The accelerated pace at which retail stores have shuttered in recent years has resulted in record high vacancy rates at shopping malls across the country. But one sector’s loss could be another’s gain as the healthcare sector seeks to find solutions to rising patient volume and expanding access to care.

A study by Moody’s Analytics, “COVID-19 and the Convergence of Retail and Industrial,” reports that millions of square feet of retail space is expected to become available in the coming years, and the healthcare industry is uniquely poised to fill the empty shells of those closed big-box retailers and department stores. One reason is that many of the metrics retailers use to choose locations—high traffic areas with easy access and ample parking—are also beneficial to healthcare service providers. Additionally, large quantities of square footage can be acquired in urban and suburban locations at a low cost.

However, retrofitting a vacant former Macy’s or Dillard’s department store into a medical facility isn’t without its challenges and requires creative design solutions to meet codes and structural needs.

In 2018, the Medical University of South Carolina (MUSC; Charleston, S.C.) brought McMillan Pazdan Smith Architecture (Charleston, S.C.) on board to convert a former JCPenney department store in the Citadel Mall in Charleston into the West Ashley Medical Pavilion. The new facility provides a variety of services, from primary care to specialized diagnostic and surgical disciplines. Here, we discuss some of the solutions the design team implemented, which can provide lessons and ideas for future projects.

1. Building structure. Retail spaces usually have taller floor-to-floor heights that most medical office buildings (MOBs). In the case of the MUSC project, the two-story former department store featured 20-foot floor-to-floor heights, which is 5 to 6 feet higher than typical MOBs. The extra space allowed the project team to add above-ceiling infrastructure such as electrical conduits, ducts, mechanical and domestic water piping, and operating room boom and equipment supports without dramatically compressing the ceiling heights. However, some complications emerged as construction progressed.

Items requiring regular maintenance, such as above-ceiling variable air volume boxes, needed to be placed low enough to be easily accessed via a ladder, but the building’s existing ceiling heights made it difficult to access these items. Lowering the ceiling height throughout the building wasn’t a cost-effective design solution, so instead, the team decided to lower the ceiling height only in areas that housed systems that would require more maintenance and frequent access. Additionally, because tall ceilings amplify ambient noise, sound batt insulation and white noise systems were included in the design to offer some relief.

2. Working with the existing footprint. Most big retail stores are designed in a square layout. However, rectilinear footprints are commonly used in MOBs to create clinical pods and distinct patient and staff circulation flows. Square footprints also can make it difficult to place vertical components, like elevators, within public spaces. To maximize space along exterior walls with natural lighting, square layouts often result in centrally located public areas when renovating multitenant configurations.

To overcome this, the design team routed the main concourse through the middle of the MUSC facility, with the elevators at the center. The main lobby and access points were oriented toward the edges with windows to provide as much daylight as possible. Clinics were also located in areas with access to daylight, especially dermatology exam rooms, which require daylight for certain procedures.

3. Providing access to daylight. The standardized clinical pod layout is designed to allow natural light into the building, usually at the end of corridors. Because retail spaces tend to be designed with square footprints, finding ways to channel daylight into more areas of the building can be a challenge. Additionally, windows are often sacrificed along exterior walls of big box stores to maximize shelving space.

At the MUSC West Campus, the former JCPenney was lined with windows along one side of the building. When walls were added to the interior to create clinic pods, much of the natural lighting was lost. The team solved this by adding windows in exterior walls for areas designated for patient and staff activities. Glazed openings were also made in areas where patients would spend prolonged periods of time such as waiting and exam rooms to create a feeling of openness.

As budget is always a consideration, careful planning and coordination of design and implementation were used to maximize the effectiveness of windows, while staying within the budget. Designers used target value design, where they developed “buckets” of funding for each group/area in the facility, then reconciled the layout based on the owner’s priorities.

4. Capitalizing on bay spacing. The 32-by-32-foot structural bay spacing in retail stores is ideal for conversion into large procedure and operating rooms, as well as open clinical areas for pre- and post-treatment. Additionally, floor slabs designed to withstand heavy shelving units are strong enough for medical equipment, allowing unencumbered collaborative spaces with great view angles to be achievable.

5. Upgrading plumbing and HVAC systems. HVAC systems in big-box retail stores are designed to move a high volume of air through open spaces. However, because MOBs include many interior rooms, the HVAC system needs to be replaced to provide a moderate flow throughout partitioned floor plans with a multitude of zoning. Additionally, most retail HVAC systems don’t meet energy efficiency levels mandated by codes for healthcare facilities.

Upgrades to plumbing systems are necessary, too, as healthcare facilities require more plumbing structures than retail big boxes for features such as exam room sinks. Therefore, plumbing must be driven from its usual locations toward the front and back of a former store layout to the interior of the building to accommodate healthcare facility needs. The increased floor-to-floor heights create additional room for above-ceiling infrastructure to help accommodate the modifications.

Because millions of square feet of space are expected to become available in upcoming years as brick-and-mortar stores continue to close, it’s important for healthcare design teams to understand the costs and constraints involved in converting former big box structures into viable healthcare facilities. That effort will put the healthcare industry in a position to fill the void for additional and convenient care options for patients and communities.

Aaron Jeffers is a principal in the healthcare studio of McMillan Pazdan Smith (Greenville, S.C.). He can be reached at