ARCH7130_Retail medical clinics_Fall2014

innovations in healthcare

RETAIL MEDICAL CLINICS Northeastern University School of Architecture ARCH 6330 Master’s Research Studio - Fall 2014

1

2

RETAIL MEDICAL CLINICS Northeastern University School of Architecture ARCH 6330 Master’s Research Studio - Fall 2014

4

PREFACE Over a 10-week period, 13 graduate students in Northeastern University’s Graduate Program of Architecture analyzed new and emerging models of primary care facilities, focusing specifically on the development of retail medical clinics. The class objective is to thoroughly understand the history, operations, and potentials of the retail medical clinic in the broader landscape of health care services.

Created in collaboration with the design and management teams of the CVS Health MinuteClinic, the research is aimed at identifying possibilities for improved clinic models. Through an understanding of the successes and failures of the existing facilities and the ways in which design can play a role in improving the experience of caregivers and patients, we can establish a better understanding of how design can positively impact and respond to evolving modes of health care delivery.

This effort is the second in a multi-year effort to explore the role of design and architecture in health care. Unlike the previous year’s research, which provided a quantitative overview of primary care venues generally, this document goes into greater depth on hybridized programs such as retail medical clinics. The group has emphasized qualitative aspects, including spatial analysis of the exam room, experiences related to the waiting room, branded environments, and certain program boundaries to lead to ideas for future innovation in retail medical clinics.

innovations in healthcare

ACKNOWLEDGEMENTS We would like to thank the following people and companies for their generous contribution of time, knowledge, and resources:

CVS Health HEALTH

FACULTY / ADVISERS

Christina Sprows Stephanie Szneke Mike LePage Neil Vecchiarelli Christine Sawicki Neil Keisling Nini Silva Dan Kerls Liz Booth Ben Sprows Debra Hoffsman (NP) Lori Phinney (NP)

Matthew Littell George Thrush Jordan Goldstein RESEARCH TEAM Colin Gast Jessica Cooper Laurel Clark Rebecca Smith Victoria Wiegand Zahidah Alzain Deema Elmoisheer Carol Goforth Meghan Doran Heather GIllam Zhongmei Cao Sara Al-Otaibi John Hayford

8

TABLE OF CONTENTS 1 THE CLINIC

retail clinic target markets scope of services

2 HOW + WHERE CARE HAPPENS exam room functionality telemedicine infusion therapy

12 20 26

34 60 70

3 WAITING + PRIVACY psychology + magementment tactics precedents variables to consider identifying patterns

4 BRAND + PLACEMAKING + ENVIRONMENTS

brand blend interior environment design graphic design + wayfinding

82 94 108 136

6 PROGRAM BOUNDARIES boundary types + elements precedent studies metrics

298 310 364

7 BUSINESS DEPLOYMENT alternative retail experiences components of CVS Health types of CVS Health examples of prototypes layout analysis

370 378 382 390 398

8 APPENDIX sustainability

408

9 SOURCES

166 190 220

5 USER EXPERIENCES user types caregiver experience patient experience

258 260 250

9

THE CLINIC retail medical clinics 12 target market 20 scope of diagnostics 26

11

THE RETAIL CLINIC With new health care and health insurance changes, the way in which we receive care is leading towards retail medical clinics. This section will explain the dynamics of a retail medical clinic including what it is, their recent rapid growth and their target markets.

12

13

the clinic / retail clinic

WHAT IS A RETAIL CLINIC? A retail medical clinic, or convenient care clinic (CCC), is a type of walk-in clinic which offers a variety of health care services within common retail store environments. The aim of the retail medical clinic is to help people of average health get convenient and quality health care when needed.

Therefore, retail medical clinics are often open 7 days a week (including weekends), require no appointment and are often more cost efficient when compared to primary care or hospital visits.

Some advantages to using retail medical clinics include: - Guaranteed appointment times - Short consultations - Convenient locations + hours - Up front pricing - Lower prices than ER and urgent care - Cash or insurance payments accepted - Electronic health record available Some disadvantages include: - Short consultation (may not leave much time to explain health history, details of current complaint) - Detract from development of a medical home and relationship with primary care doctor - Limited set of conditions treated - May miss important follow up care required from certain conditions - Oversight of clinics varies from state to state - Usually not treated by an M.D. 14

Retail medical clinics are located in common pharmacy and retail stores such as CVS Health, Target, Walmart, Walgreens and various other stores which have the capacity to offer medical care needs. On the right is a series of maps which show states with major retail medical clinic as of 2014, in addition to a map which shows which states contain frequent locations.

4 Major Clinics

2 Major Clinics

3 Major Clinics

1 Major Clinic

States with Major Clinic Locations

retail medical clinics

CVS Health Clinic

Walgreens Clinic

Target Clinic

Walmart Clinic 15

the clinic / retail clinic

RETAIL CLINIC GROWTH As health care reform has produced a sudden increase in newly insured people seeking care, and the ratio of elderly to young continues to rise, the health care system struggles to keep up with the challenge of providing an adequate amount of health care facilities to provide the necessary services that meet the current demands. One of the answers to the health care issue was the rapid growth of the retail medical clinic. The addition of many retail clinic act as a tool within the health care system through their ability to manage the volume of patients while more conventional health providers focus on higher acuity and more complex treatments, and programs like population health management and telemedicine.

