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How to Navigate Healthcare Real Estate Development

The landscape of healthcare real estate development is exciting and complex, offering providers opportunities to significantly enhance patient care and operational efficiencies. However, navigating this process without expert guidance can lead to unnecessary expenses, compliance nightmares, and delayed project timelines. Understanding the key steps and challenges can streamline the journey and avoid many common pitfalls.

The Importance of Seamless Healthcare Real Estate Development

Healthcare real estate development involves the planning, financing, construction, and ongoing management of facilities such as hospitals, clinics, specialized outpatient centers, and medical office buildings. Unlike standard commercial projects, these facilities must meet strict clinical requirements, patient safety standards, and often intricate regulatory guidelines. Executing this process efficiently is crucial, as any misstep can have significant financial ramifications and potential legal implications.

Modern healthcare facilities have evolved beyond traditional brick-and-mortar structures to incorporate telehealth, advanced diagnostic technology, and more patient-centric designs. A seamless healthcare construction and development process ensures your facility remains competitive, provides top-tier care, and aligns with the latest healthcare trends. By embracing a structured approach, organizations can optimize their short-term project goals and long-term operational success.

The Challenges of Healthcare Real Estate Development

Developing a healthcare facility is a multi-faceted undertaking that involves navigating numerous requirements and variables. Unlike generic commercial properties, healthcare projects must address clinical workflows, accommodate specialized equipment, and deliver an environment conducive to patient well-being. Understanding the challenges upfront allows for a more strategic and proactive approach.

Regulatory Hurdles

Healthcare regulations are continually evolving, which means your facility must comply with federal, state, and local guidelines. For instance, hospitals may need to meet specific criteria for infection control, while outpatient surgical centers might have stringent safety requirements for operating rooms.

These regulations vary greatly based on the type of healthcare services you provide and the geographic region in which you operate. Falling out of compliance can lead to hefty fines, legal disputes, or even forced closures. As a result, ensuring you have a dedicated team to interpret and integrate these regulations into your project design is not just beneficial—it’s indispensable.

Zoning

Zoning laws dictate how land can be used in a given municipality. In healthcare real estate development, you must confirm that the property is zoned for medical use or secure the appropriate variances or conditional-use permits. Because healthcare facilities often generate heavier traffic, require expanded parking, or operate 24/7, local authorities may impose additional constraints.

Overlooking zoning requirements can derail a project early on or slow healthcare construction with extended approval processes. Meticulous planning and open communication with local planning boards and community stakeholders are crucial in this phase.

Site Constraints

Even if the zoning is favorable, the physical characteristics of your chosen site might pose significant challenges. For example, sloping terrain could require extensive grading, or existing structures might need demolishing. Utilities access—such as water, electricity, and sewer lines—must be robust enough to handle medical equipment demands. In some cases, environmental assessments may reveal contamination issues that require mitigation. These factors can substantially increase your budget and timeline if not anticipated and addressed.

Long-Term Viability

Beyond regulatory compliance and site suitability, the long-term success of your healthcare facility hinges on factors such as demographics, local competition, and community growth. A hospital or medical office building that performs well today could struggle tomorrow if population patterns shift or new competitors emerge. Assessing long-term viability means looking beyond initial construction to ensure the facility can adapt to new technologies, scale up for growing patient volumes, and remain financially sound in an ever-evolving healthcare landscape.

Additional Challenges

Other obstacles may include obtaining the specialized equipment needed for your practice, recruiting qualified healthcare professionals to staff the facility, and integrating telehealth capabilities or other technological advances. Properly addressing each of these challenges requires early planning and often the support of experts who understand the unique demands of healthcare operations.

Discover the role of enhanced customization for your healthcare real estate development project and ensure a welcoming, efficient medical space.

Learn More

The Process of Healthcare Real Estate Development: Step-by-Step

From initial feasibility studies to final occupancy, each phase of a healthcare real estate development demands careful coordination among various stakeholders. Providers can tackle issues proactively and keep their projects on track by breaking down the project into distinct steps.

Site Selection

Choosing the right site is arguably the most crucial healthcare real estate development decision. Organizations must evaluate demographics to ensure that the local population’s age, income, and healthcare needs align with the services to be provided. In addition, proximity to existing hospitals or competitors is essential; locating near complementary or feeder services can lead to a steady referral network, while oversaturation in an already crowded market can hinder growth.

