Healthcare by Design: Medical Office Buildings

HEALTHCARE BY DESIGN Medical Office Buildings

PREFACE In this evolving healthcare climate which relies increasingly on outpatient care, spaces designed for maximum efficiency, flexibility, and patient comfort are critical to project success.

The health care market encompasses diverse populations, and different practices will have very different needs; however, working within proven design parameters, we can tailor a Medical Office Building’s design to suit the needs of each tenant, and be comfortable and convenient for patients, while providing flexibility for future uses and changing medical technologies.

From the outset of the process, the MOB project team should be aware of a number of factors which will influence the design.

SITE SELECTION CRITERIA

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PLANNING CONSIDERATIONS

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BUILDING ORGANIZATION

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MECHANICAL | ELECTRICAL | PLUMBING | SYSTEMS

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COMPONENTS FOR CONSIDERATION 23 LS3P CASE STUDIES

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ABOUT LS3P

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Travel burden is a key element in conceptualizing geographic access to healthcare. A better understanding of distances and mode of travel for individuals seeking healthcare is particularly important.

The average distance traveled for medical/dental care was 10.2 miles, slightly less than the average trip to work at 12.4 miles in 2015.

Access to the site is critical for providing adequate care to individuals. Equally important is the visibility and street presence a MOB can play within the community. creating a billboard that states a particular brand identity can provide the owners a leg up on competitors.

SITE SELECTION CRITERIA A building’s site will have a major impact on its orientation, form, circulation, and other design decisions. Carefully consider the following elements regarding site selection: • proposed building type • land use information • site and building entry (pedestrian and vehicular) • current and future parking requirements • accommodations for mobile services • relationship to existing buildings (hospital or MOB’s) • physical or visual connection to other buildings • potential expansion to medical campus

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parameters site

functional organi zat ion

PLANNING BUBBLE DIAGRAMS

PLANNING CONSIDERATIONS During the earliest stages of programming and conceptual design, a number of important issues will need to be addressed: • site parameters and traffic flow • medical practice types and supporting clinical services • staff and patient flow • functional organization of primary program elements • check-in & check-out relationships • practitioner/exam room ratios The efficiency of the medical practice is largely influenced by staff, patient, and supply flow.

Diagramming the users’ needs at the beginning of a project will help eliminate inefficient or wasted space.

A

Grouping compatible Medical Practices can provide efficiencies of scale.

Shared space for Waiting, Reception/ Check-in, and Scheduling/Check-out can save space and reduce staffing for long term operational cost savings.

B Co-locating Clinical services that support the Medical Practices enhances the care model and provides convenience resulting in high customer satisfaction.

C

Health System based physician and outpatient services can create efficiencies by consolidating and sharing Billing, Scheduling, and Administrative support. Operational costs can be further reduced by locating these services in a more cost effective location.

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CORE DESIGN AND STAIR PLACEMENT

BUILDING ORGANIZATION A building’s form and layout will affect its efficiency and economy. Different strategies will perform better for different scenarios.

CORE DESIGN AND STAIR PLACEMENT The overall layout will need to accommodate ample space for core functions and stairs with required separation distance. Determine whether public restrooms will be included; MOB’s often have minimal public toilets per floor, since build-out of suites will satisfy code requirements. Also, carefully consider exiting requirements for various suite sizes. Possible configurations include: • Central core w/lease area wrapped around • Double loaded corridor w/ stairs @ ends • Double loaded corridor w/stairs at ends and additional central stair to allow flexibility for larger tenant occupying a half or full floor

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CORE RATIOS ELIMINATE PUBLIC CORRIDOR

TO ACCOMMODATE A

LARGER TENANT

EXTENSION CORRIDORS MAY BE REQUIRED FOR SMALLER SUITES

LARGE TENANTS 2/3

small tenants

MEDICAL PRACTICES

ASYMMETRICAL CORRIDOR LOCATIONS PROVIDE MORE FLEXIBILITY IN TENANT SUITE SIZES

1/3

SUPPORTING CLINICAL SERVICE

CENTRAL CORE PROVIDES A FUNCTIONAL SEPARATION BETWEEN MEDICAL OFFICES AND CLINICAL SUPPORT SUITES.

