Healthcare by Design: Medical Office Buildings

HEALTHCARE BY DESIGN MEDICAL OFFICE BUILDINGS

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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 and staff, while providing flexibility for future uses and changing medical technologies.

From the outset of the process, our Healthcare Design team is aware of a number of factors which will influence the design.

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HEALTHCARE BY DESIGN

THE MEDICAL HOME

Our current healthcare landscape will continue to rely on outpatient care to streamline service delivery for providers and support the best possible experience for patients. Strategies to optimize the clinical environment yield lower facilities and operational costs, a more relaxed and collaborative staff, and a better patient experience.

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TABLE OF CONTENTS 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

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LS3P Case Studies

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About LS3P

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SITE SELECTION CRITERIA Site Parameters | Figure A 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

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land use information

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site and building entry (pedestrian and vehicular)

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current and future parking requirements

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accommodations for mobile services

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relationship to existing buildings (hospital or MOB’s)

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physical or visual connection to other buildings

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potential expansion to medical campus

Travel Distances | Figure B

Visibility | Figure C

Travel burden is a key element in conceptualizing

Access to the site is critical for providing adequate

geographic access to healthcare. A better

care to individuals. Equally important is the

understanding of distances and mode of travel

visibility and street presence an MOB can play

for individuals seeking healthcare is particularly

within the community. Creating a billboard that

important.

states a particular brand identity can provide with a

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.

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competitive advantage.

Figure A

Figure B

Figure C 7

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

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medical practice types and supporting clinical services

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staff and patient flow

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functional organization of primary program elements

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check-in & check-out relationships

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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.

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Administration Patient / Public Exam Pods Clinical Support Building Support

Grouping compatible Medical

Co-locating Clinical services

Health System based physician

Practices can provide

that support the Medical

and outpatient services

efficiencies of scale. Shared

Practices enhances the

can create efficiencies by

space for Waiting, Reception/

care model and provides

consolidating and sharing

Check-in, and Scheduling/

convenience resulting in high

Billing, Scheduling, and

Check-out can save space and

customer satisfaction.

Administrative support.

reduce staffing for long term

Operational costs can be further

operational cost savings.

reduced by locating these services in a more cost effective location.

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

Core Design & Stair Placement The overall layout will need to accommodate ample space for core functions and stairs with required separation distance. Determining whether public restrooms will be included should come early in the planning process; 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

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Double loaded corridor w/ stairs @ ends

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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 Efficiency Factors

12%

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

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well for an estimated 20,000 square foot MOB. Two-toThree-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:

20%

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28’-0” bay depth for smaller tenants of 550 - 1,000 SF

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32’-0” bay depth for smaller tenants of 1,200 - 3,000 SF

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44’-0” bay depth for medium tenants of 1,800 - 4,000SF

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60’-0” bay depth for larger tenants of 4,000 - 10,000SF

Eliminate public corridor to accommodate a larger tenant

Extension corridors may be required for small suites

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Large Tenants

Asymmetrical corridor locations provide more flexibility in tenant

Small Tenants

Medical Practices

suite sizes

1/3

Supporting Clinical Service

Central core provides a functional separation between medical offices and clinical support suites.

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STANDARDIZATION, FLEXIBILITY & 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.

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3-Bay Exam Room Pod

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 15

9 x 12

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10 x 10

12 x 12

PLANNING MODULES 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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Floor to Floor Heights

Window Height + Spacing

MOB’s can have extensive above-ceiling

Planning modules sizes will also affect the window

requirements for structure, ductwork, piping,

placement or mullion placement locations.

lighting, equipment supports, and data cabling.

A larger-than-average floor-to-floor height is

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maintains privacy and allows cabinetry to

recommended.

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14’-0” floor-to-floor is the minimum, higher is better for future flexibility

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Window sills +/- 42” above finished floor: pass beneath windows

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Multiple vertical mullions in larger openingsprovides flexibility in partition placement

9’-0” ceiling heights are typical for exam rooms

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9’-0” to 10’-0” ceiling heights are needed for specialty spaces such as Radiology, Ambulatory Surgery, Physical Therapy, etc.

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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

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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

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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

Plumbing Considerations

Rooftop packages with VAV units are preferred

Available water quality and pressure impact HVAC,

within suites. Each floor must provide adequate

plumbing and fire protection systems design.

space for mechanical needs. Often, mechanical

Wet column locations, water metering and toilet

shafts are located at column locations and at the

locations affect cost and flexibility.

building core to allow flexibility within the suites to accommodate multiple tenant needs. Mechanical shafts should be sized early in the design process.

Electrical Considerations

Certain specialty rooms require additional cooling to offset the equipment heating loads. Liebert units

Metering provisions requirements will vary

are often used for CT Scan and MRI rooms to offset

according to building-wide vs. individual tenants.

the special heat loads. Plan for adequate ventilation

Additionally, careful consideration for standard

and exhaust in restrooms, dark rooms, cast rooms,

lighting requirements for the general public and

and other special areas with equipment such as

administrative areas vs. specialty areas must be

laboratory, pharmacy, procedure and surgical

taken into account. If the MOB requires emergency

rooms.

power an emergency generator may be necessary.

