacts, risks and long-term value of the investment.

Harborview Medical Center officials in Seattle faced the challenge of modernizing critical healthcare infrastructure while maintaining operations at the region鈥檚 only Level I adult and pediatric trauma and burn center. Rather than applying a one-size-fits-all solution, officials evaluated individual facilities across the campus and selected the approach that made the most sense for each asset, including new construction where seismic, operational and long-term care delivery requirements made replacement the best path forward. The chosen phased modernization strategy improves resilience and continuity of care while positioning the campus for future needs.

4. Timing, disruption and long-term value

How will the project affect patient care, staffing and operations during construction, and will the long-term benefits justify those disruptions? In an active healthcare environment, the right solution is not just the one that meets future needs but the one that can be delivered while safely maintaining care today. That鈥檚 why project phasing, operational impacts and timing should be evaluated alongside cost and scope when determining whether to renovate, expand or replace.

At Children鈥檚 Hospital Colorado, a new 25-bed unit needed to be constructed between two active patient care units, including a bone marrow transplant unit serving highly vulnerable pediatric patients. With respiratory season approaching, the project team had a limited window to complete the work while maintaining strict infection control and patient safety requirements. Through intensive planning and coordination, the team completed the project three weeks early while maintaining continuity of care, achieving zero unplanned outages, and minimizing disruption to patients and staff.

Plan before the facility forces the decision

Balancing today鈥檚 operational demands with tomorrow鈥檚 care delivery needs is no small task for healthcare leaders, particularly as the pressures on capital planning keep shifting nationwide. While the pressure to act can be immediate, the most successful capital decisions aren鈥檛 driven by urgency alone. Instead, they are grounded in a clear understanding of how each facility supports the broader health system, the communities it serves, and the future of care delivery.

There is no one-size-fits-all answer among renovation, expansion and replacement. In many cases, the right strategy may be different from one facility to the next. Engaging the right design and construction partners early allows healthcare officials to see the full picture and identify opportunities that might otherwise be missed. By considering infrastructure, future care needs, compliance requirements and operational impacts together, leaders can land on investments that improve flexibility, preserve value and position their organizations for long-term success.

Trent Rehfeldt is director of business development in Mortenson鈥檚 Portland office. Contact him at 971-202-4100 or聽[email protected].

The opinions, beliefs and viewpoints expressed in the preceding commentary are those of the author and do not necessarily reflect the opinions, beliefs and viewpoints of the Daily Journal of Commerce or its editors. Neither the author nor the 91视频 guarantees the accuracy or completeness of any information published herein.