EFFICIENCY FACTORS Typical desirable shell and core ratios include 1.12, 1.15, and 1.20.

BUILDING DEPTHS + FLOOR PLATES: 100’-0” or 120’-0” x 200’-0” are typical floor plates that work well for an estimated 20,000 square foot MOB. Two-to-Three-story MOB’s are most common but there are many MOB’s that flex up or down from this statistic depending on hospital relationships, developer requirements, and tenant needs.

LEASING DEPTHS: Asymmetrical corridor locations provide more flexibility in tenant suite sizes. Common bay depths include: • 28’-0” bay depth for smaller tenants of 550 - 1,000 SF • 32’-0” bay depth for smaller tenants of 1,200 - 3,000 SF • 44’-0” bay depth for medium tenants of 1,800 - 4,000SF • 60’-0” bay depth for larger tenants of 4,000 - 10,000SF

12% 15% 20% 13

-0”

10’

-0”

10’

-0” 10’

3-BAY EXAM ROOM POD

STANDARDIZATION, FLEXIBILITY AND EXPANDABILITY Several “tried-and-true” planning modules have been proven to work effectively within the needs of most MOB tenant suites. Planning modules can be laid out such that each module footprint can be used for a variety of functions. For example, a 3-bay exam room pod may be transformed into a 2-bay exam room with a physician office or 1 exam room and one larger procedure room which include a toilet room.

Same handed exam rooms provide standardization, a benefit in suites shared by multiple providers. Attention must be paid to the window placement and mullion placement within curtain walls to accommodate these flexible tenant modules.

THE SAME EXAM ROOM SPACING LAYOUT CAN EASILY BE MODIFIED TO ACCOMMODATE OFFICES

tHE SAME EXAM ROOM SPACING LAYOUT

CAN EASILY BE MODIFIED TO ACCOMMODATE PROCEDURE ROOMS AND TOILET ROOMS

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10'-0"

12'-0"

10'-0"

12'-0" 9'-0"

12'-0"

9x12 10 x10 12x12

PLANNING MODULES

planning modules

floor to floor heights window spacing

PLANNING MODULES: Consider exam width in planning modules. A 9’-0” x 12’-0” clear exam room allows for a tight exam module. A 10’-0” x 10’-0” module provides an opportunity for the door to swing in towards the exam table, providing privacy for the patient. A 12’-0” x 12’-0” module allows for ample family waiting or a consultation table.

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2'-10" or 3’-0” 4"

3'-6" AFF

9'-0" 14'-0"

4'-0"

WINDOW HEIGHT + SPACING: Planning modules sizes will also affect the window placement or mullion placement locations.

• Window sills +/- 42” above finished floor: maintains privacy and allows cabinetry to pass beneath windows • Multiple vertical mullions in larger openingsprovides flexibility in partition placement

FLOOR TO FLOOR HEIGHTS: MOB’s can have extensive above-ceiling requirements for structure, ductwork, piping, lighting, equipment supports, and data cabling. A larger-than-average floor-to-floor height is recommended.

• 14’-0” floor-to-floor is the minimum, higher is better for future flexibility • 9’-0” ceiling heights are typical for exam rooms • 9’-0” to 10’-0” ceiling heights are needed for specialty spaces such as Radiology, Ambulatory Surgery, Physical Therapy, etc.

• Additional height is helpful in corridors & lobby/waiting areas for ceiling features such as soffits over reception counters and nurses’ stations which create good wayfinding features

HEIGHT REQUIREMENTS

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BUILDING INFORMATION MODELING (BIM) ALLOWS INTEGRATION BETWEEN ARCHITECTURAL, ENGINEERING, AND CONSTRUCTION TEAMS PROVIDING CONSISTENT, COORDINATED, AND MORE ACCURATE BUILDINGS BEFORE THEY ARE BUILT.

MECHANICAL | ELECTRICAL | PLUMBING | SYSTEMS MEP systems are important in any facility; in MOB’s, these systems can be critical to patient safety. The following design elements must be addressed.

