As modern care delivery increasingly focuses on the whole person, the healthcare built environment is changing to reflect that. Many hospital systems today are establishing outpatient care locations—clinics—in underserved suburban communities. The move decentralizes care and improves wellness, bringing services closer to patients’ homes.

These new suburban clinics are often located in highly visible areas—such as retail strips or shopping centers—with easy access to public and private transportation. From the facilities planning perspective, locating clinics and accompanying parking in a location with lower leasing rates increases the convenience for patients and decreases clients’ operational costs. Choosing a site for such a clinic is contingent on proximity to a strong medical center’s resources and avoiding redundancies by not building too close to other clinics’ service areas.

In 2013, when Seattle Children’s sought to expand its services south of Seattle in Federal Way, Wash., the opportunity to adapt a vacant big-box retail store—a former Circuit City—emerged.

Seattle Children’s was cognizant of other hospital systems’ adaptive reuse of big-box stores, but the hospital had no prior experience executing such a renovation. Despite initial reservations, Seattle Children’s realized that elements of the 37,000-square-foot former store, including that it was one level with wide spans between structural columns, offered ready-made features that would actually advance clinic goals. The store’s footprint accommodated a floor plan for Seattle Children’s designed to centralize services within an open, flexible system of efficient workspaces and modules that incorporate principles of Lean design.

Located in a shopping center in a transit-oriented area, the former Circuit City also lent itself to a high degree of visibility thanks to nearby major highways and arterials. Shopping centers generally provide ample parking and existing site features, such as signage, entrance and egress, and proximity to other retail destinations such as grocery stores, libraries, and restaurants that make it convenient for patients and families. Although Federal Way lacked proximity to nearby support facilities, the sheer amount of usable, flexible space facilitated the incorporation of laboratories, general X-ray, ultrasound, pharmacy, and rehab therapy functions into the design.

However, challenges did arise that wouldn’t typically be encountered in a healthcare tenant improvement. For instance, adapting the building required significant infrastructure upgrades, environmental abatement to adjacent tenant spaces, and collaboration with a property manager uninitiated to the requirements of healthcare projects.

The flexible qualities of the building, the location of its site, and the opportunity to serve that community inspired the provider to proceed with the conversion. Construction began in June 2014, and, as expected, upgrading the infrastructure proved to be among the project’s biggest tasks. A retail store isn’t designed with the extensive electrical and mechanical systems necessary for exam rooms or labs; those utilities had to be added or overhauled. Facilitating these upgrades in a space with a 25-foot clear height included the creation of an internal frame to support infrastructure improvements. Ultimately, the space included three identical clinic modules consisting of 10 exam rooms and a team room per clinic pod. Construction was staged so the interior tenant improvement work occurred at the same time as the site’s abatement.

While there was undoubtedly a learning curve that came with developing the building, the Seattle Children’s South Clinic opened in August 2015, under budget and on schedule, providing outpatient services to families in two of Washington state’s most populous counties. The success of the project allows the main Seattle Children’s campus in Seattle to focus on acute care services.

Considering that the previous Seattle Children’s Federal Way clinic was located on the third floor of an aging medical office building, this adaptive reuse tenant improvement provided a significant upgrade, both for the quality of healthcare available in the South Sound region and for the spectrum of care offered by Seattle Children’s. While Seattle Children’s could have chosen to expand to another city or via a more traditional design-build process, the choice to adaptively reuse an existing building of a different typology proved to be the best choice. As healthcare continues to move in a preventive-care direction, adaptive reuse has established itself as a viable option for providing healthcare within communities.

Mandy Hansen is interim director of facility planning, design, and construction at Seattle Children’s. She can be reached at Victoria Nichols is principal at ZGF Architects LLP (Seattle). She can be reached at