Samenvatting

Substantial changes in the Dutch health care landscape have led to new ways of funding and designing hospitals. Flexibility in the design of hospital real estate provides options to adapt to changing circumstances. FREM plays an important role in managing hospital real estate and the utilization of these options. This research aims to contribute to a better understanding of the role FREM plays in utilizing flexibility options of hospital real estate and the influence of market regulation on hospital building design.
The most important conclusion of this research is that hospital organisations occupying modern buildings, with more flexibility options than older ones, are not necessarily better equipped to utilize those options. A well-aligned real estate strategy, good objectivation methods and the proficiency of the organisation to ensure proper use of the real estate, are equally, or perhaps more important to utilize the provided flexibility options. 
Hospital FREM departments are recommended to develop well-alligned real estate strategies to serve as a compass for all real estate decisions. In addition, it is advised to develop methods to objectify space demand and agree upon manageable rules to ensure proper utilization of the flexibility options provided.