MECHANICAL CONSIDERATIONS Rooftop packages with VAV units are preferred within suites. Each floor must provide adequate space for mechanical needs. Often, mechanical shafts are located at column locations and at the building core to allow flexibility within the suites to accommodate multiple tenant needs. Mechanical shafts should be sized early in the design process. Certain specialty rooms require additional cooling to offset the equipment heating loads. Liebert units are often used for CT Scan and MRI rooms to offset the special heat loads. Plan for adequate ventilation and exhaust in restrooms, dark rooms, cast rooms, and other special areas with equipment such as laboratory, pharmacy, procedure and surgical rooms.

PLUMBING CONSIDERATIONS Available water quality and pressure impact HVAC, plumbing and fire protection systems design. Wet column locations, water metering and toilet locations affect cost and flexibility.

ELECTRICAL CONSIDERATIONS Metering provisions requirements will vary according to building-wide vs. individual tenants. Additionally, careful consideration for standard lighting requirements for the general public and administrative areas vs. specialty areas must be taken into account.

If the MOB requires emergency power an emergency generator may be necessary.

SYSTEMS CONSIDERATIONS Individual data closets are often required within tenant suites. A building data closet should also be provided. Nurse call and patient tracking may be required within suites. Security considerations must be taken into account building wide as well as within each tenant suite.

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COMPONENTS FOR CONSIDERATION FURNITURE, FIXTURES, & EQUIPMENT • Lobby furnishings, reception desk, check-in kiosks, vending machines, artwork and window treatments • Tenant furnishings, demountable partitions, exam room equipment, charting stations, lockers and marker boards.

MEDICAL EQUIPMENT & COMMUNICATION SYSTEMS • Data/telecommunication wiring and equipment • Telephone equipment • Security system for tenant spaces (beyond base building system) • Computer equipment (health information system) • Location for imaging equipment and structural implications

SPECIAL MECHANICAL AND ELECTRICAL SYSTEMS • Supplemental cooling for computer rooms • Mechanical humidification during heating cycles • Distribution or hook-up of tenant equipment • Tenant power in excess of 6.5 watts/SF (power and lighting) • UPS for computers and/or selected outlets • Computer panels and/or equipment • Exhaust fans for lab and pharmacy equipment

BUILDING SHELL, MISCELLANEOUS • Window washing equipment • Manned security station • Roof top access criteria • Food service equipment • Monumental signs • Removal of unsuitable soil • Removal of underground obstructions man made or natural

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CASE STUDY NEW HANOVER REGIONAL MEDICAL CENTER CARDIOLOGY CENTER The new Cardiology Center for NHRMC consolidates multiple offices and departments to provide improved outpatient services. This 3-story, 63,000 SF medical office building is sited on hospital-owned land near the main NHRMC campus. The new location is more convenient for users and helps decrease congestion on the main campus. The ground floor of the new facility consolidates three existing medical practice facilities into one clinical space.

Upper floors provide space for cardiac imaging (stress testing, nuclear imaging, etc.), a pacemaker lab, office space, and a full cardiac rehab area with walking track, education counseling rooms, central registration, and education spaces.

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CASE STUDY MUSC CHILDREN’S R. KEITH SUMMEY MEDICAL PAVILION The concept of patient-centered care drove the entire design process for this 98,000 SF pediatric ambulatory center, informing decisions from site selection through the final finishes. This bright, welcoming facility reduces the stress associated with a clinical visit while paving the way for new models of healthcare delivery.

LS3P led the administration and various user groups through an extensive programming and conceptual design process. Flexible, multifunctional spaces were a primary design goal. Strategies included induction rooms outside of the operating room to maximize throughput while reducing stress for patients by allowing families to bypass the gowning and gloving process to stay together until the procedure begins. An orthopedic clinic transitions to an urgent care in the evening, while standardized exam pods allow rotating teams of specialists to rotate through the clinic for flexible scheduling.

MUSC NORTH CHARLESTON PEDIATRIC MOB AND IMAGING

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CASE STUDY DUKE HEALTH PRIVATE DIAGNOSTIC CLINIC MOB AT CROOKED CREEK This 5-story, 125,000 SF medical office building houses diverse practices for one of the largest physician’s practice groups in the country. Located on a high-visibility site with easy access to the interstate, this new facility serves as a marquee building for its owners.

The design focuses on a welcoming patient experience, with parking deck, covered walkway to the entry, carefully considered circulation, and a rear entrance for ambulances and staff.