Accenture Research has projected that, between 2012 and 2015, the number of health care clinics will grow between 25% and 30% annually. This impacts the number of retail medical clinics by nearly double, increasing the number of current clinics to nearly 2,800. This will allow the clinics to take on nearly 10.8 million visits per year that hospitals and primary care facilities currently cannot fill, and save approximately $800 million per year in health care expenditures through the use retail clinics which are able to provide the same care at more cost efficient prices.

16

retail medical clinics

Retail Medical Clinics Percent of Growth, 2001 to 2015 500% 442%

Percent of Growth

400%

300%

200% 170%

100%

157%

100% 71% 50%

56% 30% 1%

0% 2001

2002

2003

2004

2005

2006

2007

2008

2009

3%

2010

11%

2011

25+ %

30+ %

30+ %

2014

2015

5%

2012

2013

Year

Since the beginning of the rapid growth of retail medical clinics in 2000, the number of clinics has continually increased each year. The graph above compares the percent of the increase of retail clinics by year between 2001 and then projected until 2015. As you can see, there have been years where there was a large amount of growth (up to 442%) compared to some others which appear to be have a low increase in number (as low as 1%). However, to put it into perspective, a 1% increase within a year can equal approximately 280 additional clinics. While there are many reasons for the growth of retail clinics, one which has changed the demand for health care services was the

addition of the Patient Protection and Affordable Care Act which went into effect as of 2010. This act was intended to increase the quality and affordability of health insurance, lower uninsured rates by expanding public and private insurance coverage, and reduce costs of health care for individuals and the government. This meant that the number of clinics had to increase again in order to try to meet the demands of the additional patients now seeking health care.

17

the clinic / retail clinic

CVS HEALTH MINUTECLINIC GROWTH

Number of Clinics

600

450

300

150

2006

2007

2008

2009

2010

2011

2012

Year

CVS Health is one of the pioneers in the retail health care industry and continues to be the leading example of retail clinics. CVS Health’s MinuteClinic is an interesting alternative for various health care services. The company expects to operate 1,000 MinuteClinics by 2016, as well as place a MinuteClinic in every state that has a CVS Health/pharmacy location. MinuteClinic facilities are constantly opening in new locations, both renovated into existing stores and built into new stores Above is a line graph which shows the rate in which MinuteClinics have increased throughout the United States. As you can see, they had most of their growth in the early years (2006-2008) but continue to grow into the future.

18

The map on the right shows locations of MinuteClinics within Massachusetts. As of now, there are 50 MinuteClinic locations with the majority of these locations on the eastern, more populated part of the state. Mapping the locations themselves provides insight to why CVS Health chooses certain stores to include a MinuteClinic. By mapping the median family incomes by county, it is evident that the majority of MinuteClinic locations are present in counties with higher median family incomes. It would seem that these areas with more wealth would have less demand for affordable retail clinics, however the goal of CVS Health’s MinuteClinic is to work as part of a larger health care system.

retail medical clinics

Household Income $75,000 - $84,999 $65,000 - $74,999 $55,000 - $64,999 $45,000 - $54,999

19

TARGET MARKETS The market of users of retail medical clinics is evolving and becoming more widely used as services and locations expand to reach additional groups of the population. The section will look into the target markets of both retail medical clinics in general, as well as the target market that CVS Health is striving for.

20

21

the clinic / target markets

RETAIL CLINIC TARGET MARKET The target market for the retail clinic can be looked at in a number of ways and compared across a wide scope of demographics. Some aspects to consider when deciding upon an ideal user are Age, Gender, Demographic, Education levels, Marital Status, Income, Residential Status, and locations of Residency. The charts are based on studies conducted by the Annals of Family Medicine (AFM) According to the research, we can see that the majority of people who will seek medical assistance for minor illnesses and injuries in a retail clinic fit into this criteria: relatively wealthy, white women, with a bachelors degree, that are married, own a home, and live near a Metropolitan Statistical Area (MSA). While this is possibly the most common user, it is not to say that this is the only user or the ideal market. Retail clinics are trying to provide quality and affordable care to all of their patients.

Age Groups

Elderly Adult Adolescent

Gender Ratio

Female Male

22

retail medical clinics

Demographic White Black Asian Hispanic Multiracial

Income Less than $25,000 $25,000 - $49,999 $50,000 - $74,999 $75,000 or more

Education Less than 12 High School/GED College 2-Year College Bachelors degree Professional degree

Residential Status Own Rent

Marital Status Married Divorced Separated Widows Never Married

Place of Residence Lives in MSA Lives outside of MSA

23

the clinic / target markets

FUTURE TARGET MARKET

24

125 Number of Elders (Millions)

Although the entire U.S. market purchases a growing amount of pharmaceuticals, CVS Health’s target market is primarily focused on the elderly.

