By Carey Sealy, Contributing Writer

An aging population, rising outpatient demand and the push to put care closer to home are reshaping healthcare’s real estate footprint, filling neighborhoods with imaging centers, infusion suites, urgent care clinics and surgery centers faster than most systems’ operating models can keep pace. 

The data backs this up. JLL’s 2026 Medical Outpatient Building Perspective puts occupancy in these ambulatory spaces at a record 92.7 percent, with new development still constrained — a tight squeeze on the space available to deliver care in. The Advisory Board projects outpatient volumes growing 10.6 percent over the next five years, even as coverage declines and the economic outlook adds uncertainty. Eight of the 10 fastest-growing service lines, from endocrinology to psychiatry, are outpatient. 

One critical question remains: What happens when a system built to run five hospitals is asked to run 150 scattered facilities instead? 

More sites, more variables 

Running facilities management across five hospital campuses is a fundamentally different discipline than coordinating across a vast network of dispersed sites. One of the biggest headaches for health systems is compliance. Joint Commission compliance requirements are constantly evolving and are different across the full range of healthcare facilities. 

Hospitals, medical outpatient buildings (MOB), urgent care centers, imaging centers, Program of All-Inclusive Care for the Elderly (PACE) sites, micro hospitals and ambulatory surgery centers (ASC) each has a distinct operational, regulatory and compliance profile. 

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Among the nuances related to ASCs are these: 

• ASCs must meet the Life Safety Code provisions applicable to ambulatory healthcare occupancies. ASCs also must maintain a life safety compliance book that documents all maintenance records of building equipment associated with life safety. This maintenance includes testing and inspecting equipment to ensure proper operation in case of an emergency. 
• ASCs, as well as imaging centers, face surveys by the Joint Commission, the Accreditation Association for Ambulatory Health Care, and Centers for Medicare and Medicaid Services Conditions for Coverage that are more expansive than Joint Commission alone, and they are fundamentally an environment of care and facilities management challenge. 

Healthcare facility managers must proactively organize responses and documentation, and they need to address deficiencies promptly to ensure proper corrective action. They also should note that a new set of ambulatory-specific Joint Commission codes are expected in the next year. This situation reinforces the idea that an ASC requires its own tailored standards and purpose-built operating model, not a simple copy of the acute care playbook. 

Additional common considerations when moving to a dispersed real estate footprint include: 

Vendor networks. These relationships that once covered one building now stretch across metro areas and states — sometimes several states — even as acquisitions, joint ventures and private-equity groups fold in new sites, each with its own vendor relationships to absorb. 

Talent strategy. Staff who once served one building now need to be mobile across a much wider range of asset types, since an infusion suite, a surgery center and a single-provider clinic do not share the same systems or risk profile. 

Geography. Managers in systems expanding into hurricane- and earthquake-prone regions in the same growth cycle suddenly must manage two categories of emergency preparedness at once, with protocols that have to be standardized across dozens of local teams instead of one building. 

Underneath all of this lies a technology gap. Cost, asset and vendor-performance data end up scattered across whatever system was in place when each site joined. One building’s HVAC failure and another’s plumbing issue rarely land on the same desk. A centralized integrated workplace management system often can extend the existing platform to new sites, but those that grew through acquisition usually must juggle several disparate systems, and unifying that view takes serious investment. 

Carey Sealy is managing director with JLL. He leads two practices across the Work Dynamics Healthcare division: Ambulatory & Outpatient and ATG, which aim to help health systems and large organizations operate smarter across their real estate and facilities portfolios.