Thank you for the reply. Unfortunately moving the repeater is not an option and we don't have a simplex frequency. We have four frequency pairs that are used by plant ops, PD and other dept's. I have always believed that we should have a simplex freq for a time when the repeater may go down but the powers that be didn't see a need for it.
A couple of things….
As for the coverage issues:
Can the repeater here you? Can you hear the repeater? Differentiating between the type of coverage deficiency will tell you something and point to the type of solution you might need.
What kind of coverage are you trying to get out of the system? Is it interior of the hospital only? Interior of the hospital and immediate surrounding areas? Or is it a wider coverage system?
Did the system ever work satisfactorily? Did it change with new construction on the building? Has it deteriorated over time?
As for the simplex frequencies if the repeater fails, this likely isn't a licensing issue, it's a radio programming issue. If the repeater fails, you can go into talk around mode and use it in simplex. No additional licensing needed. Whoever set up your radios/designed the system/oversaw the project should have figured this in as part of the design. Having talk around capability to allow communications if the repeater fails is/should be common practice. This could easily be fixed by adding a button for talk around, or preferably, setting up a separate channel.
Sounds like the antenna system was originally designed for a wider area coverage. As PRC said, the upside down 1/4 wave or Yagi pointed downwards would likely be a cheap/easy solution. I've seen this same solution done for UHF radio coverage for the interior of ships. Upside down quarter wave ground plane antenna mounted near the top. They still provide pretty decent coverage locally around the antenna.
Leaky coax systems can work, but there's a lot of design that needs to go into it. I've never installed in a hospital, so there's probably a lot of funny code things I'm not aware of, but I can tell you that it would probably require plenum grade cable. Running down elevator shafts might trigger some code things you'd have to address. If it's an "emergency responder" type system as in used by fire, the BDA systems usually have to be hardened. Coax has to be in conduit, battery backup, fire/water rated enclosures, etc. None of those systems are cheap.
The antenna change is probably the right approach.
Either that, or start looking at WiFi based radio systems, either for your operations or for facilities. Most hospitals have pretty good WiFi networks that can be leveraged for these sorts of internal systems. For non-critial applications, it can be a cheaper solution. Also, IT tends to get better funding than the radio guys, so sometimes it's an easier way to approach it.