In the healthcare industry’s shift toward a value-based care delivery model over its current volume-based one, success largely depends upon patients themselves. Providers need patients to be invested in their own health. After all, you can’t begin supporting wellness in place of treating illness if the very people you’re supposed to keep healthy don’t show up at their family doctor’s office from time to time.

Enter the other shift taking place: healthcare’s move to ambulatory settings. It isn’t just about the preventive care being offered in these types of spaces, albeit that’s important. But what’s also significant is where these ambulatory facilities are being sited.

Across the country we’re seeing clinics cropping up right in the middle of the communities where patients live, close to shopping centers, libraries, daycares, salons—you name it. Conveniently, there’s plenty of real estate to choose from.

Whether it’s space once inhabited by a now-defunct retailer like Circuit City, or a retailer in the process of scaling back its footprint like Best Buy, or even a retailer scaling up operations like Walmart (for example, an old Walmart abandoned for a new, shiny Super Walmart built down the street), there are plenty of existing structures available that are in the heart of where patients are spending their time, likely with convenient access to highways, plenty of parking, and all the access points you want.

But converting former retail locations into modern healthcare clinics and MOBs doesn’t come without challenges.

For example, in the conversion of a former Circuit City space in Portland, Ore., Kaiser Permanente discovered that the wholesale change in building use alone complicates matters. Think about it—how many windows are in your nearest big-box store? Probably not many. Contributing editor Janet Brown shares more about this particular project in her Green column appearing in our September issue of Healthcare Design.

In an in-depth feature on ambulatory care also coming up in September, contributing editor Sara Marberry shared similar insights from Paul Pannier, senior architect with Gresham, Smith & Partners, who notes that while retrofit costs are typically less than the price of building a new facility, it can be easy to overlook expenses like the addition of emergency power services, medical gas, and even backup power—an oversight that just may push the cost beyond that of fitting out a building that already has those utilities.

So while these facilities certainly offer “location, location, location,” not to mention a nice reuse of vacant space that any community would likely value, where is the point when the cost of that reuse tips the scales in favor of building new or renovating existing healthcare space? We'll be exploring this topic more here at Healthcare Design and it will be covered at our 2013 Healthcare Design Conference (Nov. 16-19, Orlando) in the session “The retailing of healthcare: Challenges and opportunities of converting former retail spaces into clinics.”

In the meantime, we'd love to hear what kinds of experiences our readers are having with big-box conversions. Share your stories in the comments below, or email me at