Transportation access, including highways, public transit, and convenient parking, is another factor that determines patient and staff satisfaction. It is also wise to assess whether the property has enough room for expansion as healthcare demands and technologies evolve. Before making a final decision, it is vital to consider local economic indicators and development plans to ensure the site supports long-term growth and market demand.

Zoning

Once a suitable location has been identified, verifying that it meets all zoning requirements becomes the next priority. Given their unique service offerings and operational hours, healthcare facilities may require specific classifications or conditional-use permits. Complying with local regulations often entails submitting detailed site plans to zoning boards and attending public meetings where community input is gathered.

Because healthcare facilities can significantly impact local traffic patterns and noise levels, municipalities may impose additional conditions to mitigate concerns. A proactive approach that involves regular communication with planning officials and stakeholders helps avoid lengthy approval delays and helps ensure the project aligns with community expectations.

Financing

The development of a healthcare facility can be expensive, so having a comprehensive financing strategy from the start is critical. Organizations often seek traditional loans, which may come with competitive rates but require stringent documentation and a sizable down payment. Nonprofit hospitals and clinics may be eligible for tax-exempt bonds, providing a cost-effective means of financing large-scale projects.

Other options include public-private partnerships, venture capital investments, or government grants targeted at expanding healthcare services in underserved areas. Once the facility is up and running, it is imperative to create a detailed budget accounting for construction costs, contingency funds, and ongoing operational expenses. By accurately forecasting both short-term and long-term financial needs, healthcare organizations can minimize risks and ensure stable funding throughout the project lifecycle.

Construction and Design

The construction and design phase is where the vision of a healthcare facility begins to take shape. Unlike traditional commercial buildings, healthcare facilities must be built with specialized layouts that prioritize patient care, infection control, and operational efficiency. Architectural designs should incorporate features such as optimized patient flow, natural lighting, soundproofing, and ergonomic workspaces for medical staff.

Construction teams must also adhere to strict industry regulations, ensuring compliance with healthcare-specific safety and accessibility standards. By working with experienced healthcare architects and builders, organizations can create a facility that is functional, compliant, and built for long-term success.

Long-Term Sustainability

Modern healthcare real estate development requires forward-thinking designs that adapt to shifting regulations, emerging medical technologies, and changing patient expectations. Flexible floor plans that accommodate possible service expansions or telehealth integration reduce the need for costly renovations later. Implementing energy-efficient systems, such as advanced HVAC units, high-grade insulation, and LED lighting, lowers operational expenses and appeals to eco-conscious patients.

Future-proofing also extends to technological infrastructure, including robust data security measures and high-speed connectivity for telemedicine, remote monitoring, and electronic health records. By prioritizing these sustainability and adaptability measures during the planning and construction stages, healthcare providers can maintain a competitive edge and deliver a consistently superior patient experience.

Healthcare Real Estate Development Considerations

Even after accounting for challenges and following a structured development process, there are still important factors that can impact the success of a healthcare real estate project. These considerations often revolve around day-to-day operations, sustainability goals, and regulatory compliance.

  • Sustainability and Energy Efficiency: Implementing eco-friendly design choices and building materials can lower utility costs and attract environmentally conscious patients.
  • Compliance and Regulatory Considerations: Regularly reviewing healthcare guidelines and best practices ensures your facility remains up to date with evolving standards.
  • Patient Experience: Designing spaces for optimal patient flow and comfort contributes to better satisfaction, retention, and overall care outcomes.
  • Technology Integration: Investing in advanced IT infrastructure from the start simplifies future upgrades and supports telemedicine, digital records, and more.
  • Scalability: Planning for potential expansions or additional services ensures your facility can adapt to changing community demographics and medical innovations.

By considering these considerations from the outset, you create a healthcare facility primed for both near-term functionality and long-term success.

Manage Your Commercial Real Estate Development With Hokanson Companies

Healthcare real estate development demands a comprehensive approach, from navigating complex regulations to securing adequate financing and addressing patient-centric design. At Hokanson Companies, our experienced team understands the unique demands of the healthcare industry—ensuring each project aligns with clinical excellence, operational efficiency, and long-term sustainability.

Whether you’re planning to expand an existing clinic or medical office or build a new outpatient clinic from the ground up, we can help guide you through every stage of development. With our proven expertise, you’ll have a partner committed to realizing your vision, controlling costs, and elevating patient care in a rapidly evolving healthcare landscape.

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Christopher M. Horsley

President and Chief Executive Officer
cmh@hokansoninc.com

“Working hard to make a difference to earn your business.”

