The Judicious Use of Demolition is Key to Rightsizing a Hospital for the Future

October 29, 2014  |  Mark Furgeson

 As the healthcare industry continues to evolve, many organizations struggle with the inherent conflict between cost-effective care and aging/overbuilt acute care facilities. Will reform improve patient care? Absolutely, but only if it creates a well-coordinated delivery system with facilities that are efficient and competitive. In this series, we discuss principles to guide investment in inpatient environments.

Older buildings are not only expensive to maintain and complicated to renovate, often the configuration of floor-to-floor heights, column grids, and proportions do not lend themselves to the delivery of 21st century medicine.

So why do we continue to pour money into so many buildings on Hill Burton era campuses? Frequently, tearing them down is challenging. Community members, particularly those who went to great lengths to fund the construction, may view hospital administration as wasteful for demolishing a perfectly good building. Or the heirs of a generous philanthropic donor may expect it to remain.

Despite the challenge of internal politics, FreemanWhite recommends that hospitals demolish any building requiring significant investment to maintain its viability in order to reduce an institution’s fixed cost. Typically, such buildings are more than 40 years old, although sometimes the physical makeup of newer buildings causes them to fall into this category as well.


  • Campus growth patterns in a pinwheel or outward-radiating form often have the oldest buildings in the center of a complex medical center, making them impossible to demolish.
  • Wayfinding-enabler buildings serve as key connectors for patient movement or utilities.
  • The true programmatic need for strategically purposeful (be honest!) support programs that must reside on campus.

On a recent project, the site, capacity, and configuration of a large, urban campus with buildings dating to 1909 presented several challenges. Aligning data analytics with the hospital’s overarching goals, our team developed a prioritized list of facility responses to create a more efficient footprint, reduce non-revenue producing square footage, and maximize the quality of care through lean operations.

We recommended smart demolition for three buildings to reduce the footprint of the campus and create a leaner and more efficient environment. Now that the demolition of two of the buildings is complete, the hospital has realized an annual operational savings of nearly $1 million.


outcome_Mark Furgeson

Mark is an adjunct professor at Cornell University co-teaching a course on the intersection of policy and design in the School of Design and Environmental Analysis. The course investigates Evidence Based Design (EBD) with the intention of clarifying the uncertainty regarding scientific evidence and the investment in facilities. This experience provides FreemanWhite access to world class research and a unique perspective regarding the components of EBD that are most beneficial to healthcare.

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Image courtesy of Rhys A. on Flickr



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