Purpose The fast advancement of medical technology and processes poses challenges to hospital construction and management. The purpose of this paper is to provide a structured approach to advancing adaptability in hospital retrofits, proposing the preferable timing and scope of different adaptability strategies. Design/methodology/approach A qualitative research approach was chosen, with 28 semi-structured interviews designers, project managers, clients and healthcare professionals as the primary research data. Findings This paper presents a model for planning for the future in hospital retrofits. The model includes 11 different adaptability strategies, categorized based on the level of adaptability. Furthermore, each strategy is linked to an open building system level, indicating the appropriate timing. Based on the findings, generality strategies in the tertiary building system level are the most effective forms of adaptability, as they are easy to implement and answer to non-specific changes in hospital operations. Research limitations/implications The findings contribute to existing knowledge on adaptability in buildings, and provide practical guidance particularly for designers. A new type of service offering, an adaptability roadmap detailing the scope and timing of adaptability, is suggested. Originality/value The paper contributes to the existing research by detailing different approaches and knowledge related to adaptability and its strategies in hospital retrofits. More specifically, the three-fold categorization of adaptability is linked to both timing and intrusiveness in a novel way.

This thesis revolves around specifying the problematics concerning hospital retrofits as well as finding solutions for overcoming them. The solutions are constructed with the help of earlier research and thematic expert interviews. Altogether 28 actors, including project managers, architects, engineers and property managers, are interviewed.Due to its old age, the Finnish hospital stock has several problems in addition to the frequent need for adaptation. The problems include structural deterioration, indoor air quality problems and outdated facility designs that reduce the operational efficiency. Versatility of the problems results in large and complex retrofit projects. Complexity of the projects is mainly due to A) technical limitations of the old structures and B) continuous need for unforeseen adaptations.Project complexity and challenges can be alleviated by utilizing different design strategies, including adaptability, which divides change demands into three separate categories: expandability, flexibility and generality.Productive utilization of the strategies can be managed with the help of service modularity. The study proposes five distinct service modules and 16 service components for service providers and hospital property managers. The service modules can be used to construct a modular service that matches the project-specific needs of any hospital retrofit, thus simplifying the design process and improving life cycle costing.