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SHOWCASE 3

Vanderbilt University Medical Center

ONe Hundred Oaks

An aging, dying mall is repurposed into a visitor-friendly, mixed-use medical center and retail destination. Originally built in 1968, Nashville’s One Hundred Oaks Mall was in serious decline and threatening to become another casualty of suburban blight. GS&P became the glue in a serendipitous relationship between Vanderbilt Health and the developers to save the outmoded facility. With a reimagined 450,000-square-foot second floor and office tower, dignified exterior and interior, and reconfigured traffic circulation and parking, the facility is wholly rejuvenated and brings convenient top-tier medical care to Nashville suburbs.


Vanderbilt u niversity m edical center One hu ndred Oaks Redevelopm ent I N T E RVI E W /

J e f f K u hnhenn , S teve verner , E ric B ear d en , J e f f er y m orris

How did Vanderbilt University Medical Center come to take up residence in a mall?

Jeff: We were originally engaged by the developer that purchased the property to help brainstorm tenant and renovation options. This lead to an entire site master planning overhaul, which was an effort to understand how we could reimagine the site, not just in the short term, but for the long term as well. Somewhere along this exploration, Vanderbilt’s interests intersected with that of the developers. Vanderbilt’s issue was they had all of their outpatient clinics in their medical center located on their main hospital campus, which is an extremely dense, crowded area near midtown Nashville. They needed to work on a plan for growth and development, but they did not know how or where to start. They just knew they needed more space. Steve: Vanderbilt really targeted what clinics were appropriate to get out of the academic hospital, and those clinics focused on specialties that were more about wellness and less about being sick. And while this project was about growth and development, it was also a chance to reach out to the community, make Vanderbilt medical services more accessible to the public, and make the new location staffand patient-friendly.

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So, how do you turn 450,000 square feet of mall into multiple, patient-friendly health clinics?

Jeffery: One of the fundamental ideas that we talked about with Vanderbilt was the concept of hoteling—creating spaces that can expand almost indefinitely to the boundaries of the mall. They asked us to help design a process for the patients that was much more userfriendly than what was typical on the current campus. We asked ourselves, “How can we reinforce the hoteling concept, but also reinforce the ease-of-access that this mall was able to give Vanderbilt?” How did those ideas translate into improving the patient experience?

Jeffery: The final design was a very logical progression from public to private with the central mall space creating a very public, recognizable wayfinding element orienting all patients to their respective clinics. All clinics adopted a standardized delivery-of-care model that progresses from the pre-exam/patient-intake room to the exam room. What other ways did the building respond to this progression from public to private?

Jeff: The exterior wall was reserved for physician offices and team/resident work

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judges' comments

Brilliant reinvention of a worn out space g resha m, s mith an d partners

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All clinics share access to on-site lab and diagnostic equipment instead of having to depend on Vanderbilt’s downtown campus, thus improving efficiency and reducing costs.

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areas. We were fortunate both sides of the mall had the depth to facilitate the public to private progression without compromising the side-to-side relations between clinics. Can you explain the scalability and standardization of the clinics?

Jeffery: Scalability and standardization are two of the 12 basic design principles we use to reduce preventable medical error in the facilities we design. Scalability is the ability to expand or remodel easily so latent conditions are not designed into future expansions. Standardization allows for the potential to adapt space for a different or evolving service, preventing latent conditions from being created. Standardization also reduces reliance on short-term memory. Non-standard environments and non-standard processes require constant mental evaluation which increases the opportunity for distraction and decision-making errors. All of these principles help reinforce the original idea of hoteling. Now they have a space where little, if any, new construction is necessary when a clinic expands or contracts in size from side-to-side. Space left over is easily given to the clinic next door.

Ultimately, we were able to take many of the fundamental ideas that are very important to the delivery of quality healthcare—patient safety, process mapping, standardization, sustainability—and synthesize those into a very clear and user-friendly model. What technical innovations improved the visitor experience?

Steve: Vanderbilt was also open to new technologies. They have wireless internet access inside and a pager system where you can walk around and do not have to sit right in front of your clinic and stay in a waiting space. You can move around and the pager calls you back. It is perfect for a mixed-use facility. You also have a check-in kiosk rather than waiting for a person to become available, much like a boarding pass kiosk at an airport. It is as paperless as you can get for a medical process. Jeff: It is well-suited, too, for the future of electronic medical records and the transferability of those over time. How have you improved the exterior atmosphere of the site?

