Regulatory pressures, economic constraints, and emerging technologies are transforming healthcare. Learn how Building Teams are responding with efficient, appealing, boundary-blurring buildings.
4. The new MOBs are leaner.
The pervasive influence of “lean” thinking in medicine—to reduce waste, improve productivity, and achieve the best clinical outcomes—is flowing over to AEC firms, both in the buildings they create and in their delivery methods.
For instance, some outpatient facilities are providing the equivalent of a hoteling situation, with little or no private space for individual physicians, according to Steffian Bradley’s Wilson. “All the dollars are concentrated on the clinical space,” she says. “If the organization discovers that this is the most efficient use of doctors’ time, they can potentially see more patients and make more profit.”
Indicative of a growing focus on community-based care, the ACCESS Ashland Family Health Center serves Chicago’s South Side. ACCESS Community Health Network worked with RK Development, D+K Architects, and Fraton Construction on the 10,200-sf facility, which has 15 exam rooms, a living-room-like consultation space (also used for behavioral health), a lab, and an immunization room, plus a community room provided as a neighborhood service. Opaque architectural panels, alternating with IGUs treated with colored films, create a façade that balances the need for daylighting with privacy and security concerns. PHOTO: JACOB CLARY
Wilson says lean is part of the reason providers are starting to embrace shared medical appointments. Lean is also spawning models where patients stay in one space and specialists rotate to see them during a longer appointment, rather than making the patient bounce through multiple offices and facilities.
Another product of lean thinking is the facility template, whereby a healthcare organization crystallizes its best ideas in a design that can be replicated, customized, and scaled. SmithGroupJJR has created such a template for Phoenix-based Banner Health, with the group’s Maricopa, Ariz., clinic as the first built example. The prototype incorporates four basic models—Entry, Neighborhood, Community, and Regional—ranging from 18,000 to 105,000 sf.
“Templating is a highly iterative design approach and allows owners to build multiple facilities that are identical in planning concept yet adaptable to different locations,” says Lyle K. Steely IV, AIA, LEED AP BD+C, Associate and Design Architect at SmithGroupJJR. “It not only helps reduce the cost and time of design and construction, and thus speed to market, but also helps provide a universal standard of care among an organization’s facilities.”
5. The new MOBs are more digital.
While many physicians are struggling to master new electronic medical records systems, patients, too, will need to adapt to streamlined methods for organizing visits, with important implications for floor plans and communications infrastructure.
“Maximizing the available floor area for the patient/provider encounter means shrinking the spaces that don’t generate revenue,” says J. Andrew Jarvis, AIA, LEED AP, Healthcare Practice Director in EwingCole’s New York City office (ewingcole.com). “To reduce waiting room size, for example, we are now using new technologies such as self-service check-in kiosks, patient-location tracking systems, exam room occupancy sensors, and just-in-time scheduling to reduce or eliminate the wait. These strategies not only save floor area but also improve patient satisfaction.”
Providers that offer shared medical appointments need rich A/V technology so off-site specialists can be part of the session mix, says Margulies Perruzzi’s Cardoso. Ware Malcomb’s Petersen predicts that telepresence, cloud computing, and artificial intelligence will eventually revolutionize care—reshaping buildings and eliminating some site visits altogether.
Steffian Bradley’s Waltz agrees. “You won’t need so much parking. You won’t need registration. It could end up being simple as Skype with your physician. The problem is the billing and reimbursement catching up. But I think it’s definitely coming.”
6. The new MOBs are more aesthetically appealing.
In their fight for market share, healthcare providers are striving to improve the stereotypical image of the MOB. “The competitive environment has fueled the already popular patient- and family-friendly feel that clients are striving for,” says Francis Cauffman’s Gow. “Consumerism is king,” she says, and with women making most healthcare decisions for the family, institutions are choosing materials and finishes that create a spa- or hotel-like feel.
Jason Harper, AIA, LEED AP, Associate Principal, Healthcare, at Perkins+Will New York (www.perkinswill.com), says the Affordable Care Act will give many patients new healthcare choices, and providers want to make sure their facilities are a long-term draw. “Healthcare is increasingly being delivered in branded, retail-like outpatient centers that are geared toward a relatively fickle customer who needs ongoing care due to one or more chronic conditions.”
The desire to create a pleasant facility, as well as an effective one, is evident in Kaiser Permanente’s Antelope Valley Medical Offices, under construction in Lancaster, Calif. With a Building Team including architect/interior designer TAYLOR and contractor McCarthy Building Companies, the facility encompasses 137,000 sf, including 94 exam rooms and offices for 66 specialty physicians. Indoor and outdoor common spaces, a healing garden, and amenities such as an open-concept café are intended to serve both staff and patients. Poppies and butterflies, native to the mountain locale, are a prominent design theme.
Some adaptive-reuse jobs, such as the 55,000-sf outpatient center that Environetics recently created for Lourdes Health System in Cherry Hill, N.J., also reflect owners’ concern for curb appeal. Built in a former supermarket, the LourdesCare site features an expansive glass storefront, offering views into nicely furnished spaces combining wood and natural stone walls.
7. The new MOBs are greener.
Concerns about sustainability and life cycle costs have been extended from the hospital to the outpatient facility, especially as primary care moves from low-tech office environments to more resource-intensive buildings.
“The greening of MOBs is a trend, with requirements for new items from bike lockers, showers, and electric-vehicle charging stations to super-efficient HVAC systems to reduce energy consumption,” says Bill Foulkes, Vice President and Regional Manager with healthcare consultant Hammes Company (www.hammesco.com).
ColumbiaDoctors Midtown, designed by Perkins+Will for Columbia University Medical Center, is a new outpatient facility in central Manhattan, supporting 225 doctors, dentists, and nurse practitioners. Designed to draw urban professionals, the project, which renovated an existing nonmedical office building (in itself a highly sustainable strategy), achieved LEED Gold. Kaiser Permanente’s Antelope Valley building is shooting for both net-zero and LEED Platinum.
Reducing travel—and, presumably, greenhouse gas emissions—is a less heralded but potentially significant sustainability benefit of placing healthcare facilities closer to patients’ homes and workplaces.
There’s plenty of debate about the best ways to deliver outpatient services in a brave new regulatory world. But experts all agree on one point: the MOB will change. To remain competitive, Building Teams will need to do deep research on healthcare trends, and engage in frank discussions with their clients.
“It is paramount that we understand our clients’ business models so we can successfully design and build facilities that serve their needs and fit their brand,” says Angeles Garcia-Tapia, Project Director, McCarthy Building Companies (www.mccarthy.com). “Healthcare demand, cost, and efficiencies are going to drive the new standard of services for MOB construction and renovation.”