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CASE STUDY EAST COOPER MEDICAL OFFICE BUILDING LS3P was commissioned by East Cooper Medical Center to build a new medical office building in Mount Pleasant, SC. The two story, 42,000 SF medical office building sits adjacent to the East Cooper Medical Center on their 55 acre campus. It includes physican practices focusing on women’s services, orthopedic services, outpatient physical therapy and laboratory services.

The design features a prominent curved facade which addresses and responds to the traffic circle at the corner approach, and includes a large parking area with dedicated drop off behind the building. The site is adjacent to the main hospital’s garden space with easy access to dining area and other support services. Materials are complimentary and take cues from the main hospital (brick, metal and simulated stucco).

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TENET HEALTHCARE CORPORATION

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 ECMC MEDICAL OFFICE BUILDING

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W LKR ROOM 176 SF

3054 SF

TLT 50 SF

TREATMENT 85 SF

PARALLEL BARS

GYM 1056 SF STEPPER

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PRO2

TENANT 1

102

TREADMILL

VEST

LOBBY

SCIFIT 7000

DUMBBELL RACK

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TLT 50 SF

TREATMENT 85 SF

CABLE CROSS

TREATMENT 82 SF

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106

ELEV 1-1 E1-1

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ELEC

TLT 49 SF

TENANT 3 118

JANITOR 45 SF

ELEV 1-2

DATA

E1-2

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STAFF TLT/SHWR 78 SF

STAFF OFFICE 119 SF

OFFICE 85 SF

WAITING 128 SF

MENS

108

BREAKROOM 137 SF WAITING 168 SF

RECEPTION 94 SF

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507 SF

C

HAND WASHING STATION

WATER COOLER

2763 SF

BLOOD DRAW 121 SF

RECEPTION TENANT 2 76 SF

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REX

M LKR ROOM 169 SF

6456 SF ?

STORAGE 36 SF

WOMENS

REF.

JAN

R. BIKE

TENANT SPACE

ELEV EQUIP

ABD/ADD

MIRROR WALL

205 1/2 KING ST. CHARLESTON SC 29401 TEL. 842.577.4444 FAX 843.722.4789 WWW.LS3P.COM

WATER

MAIL/ RECY

113

114

15'-8 1/2"

CORRIDOR 111

STAIR 1-2 ST1-2

STAIR 1-1

RECEPTION/ ADMIN 310 SF

ST1-1

TECH 133 SF

X-RAY 1 189 SF

WAITING 818 SF

X-RAY 2 196 SF

STORAGE

OFFICE MANAGER 93 SF

SCHEDULER 78 SF SHARED EXAM 2 129 SF

B POD 1 EXAM 1 125 SF

X-RAY WAITING 225 SF

CLEAN UTILITY 62 SF STAFF OFFICE 57 SF

SOILED UTILITY 67 SF

STOR. 57 SF

ST. TLT 69 SF

STORAGE 124 SF

NURSE 94 SF

SHARED EXAM 1 124 SF

STORAGE 45 SF

STORAGE 41 SF SHARED EXAM 3 124 SF

SHARED CAST 2 124 SF

119 1771 SF

PT. TLT. 53 SF DUMBBELL RACK

POD 2 EXAM 2 134 SF

POD 2 EXAM 3 134 SF

POD 2 EXAM 4 129 SF

POD 2 OFFICE 134 SF

POD 3 OFFICE 134 SF

POD 3 EXAM 2 129 SF

POD 3 EXAM 3 134 SF

POD 3 EXAM 4 135 SF

SC IF IT

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PR O2

PROJECT:

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T-1

Date 09/27/2013

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POD 2 EXAM 1 129 SF

Description Revision 1

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POD 1 OFFICE 2 129 SF

REVISIONS: No. 1

D EA

POD 1 OFFICE 1 144 SF

MIRROR WALL

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POD 1 EXAM 4 151 SF

M-1

IN ANY FORM WITHOUT WRITTEN PERMISSION

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F-4

DOCUMENTATION MAY NOT BE REPRODUCED FROM LS3P ASSOCIATES LTD.

BIK U.