Jeff: The old main, central entry space was very dated and had a retail feel. We wanted to turn it into a dignified judges' comments

Bold move and highly innovative g resha m, s mith an d partners

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institutional space; a space that would inspire confidence in the people arriving and give them a sense of, “I am here to be taken care of, and this place is a permanent place that has the knowledge, education, equipment and tools to take care of me.” What were your goals for the interior spaces?

Jeff: We wanted to create spaces that said, “I am not in a hallway; I am in a waiting area. I am sitting in a waiting room. There are not people who are going to step on my toes walking by me to get to the next place. I have got my own area, there is the front desk for my clinic and my doctor.” What we were able to develop was a design that supported that goal: a long, unified corridor transformed into a series of distinct moments that deliver a sense of arrival over and over and over again. We created changes in scale that allow people who need to pass through the area to do it efficiently and confidently, and other people who have reached their destination to feel that they are at a final destination. Along with the successful redesign of the exterior and entrances into the building, this was a key outcome that we achieved. I am amazed sometimes that we actually did it.

Eric: There is also a stigma of stress that goes with being in a clinic, and I do not think this space has that stigma at all. You do not feel that uneasiness. It is an inviting and comfortable space. The volumes and the light, the textures and the colors, everything makes you at ease. You do not feel like you are in a doctor’s office. What helps these clinics thrive in a non-typical medical campus?

Steve: For one, there is a great deal of connectivity between the clinics and the resources they share. There is a lot of infrastructure, such as information technology, conference rooms, lockers and lounges that are shared between departments. Jeffery: Vanderbilt’s desire was to make this a freestanding facility without having to rely on functions supplied from the main campus. Dedicated service lines such as central sterile/supply, an outpatient pharmacy and a central lab all support One Hundred Oaks as a standalone medical destination. Steve: Vanderbilt wanted to bring the full measure of academics to the new campus, including medical students and resident education, and clinical research. It is built to be the full measure of a Vanderbilt experience.

judges' comments

Rejuvenated the neighborhood showcase 3

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More than 100 Oak trees were planted on the site. An aim of the design was to reimagine the development so that it was closer to its original namesake. Nashville bus routes and Vanderbilt campus shuttles easily connect patients and employees to public transportation. By avoiding wholesale demolition in favor of reusing the existing structure, the useful life of the property is significantly extended. The project’s innovative and sustainable rehabilitation approach also strengthens a strategically located but under utilized area of Nashville, enhancing the economic vitality of the area. g resha m, s mith an d partners

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Amenities not normally found in an outpatient clinic setting match those found on Vanderbilt’s main campus, including diagnostic equipment, physical therapy spaces, and food for patients and families.

Kiosks allow patients to check-in, review medical records, make copayments and schedule appointments.

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There are retail tenants on the first floor. Was that a challenge during construction?

Eric: It was an extreme challenge to try to keep the retail tenants below in operation during the construction. For example, even during the construction of the new skin, demolishing the exterior masonry veneer in order to build the new façade while you have public entering and exiting the retail stores was a feat in itself. Routing new plumbing lines above the retail ceilings had to be implemented after hours under the supervision of retail staff. Much of the construction happened around their busiest seasons—some of it was Christmas and summertime. Coordinating with the contractor and the developer, and the developer coordinating with the existing tenants, and then providing public access was an extreme challenge. Renovating the parking and circulation was also a large part of the project, correct?

Eric: The parking was a pretty big challenge. Existing parking was stripped, new islands and lanes were put in, and everyone navigated the changes well. It was organized thoughtfully, even though it was a large undertaking. Jeff: Before renovation, there were multiple one-way ramps and merges that came off of the road and into the site. The design created an enormous amount of circulation that was inefficient and

confusing, even dangerous. We simplified the circulation, created more clearly defined access points, and added a traffic signal. We recaptured a lot of the space that had been devoted to the ramps and used it to create rain gardens and green space. This also allowed more efficient parking, which contributed to the additional outparcels and thereby improved the density of the space. And retailers like restaurant outparcels because they increase the number of different people that will visit the site. Steve: And I think an added benefit was that it created a clearer hierarchy to the site, which is something good for Vanderbilt’s patients and its patient care delivery. An easy-to-navigate site helps avoid some of the stress that comes with going to the doctor through these clinics. Giving hierarchy to the site, providing clear wayfinding, and designating the closest entrance to your clinic helped diminish patient anxiety. What were your drivers to restore some of the green spaces to the campus?

