“Retrofitting” is a broad term. It refers to upgrading or modifying existing systems and infrastructure to meet technological, efficiency, or operational requirements. These changes can range from upgrading HVAC systems to integrating advanced energy management technology and cloud-based platforms.
In healthcare settings, the goal is to enhance the facility’s performance, both in terms of efficiency and cost, as well as its impact on patient outcomes—all while minimizing disruption to patient care. Retrofitting hospital facilities to support modern care delivery can be an enormous challenge due to the complexity of retrofit projects combined with the potentially serious implications of disruptions in an active critical environment.
The rise of retrofitting
However, as noted on a recent Becker’s Healthcare podcast, the cost and needed real estate associated with greenfield projects has made retrofitting more attractive as healthcare systems seek to optimize CapEx spending and extend asset life.
“A survey said 61% of healthcare executives reported increased investment in infrastructure upgrades, signaling a strategic shift toward retrofitting their existing facilities… figuring out what they can do with what they have, with limited resources,” said podcast guest Braheem Santos, US Segment Lead of Healthcare at Schneider Electric.
Electrifying fossil fueled processes, shifting to predictive maintenance, installing advanced monitoring and control systems—all of these can deliver cost and sustainability benefits within a retrofit framework. The challenge is less about technology and more about process, people, and collaboration.
The continuity challenge
One of the most difficult aspects of retrofitting hospital IT/OT systems is maintaining consistency across facilities. When new construction is added to existing campuses or new sites are added through mergers and acquisitions, the introduction of advanced technologies—such as smart patient rooms or large-format engagement platforms—may cause older sections of the health system to become outdated. This can lead to an unwelcome experience of dichotomy for both patients and staff.
For example, a patient might receive care in a high-tech room with interactive displays and automated controls, then find themselves continuing their health journey in a room with a dated experience. Similarly, clinicians may need to adapt to different workflows depending on where they’re working. These inconsistencies can affect satisfaction, efficiency, and even safety.
Where retrofits make the biggest impact
Hospital digital systems are typically structured in layers, and retrofits often target one or more of the following:
- Physical infrastructure – Includes cabling, switches, racks, and network ports. Often it requires expansion to support new devices and increased bandwidth. Long-term investments, but still subject to wear and evolving needs.
- Software systems – Frequently updated to meet new regulatory, clinical, or operational requirements. Hospitals often struggle with software sprawl—too many licenses and overlapping tools. Consolidation and standardization are common retrofit goals.
- Smart technology and interfaces – Patient engagement screens, IP-based security cameras, and telehealth platforms are increasingly common. These solutions or platforms require robust network support and seamless integration with clinical systems.
Currently, hospitals are looking to boost efficiency and lower emissions, which implies a greater focus on power distribution networks.
“Hospitals are electrifying heating, transportation, and other systems,” said Andrew Carréno, Business Development Manager at ASCO on the Becker’s Healthcare podcast, “but it increases the overall load on their electrical distribution systems…. It’s driving a new level of sophistication in emergency power design, and it highlights the need for smarter, more connected systems.”
Schneider’s Santos agreed and pointed to the adoption of predictive maintenance as an industry standard, “not a nice-to-have… it’s a must.”
Finding the best fit: cloud, on-prem, or hybrid
Many hospitals have explored cloud migration to reduce the physical footprint of server rooms and improve scalability. But not all functions are suited to cloud deployment. Latency-sensitive applications (e.g., AI diagnostics, real-time monitoring) often perform better on-premises, and cost considerations can make cloud solutions less attractive for certain workloads. Also, regulatory and security requirements may necessitate keeping some systems local. Adopting hybrid models enables hospitals to support both cloud and on-premises systems.
Minimizing disruption during retrofits
Retrofits in active healthcare environments must be carefully managed to avoid operational disruptions. Facility shutdowns—even brief ones—can have a substantial impact on revenue and even compromise patient care.
“An OR typically sees six figures of revenue on a daily basis,” noted Santos. “So, in the event that something were to happen unexpectedly… even from a planned downtime standpoint, that’s super impactful operationally.”
Successful retrofits depend on:
- Clear communication among stakeholders, including vendors, contractors, and hospital leadership.
- Early identification of risks, such as missing components or compatibility issues.
- Incremental upgrades that allow facilities to remain operational while improvements are made.
Rethinking retrofit delivery models
Traditional construction models like design-bid-build often lack early collaboration between architects, contractors, and technology providers, which can lead to costly changes and delays later. Simply getting the right people in a room together can make a dramatic difference.
Historic approaches tend to focus on first cost rather than total cost of ownership over the full lifespan of the building or asset. More progressive models are better suited to retrofit scenarios.
Planning is critical, as noted by ASCO’s Carreno.
“That’s where the conversation comes in between us and the healthcare facility,” he said. “Understanding what their goals are, understanding the equipment they’re working with, and being able to work out a detailed plan and method to minimize any disruption.”
Integrated project delivery (IPD) brings all stakeholders—architects, contractors, engineers—together early in the process to align goals and reduce risk. Design-build allows the general contractor to lead from the start, streamlining execution and improving accountability. These models foster transparency and shared ownership, which are essential when retrofitting complex systems in sensitive environments.
Real-world wisdom for retrofit success
Effective communication is essential no matter what approach hospitals take. One of the most crucial elements of a successful project is being able to present a clear vision of how technologies work, how they’re integrated with other systems, and what the end product will look like. To that end, it’s helpful to use visualization tools to bridge gaps between different project participants who come from their own specialized domains and may lack essential knowledge from other disciplines.
Hospitals that succeed in retrofitting their operational systems typically:
- Engage experienced personnel familiar with legacy infrastructure
- Get all participants, especially technology suppliers, involved early to understand how different systems will interact and to smooth integration
- Maintain institutional knowledge to avoid relearning systems from scratch
- Establish direct communication channels between vendors and end users to resolve issues quickly
When a retrofit involves several upgrades of systems, they can have multiple, often unforeseen impacts. More broadly, it’s important for project teams to have a comprehensive idea of “how a building should act” in its operations and then build in flexibility to ensure it continues to perform over the long term. Early engagement facilitates both goals.
Investing in the future of care
Retrofitting hospital infrastructure systems is not just about maintenance or keeping up with technology—it’s about enabling better care, improving efficiency, and building adaptable, sustainable infrastructure. While the process can be challenging, thoughtful planning and early collaboration can turn retrofits into strategic wins. By balancing innovation with operational reality, hospitals can modernize their systems without compromising the continuity and quality of care. Retrofits are a platform for innovation.
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