Chris Horsley joined Hokanson Companies, Inc. in 1997 while completing his degree in Civil Engineering at Purdue University. Chris began his employment at Hokanson Companies in the construction area and in 2000 added Property Management to his responsibilities. Now as President and Chief Executive Officer, he focuses his efforts on construction, development, and property/facility management. Chris oversees a team of property and construction managers to provide management services to approximately 5M square feet in a 7-state geographical service area. Chris also works closely with multiple financial institutions to meet their bank branch real estate needs which includes a 140-branch system across a 3-state geographical area.

Chris graduated from Purdue University in 1999 with a Bachelor of Science in Civil Engineering. He holds a Professional Indiana State License for an Engineer in Training (EIT) and an Indiana Real Estate Broker and is a Certified Commercial Investment Member (CCIM). Chis is also involved with The Building Owners and Managers Association (BOMA) and is currently serving on the International Executive Committee and is the President for BOMA Indianapolis.

Chris enjoys spending time, working in the business, being outside, riding motorcycles, exercising, playing golf, and being with his family.

Stephen J. Adams

Executive Vice President
sja@hokansoninc.com

Stephen J. Adams joined Hokanson Companies, Inc. in 2000 and now serves as the Executive Vice President for the company.  While leading the leasing and brokerage team over the past 25 + years, Stephen has grown his client list by being accountable, trustworthy and responsive at all times.  He manages his client’s corporate real estate needs from coast to coast through providing site selection, transaction advisory, tenant representation and acquisition/disposition services.

Stephen serves as the outsourced real estate partner to many major corporations and has developed long-term relationships by integrating and learning the business of his clients.  His proactive approach to cost savings has provided an invaluable benefit to his customers.  He continues to have success with both large, multinational companies and regional businesses as he earns his client’s business daily with an eye on strategic planning, both locally and nationally.

As Executive Vice President, he helps manage a team of seasoned professionals who provide expert market research, real estate knowledge, and function as a cohesive team to enhance the decision making of his clients.  Capabilities include strategic planning, market evaluation and transaction management.

Continuing the company’s history as the premier medical real estate provider, Stephen has developed relationships with the major hospital systems in Indiana, such as Indiana University Health, Community Health Network, Ascension St. Vincent, Lutheran Health, Parkview Health, Hancock Regional Health and Johnson Memorial Hospital.  In addition, representation services have been provided to many private physician groups such as OPTUM, Otolaryngology Associates, Dawes Fretzin Dermatology, Indiana Spine Group, Midwest Fertility, Northside Gastroenterology, The Surgery Center of Indianapolis, the Suburban Health Organization and the Indiana Hospital Association.

Stephen also counts several publicly traded REITS and Private Equity groups as clients.  Major investment sales experience includes on-campus MOBs at St. Vincent – Indianapolis, Indiana University – Methodist Downtown, Indiana University Health North and West Campuses, Parkview Health, Lutheran Health and various other campuses.  Also, he has completed several national, single-tenant, industrial sale/leaseback transactions including tenants such as Hershey’s, Firestone and several 3PL providers.

Stephen has devoted his time to various organizations including Noble of Indiana, Penrod Arts Society, Youthlinks Indiana, Hoosier Oncology Group, Allisonville Youth Baseball, St. Pius X School, and Cathedral High School the Governors Awards for Tomorrows Leaders.  He is also a member of the Stanley K. Lacy Executive Leadership Series, Class XXXVII.

Jay B. Gehl

Vice Chairman
jbg@hokansoninc.com

Jay Gehl serves as Vice Chairman of Hokanson Companies, Inc.  With over thirty years of experience, Jay has been directing and managing the company’s expertise in the areas of corporate advisory work, strategic planning, tenant representation, financial analysis of leases, brokerage, and build-to-suit assistance.  He has been instrumental in assisting the efforts of several major corporations establishing or relocating their corporate headquarters and managing vast portfolios of leased and owned properties across the United States.  His attention to detail and his unparalleled customer service have been the foundation of his relationships with the institutional customers served by Hokanson Companies, Inc.

Jay has excelled in investment sales with multiple transactions each year that annually rank him as a top producing broker on a local and national level. In addition, Jay’s efforts have helped corporate clients establish or renew leases in facilities across the United States from Connecticut to California.  He has also served the international needs of his clients in six countries including a facility in Turrialba, Costa Rica with 230,000 square feet and 35 acres.