JAN. 48 SF STORAGE 42 SF

ALL RIGHTS RESERVED

PRINTED OR ELECTRONIC DRAWINGS AND

LEG PRESS

R PE EP ST

NURSE 98 SF

TLT 53 SF

TENANT 4

NURSE 96 SF

POD 3 EXAM 1 124 SF

PT. TLT. 52 SF

F-2 POD 1 EXAM 3 131 SF

MEMBERS OF THE AMERICAN INSTITUTE OF ARCHITECTS

COPYRIGHT 2013

120 8755 SF

SHARED CAST 1 124 SF

POD 1 EXAM 2 125 SF

F-3

TREATMENT 80 SF

TENANT 5

H LEGEND

F-1

TREATMENT 88 SF

GYM 1135 SF

TLT 56 SF

LEG CURL

BREAKROOM 268 SF

1401-133770

DATE:

September 27, 2013

DRAWN BY:

DS

CHECKED BY: BS

First Floor Finishes & Upfits

S-2

1

1 1

A-721a

FIRST FLOOR PLAN 1/8" = 1'-0"

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EAST COOPER MEDICAL OFFICE BUILDING

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CONSTRUCTION DOCUMENTS - REVISION 1

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CASE STUDY ROPER MOUNT PLEASANT MEDICAL OFFICE BUILDING This medical office accommodates physicians and services to support the adjacent 80-bed Roper St. Francis hospital.

The 3-story office building houses hospital administration and a women’s imaging center and connects to the hospital with a bridge accessible from the first and second floor. The design features a drop-off patient and visitor canopy, lobby, 2 patient transport elevators, public restrooms, and support areas. The interior design is consistent with that of the hospital, offering a seamless entry into the hospital via the connector bridge.

The office building and hospital share an active courtyard. The curved design of the exterior reflects the curve of the hospital, and includes space for first-floor retail.

ROPER MOUNT PLEASANT MEDICAL OFFICE BUILDING

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CASE STUDY UNC HEALTH CARE PANTHER CREEK MOB & AMBULATORY SURGERY CENTER LS3P provided master planning, architectural, interior design and engineering services for this multispecialty 99,900 SF medical office building and orthopaedic surgery center. The facility provides clinical space for family medicine, pediatrics, OB/GYN, orthopedics, internal medicine, nuclear medicine, neurology, digestive health, and heart and vascular care.

Clinics on the upper floors provide services in a collaborative model with centralized patient check-in and staff support spaces. Clinic layouts are based on Lean design principles, with dual-entry exam rooms and care team work areas separated from patient areas. The facility also includes an imaging center which offers CT, MRI, mammography, ultrasound, bone densitometry, and X-ray.

The Orthopaedic Surgery Center of Panther Creek, a joint venture between a large hospital system and a leading private orthopedic practice group, includes one operating room and two procedure rooms, 13 universal prep/recovery rooms, and a dedicated sterile processing department in a footprint designed to accommodate expansion.

This complex project was completed within a 16-month construction period using concrete tilt-up construction.

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LS3P is a dedicated, talented, knowledgeable, and passionate team of professionals working toward a common vision to create something special for every client. We customize each project process to meet its specific vision and desired outcomes.

Our role is to lead and inform that process to achieve a SPECIFIC, more holistic result. Expertise, creativity, understanding, empathy, integrity, and trust provide the foundation for bringing success to our clients and their projects.

Richmond Roanoke e

Winston Salem ns

Durham Greensboro o

RALEIGH Asheville

CH CHARLOTTE OTT TTTTEE GREENVILLE WILMINGTON MI CO COLUMBIA A MYRTLE LE BEACH

Atlanta a

CHARLESTON C LEESTON

SAVANNAH NAH

We are passionate about the process of discovery, from the earliest stages of design through project delivery. We engage with our clients in order to address the unique needs, constraints, and opportunities of each project. We observe, listen, and ask questions. We want to understand your work flow, user groups, project goals, budget, and business model.

We want you to enjoy the process.

We respond to the discovery process by using our tool kit of strategies to generate design options.

We use evidencebased design. Our extensive hands-on knowledge of effective solutions, a series of simulations, and state-of-theart technology to create the best design for your needs.

We want to streamline your operational and functional capacities, improve your bottom line, and allow you to see more patients per hour. We want to provide spaces which facilitate healing, and support physicians, staff, patients and visitors on the path to recovery and wellness.

We want to help transform your practice.

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