Steve: The property was originally developed as a log cabin or a plantation area. There were 98 Oaks, and the woman that lived there planted two acorns and called it One Hundred Oaks. Through this redevelopment we have been able to return it to 100-plus Oaks, not including the additional landscape.

Enlarged skylights add abundant reflected natural light in the waiting areas. Use of skylights, lighting occupancy censors, and task lighting aid in reducing energy consumption below ASHRAE 90.1 baseline performance. g resha m, s mith an d partners

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Jeff: There is a whole lot of pavement out there, and by code you are required to do something to mitigate that. We were updating a 40-year-old-plus site master plan, which undoubtedly had less strenuous requirements by code back when it was originally done. And consider the name of the site—One Hundred Oaks. Its very name connotes greenness and life, and what existed was a big asphalt field. So the rain gardens and the associated green spaces were excellent ways to achieve the twin aims of satisfying the code requirements for dealing with stormwater runoff as well as reconnecting the site so that it was closer to its original namesake. The very liveliness and planting of the site hopefully has a clear relationship to this idea of preventative medicine, wellness and promoting active lifestyles. This seems to be a natural fit for revitalizing dying spaces. How has the project been received?

Eric: Both Vanderbilt and GS&P have experienced tremendous amounts of interest from this project for other sites, both in Nashville and beyond. So being able to reuse an existing facility is probably the biggest success I see. Steve: While attending a national conference of mayors, Nashville’s Mayor Karl Dean participated with other mayors in a discussion about what to do with dead

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and dying malls. The mayor said he was proud to share Nashville’s One Hundred Oaks project as a successful case study for this national issue. His story reaffirmed how this project transcended its scope. It not only revived its immediate site and community, but in a broader sense, reinvigorated an area that had become discounted by most Nashvillians. Reflecting back on all that we accomplished, I think I am most proud that the project became larger than itself. Jeff: There are hundreds, if not thousands, of dying mall sites across the country that are just like this. These sites are typically viewed as blighted, but they are in fact great untapped resources. They were developed to have excellent vehicular access, but usually never came close to realizing the floor area potential to match the access potential. Over time, neighborhoods and other developments overtook them, so today they are surrounded by residential, office and other business. But because they are so underdeveloped they are seen as barriers or great asphalt deserts. Properly redeveloped, they could really become agents for creating connectivity and foster much more enjoyable and sustainable communities. To be involved in a project that very successfully reimagines one of those sites in a way that is not just simply of value to the site by itself, but also creates a real hub of energy and potential for a whole neighborhood, is a really gratifying part of this project for me.

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BEFORE


judges' comments

Not just doing design, but solving a problem for a client, a site and a city. g resha m, s mith an d partners

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Vanderbilt University m edical center one hu ndred Oaks Redevelopm ent Nashville, Tennessee Architecture Civil engineering Interior design Landscape architecture TEAM Princi pa l - in - char g e

Steven P. Johnson, AIA

p roject Mana g er

Ann Seton Trent, AIA, NCARB, LEED AP

p roject A rchitect

Eric Bearden, AIA Steve Verner, Associate AIA, EDAC

p roject C oor d inator

David N. Zegley, LEED AP

p roject Desi g ner

Jeffrey W. Kuhnhenn, AIA, LEED AP

Me d ica l P l anner

Jeffery E. Morris, AIA, NCARB, EDAC, LEED AP

I N T E R IO R D E SIG N E R

Julia A. Boren, Assoc. AIA, LEED AP

www.gspnet.com ARCHITECTURE

ENGINEERING

INTERIORS

PLANNING

Gresham, Smith and Partners provides design and consulting solutions for the built environment that contribute to the success of national and international clients. For more than 40 years, GS&P has focused on enhancing quality of life and sustainability within communities. GS&P consists of industry-leading professionals practicing architecture and engineering design as well as scientists and highly specialized planning and strategic consultants in Aviation, Corporate and Urban Design, Environmental Compliance, Healthcare, Industrial, Land Planning, Transportation and Water Services. GS&P consistently ranks among the top architecture and engineering firms in the United States. For more information regarding GS&P, visit www.gspnet.com.


Vanderbilt Univeristy Medical Center One Hundred Oaks