1. Curate the team. Health facilities professionals are not just selecting a team of architects, planners and facilities managers. They need people who can calculate capital expense and operating expense; who understand catchment area and market demand; and who can create a sound business plan.

2. Start the right conversation with the right people. A major hospital repositioning must involve the C-suite, finance and accounting, real estate brokers and various user groups, all of whom should help to shape project goals and drivers. A plurality of stakeholders on the client side will ensure that the the project team is asking the big questions and solving the right problems.

3. Know the community. Medical facilities play a major role in their respective communities and are often their largest employers. Because these buildings are enduring icons in the neighborhoods they serve, they are by their very nature emotionally and politically charged properties. A sustained and meaningful dialogue with the surrounding community is tantamount to success.

4. Consider structural attributes. Legacy health care buildings vary greatly. Most share some positive and negative attributes depending on when and where they were built. Some of the challenges include deep floor plates and larger-than-average circulation cores as well as dense mechanical-electrical-plumbing infrastructure and a specific ground floor layout that is challenging to adapt for other uses. In the plus column, many hospitals have greater-than-average floor-to-floor heights, and a structural grid that lends itself to multiple uses. In all cases, facilities professionals must understand how the building can be adapted.

5. Know the options. Once it has been decided to convert a hospital to another use, how does a health facilities professional know what will work?  First, understand what the market will bear and determine the highest and best use for the property. On a pragmatic level, facilities professionals also need to know what will fit by benchmarking the most common types of programs in existing hospital buildings, including workplace, retail and clinic programs. As an operator or developer, a facilities professional should understand what works within the framework of the existing building.

6. Think sculpture, not surgery. Facilities professionals should not be afraid of big, bold architectural moves. Changing the public perception of a hospital often requires irreverence for the original building. The most successful approach can be a provocation, not an homage to the past.

7. Seriously consider not repurposing. Facilities professionals should determine whether there are added efficiencies to gain during the planning and design process. And, as much as architects like to push sustainability and building reuse, sometimes the right option is to demolish.

8. Know the organization. Finally, it's critical that hospital owners and operators clearly articulate their risk profiles, organizational capacity and financial resources before embarking on the journey.