Jay’s resume includes multiple build-to-suits of logistics and manufacturing facilities.  In addition, investment sales such as the 550,000 square foot U.S. Postal Facility in downtown Indianapolis and a 450,000 square foot medical portfolio make Jay a top producer in the local market while managing a team of highly experienced real estate professionals.  The success of Jay’s business is benchmarked by the multiple transactions and ongoing relationships with customers that have remained satisfied by the level of service and the quality of the transactions resulting from his guidance.

Today Jay continues to excel at providing excellent advice and service to several customers that lead their individual industries in quality, growth, and innovation.

Stephen P. Hokanson

Chairman of the Board and Chief Executive Officer, CRE, CPM, RPA
sph@hokansoninc.com

“We put our clients’ interests first… always.”

Steve Hokanson serves as Chairman of the Board and Chief Executive Officer of Hokanson Companies, Inc. He began with HCI in 1971, and has been its President and CEO since 1983. When Steve joined the organization, Hokanson Companies was primarily focused on property management. Under Steve’s leadership, Hokanson Companies has grown to include four active divisions and five separate disciplines.

HCI currently manages over 6 Million square feet under its property management division, and has over $100 million in project management and development. Its sales and leasing division closes over $100 million in sales and leases annually, while they continue to be very active in construction management for its various clients and out-of-ground buildings.

In addition to his role at HCI, Steve has also fulfilled numerous civic and professional leadership roles locally, statewide, and nationally, including the International President of BOMA International 1991-1993. Steve’s other accomplishments include being selected for the Stanley K. Lacy Executive Leadership Series, the Eagle Scout Silver Beaver Award, the National Distinguished Eagle Scout Award, named in Outstanding Young Men in America, and the Sagamore of the Wabash award, which is the highest award given in the State of Indiana by our Governor.

Steve Hokanson graduated from Indiana University in 1969 with a Bachelor of Science in Management and Administration. Steve is a licensed Real Estate Broker in the State of Indiana, and his designations include Counselor of Real Estate (CRE), Certified Property Manager (CPM), and Real Property Administrator (RPA).

Boyd R. Zoccola

Chief Development Officer
brz@hokansoninc.com

“Your ideas become reality through our combined efforts.”

Boyd R. Zoccola serves as Chief Development Officer of Hokanson Companies Inc. With over 25 years of experience, he focuses his expertise on development of office and medical space, and corporate consulting. Boyd has been actively involved in the development of nearly $600 million worth of real estate, including client partners like IU Health, Springleaf Financial, Vectren Corporation, and Old National Bank.

Boyd’s industry involvement with The Building Owners and Managers Association (BOMA) is extensive beginning in 1994. He served as Chair and Chief Elected Officer of BOMA International, and has also served on the Executive, Finance, Medical, and Healthcare Facilities Committees. He also served and chaired numerous task forces along with being a panelist and/or speaker. Boyd’s BOMA Indianapolis experience includes positions as President, Vice President, Treasurer, Secretary, and multiple committee chairs. In addition, Boyd served as a Board Member of the Real Estate Round Table from 2011-2012.

Boyd graduated from Indiana University with a BA in Biology and is a graduate of the Stanley K. Lacy Leadership Series. Boyd has served the community through his involvement with Horizon House, Girls Inc., and the IYHA. He is a member of Second Presbyterian Church, Sigma Chi Alumni Association, Meridian Hills Country Club, and is an Indiana Real Estate Principal Broker.

Tony R. Townsley

Chief Financial Officer, CPA
trt@hokansoninc.com

“A great company has great people who are passionate about what they do! I am proud to be a part of the Hokanson Team, where we demonstrate that passion every day in helping our customers solve their Real Estate challenges.”

Tony Townsley serves as Chief Financial Officer of Hokanson Companies, Inc. Tony began with HCI in 2001, bringing with him 25 years of accounting and operations management experience including four years with Arthur Anderson. This vast knowledge has contributed to his success overseeing the corporate financial reporting, cash management, budget coordination, and year-end audit and tax responsibilities at Hokanson.

Tony graduated from Indiana University in 1985 with a Bachelor of Science degree in Accounting. He is a Certified Public Accountant, and was appointed by the Governor to serve on the Governor’s Council of Impaired and Dangerous Driving. Tony also served on the Wine and Spirit Wholesalers’ Board of Directors. Currently, he’s involved with the Merciful Help Center, and is an active member of Our Lady of Mt. Carmel Catholic Church.

Tony enjoys spending time outdoors with his family, camping, fishing, biking, and reading. Those same family values led him in publishing a children’s book titled “Three Cups”, which teaches children how to save, spend, and be charitable with their money. There are more than 50,000 copies of the book in distribution.