The COVID-19 Pandemic has proven that special considerations must be made for safe air floor and filtering for building occupants: patients, staff, and

System Considerations

visitors. In both new and renovated spaces, even in

Individual data closets are often required within

MOBs, adjustable negative airflow and Merv 13 (and

tenant suites. A building data closet should also

above) filtration should be considered for higher

be provided. Nurse call and patient tracking may

risk spaces, namely exam and procedure rooms.

be required within suites. Security considerations

HVAC approaches such as this should be designed

must be taken into account building wide as well as

in concert with architectural designs that promote

within each tenant suite.

social distancing in waiting areas, corridors, and/or other gathering spaces, such as conference rooms.

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COMPONENTS FOR CONSIDERATION

Furniture, Fixtures & Equipment

Medical Equipment & Communication Systems

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Lobby furnishings, reception desk, check-in

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Data/telecommunication wiring and equipment

kiosks, vending machines, artwork and window

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Telephone equipment

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Security system for tenant spaces (beyond base

treatments •

Tenant furnishings, demountable partitions, exam room equipment, charting stations, lockers and marker boards.

building system) •

system) •

Location for imaging equipment and structural implications

Special Mechanical & Electrical Systems •

Supplemental cooling for computer rooms

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Mechanical humidification during heating

Building Shell, Miscellaneous

cycles

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Window washing equipment

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Distribution or hook-up of tenant equipment

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Manned security station

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Tenant power in excess of 6.5 watts/SF (power

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Roof top access criteria

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Food service equipment

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Monumental signs

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Removal of unsuitable soil

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Removal of underground obstructions man

and lighting) •

UPS for computers and/or selected outlets

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Computer panels and/or equipment

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Exhaust fans for lab and pharmacy equipment.

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Pandemic ready airflow and filtering adjustability

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Computer equipment (health information

made or natural •

Options for acoustical privacy

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Different clinic modules

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Construction methodology

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Tilt-up

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Traditional

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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 through-put 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.

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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 highvisibility 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

UNC HEALTHCARE FUQUAY-VARINA URGENT CARE CLINIC This new medical facility for the Fuquay-Varina community will provide a supportive, reassuring experience for patients and families close to home.

The prototype design for UNC Healthcare includes an urgent care clinic and family medicine practice under the same roof. The patient-centered design for the family medicine practice includes 24 exam rooms, a point-of-care lab test area, and a phlebotomy lab; staff work areas are separated from patient corridors, allowing staff to work and collaborate in care team work areas. The compact, efficient floor plan for the urgent care is designed for operational efficiency and serves patient needs with five exam rooms, x-ray, and point-of-care lab testing. showroom provides a space to highlight student work and emerging technologies.

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CASE STUDY

WAKEMED MEDICAL PARK OF CARY MEDICAL OFFICE BUILDING This project includes master planning and design for an outpatient health campus consisting of two medical office buildings supported by a common parking deck. The core and shell design was completed via Design-Bid-Build with Healthcare Trust of America. The Phase I, 5-story, 133,900 GSF Medical Office Building includes 470 parking spaces in a parking deck that is designed for phased construction to allow flexibility of implementation of the overall master plan program. Tenant fit-ups are being completed for WakeMed for various clinics including Cardiology, Imaging, Pharmacy, General Surgery, Vascular, Thoracic, Urology, Uro-GYN, OBGYN, Maternal Fetal Medicine, and an Ambulatory Surgery Center.

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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 orthopedic 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 Orthopedic 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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MISSION 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.

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Greensboro

Raleigh

Asheville Charlotte Greenville

Myrtle Beach

Columbia Atlanta

Charleston

Savannah

Jacksonville

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Wilmington

STEVE FREYALDENHOLVEN

AIA, NCARB NATIONAL MARKET LEADER, HEALTHCARE stevefrey@ls3p.com 336.579.5367 (DIR) 336.908.3101 (CELL)

ENGAGE

DESIGN

TRANSFORM

We are passionate about the

We respond to the discovery

We want to streamline your

process of discovery, from

process by using our tool kit of

operational and functional

the earliest stages of design

strategies to generate design

capacities, improve your

through project delivery. We

options. We use evidence-

bottom line, and allow you to

engage with our clients in order

based design. Our extensive

see more patients per hour. We

to address the unique needs,

hands-on knowledge of

want to provide spaces which

constraints, and opportunities of

effective solutions, a series of

facilitate healing, and support

each project. We observe, listen,

simulations, and state-of-the-art

physicians, staff, patients and

and ask questions. We want to

technology to create the best

visitors on the path to recovery

understand your work flow, user

design for your needs.

and wellness. We want to help

groups, project goals, budget,

transform your practice.

and business model. We want you to enjoy the process.

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HEALTHCARE BY DESIGN MEDICAL OFFICE BUILDINGS

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