Because of the explosion in the elderly population, CVS Health has a gigantic, growing market for its various services. Because they offer low cost, hands-on health care services, CVS Health is greatly benefiting from the demographic shifts and gains in the market share. Additionally, in store pharmacists help senior citizens navigate Medicare prescription plans, and with Medicare spending expected to rise 8.5% annually over the next decade. CVS Health has the most to gain by focusing on the elderly population growth.

The bar graph represents the projected elderly population growth within the next forty years, showing that it will become even more important to target the elderly when marketing CVS Health and MinuteClinic. The pie chart shows the current percentage of the elderly population versus the adolescent and adult population. Although 18 percent may not seem like a large amount compared to adolescent and adult, people are living longer then ever before which means there will be an increasingly large amount of elderly, especially with the baby boomers who are starting to be labelled in the elderly range. These statistics show that it is increasingly important for CVS Health and MinuteClinic to consider the perspective of the elderly in their designs without ignoring the needs and perspective of both the adolescent and adult population as well.

100

75

50

2010

2020

2040 Year

Adolescent 27.2%

Elderly 18%

Adult 54.8%

2050

retail medical clinics

25

SCOPE OF DIAGNOSTICS CVS Health MinuteClinics offer a range of services to be provided by either a nurse practitioner or a physician assistant. All of there services mimic that of a primary care physician, however the care can be received without a prior appointment when the care is needed. All MinuteClinic locations have all necessary equipment to diagnose and treat most common ailments.

26

27

the clinic / scope of diagnostics

MEDICAL PROFESSIONALS Retail Medical Clinics specialize in primary health care provided by either a nurse practitioner (NP) or a physician assistant (PA). They provide many of the same services received from a doctor, including prescribing medicine, treating common illnesses, administering vaccinations and physical examinations without needing an appointment through a primary care doctor. With this rise in retail clinics, 1 in 6 people with better or average health use a retail clinic over their primary physician.

Most clinics are staffed with a nurse practitioner, which is a registered nurse who has acquired the knowledge base, decision-making skills, and clinical competencies for expanded practice beyond that of a registered nurse (RN). A survey taken in 2012 of Nurse Practitioners showed nearly 57 percent of nurse practitioners worked under a private physician and 2.2 percent reported as working in retail clinics opposed to other positions. Some states require a physician assistant within their retail clinics, a physician assistant is a health care professional licensed to work under the umbrella of a registered physician and provide the same services as a nurse practitioner.

28

retail medical clinics

Nurse Practitioner (NP) Number of Jobs:

37,100 33.7% Growth Rate

Unemployment Rate:

0.9%

USNews Best Jobs of 2014:

#4

Education:

Bachelors Degree in Nursing Graduate Degree

Certifications:

National Council Licenser Examination for Registered Nurses Advanced Practice Registered Nurse (APRN)

Physician Assistant (PA) 33,300 Number of Jobs: 38.4% Growth Rate Unemployment Rate:

1.2%

USNews Best Jobs of 2014:

#13

Education:

Bachelors Degree (2-4 years science coursework) Masters Degree (2-3 Years) 2,000 Hours Clinical Rotations

Certifications:

National Commission on Certification of Physician assistants 29

the clinic / scope of diagnostics

Get Healthy

CLINIC SERVICES

30

Minor Illness Exams:

Minor Injury Exams:

Skin Condition Exams:

•

Allergy symptoms

•

Blisters

•

Acne

•

Bronchitis/cough

•

Bug bites + stings

•

Athlete’s foot

•

Earache

•

Jellyfish stings

•

Chicken pox

•

Ear infection

•

Lacerations

•

Cold + canker sores

•

Flu-like Symptoms

•

Minor burns

•

Impetigo

•

Mono

•

Minor wounds + abrasions

•

Lice

•

Motion Sickness

•

Splinter removal

•

Minor infections

Preventions

•

Sprains/strains to ankles +

•

Minor rashes

knees

•

Oral/mouth sores

•

Pink eyes

•

Styes

•

Suture/staple removal

•

Poison ivy + oak

•

Sinus Infection

•

Tick bites

•

Ringworm

•

Sore Throat/ Strep

•

Scabies

•

Upper respiratory infection

•

Shingles

•

Urinary tract

•

Sunburn

•

Bladder infection

•

Swimmer’s itch

•

Wart evaluation

Wellness + Physical

Vaccinations:

Exams:

•

Stay Healthy

•

•

Screens (basic

DTaP (diphtheria, tetanus, pertussis)

health, cholesterol,

•

Flu

comprehensive health,

•

Hepatitis A

diabetes)

•

Hepatitis B

Physical exams •

HPV Gardasil

(administrative, camp,

•

Meningitis

college, sports

•

MMR (measles, mumps,

•

Ear wax removal

•

EpiPen + Twinject refills

•

Pneumonia

•

Medication renewal

•

Polio

•

Pregnancy evaluation

•

Td (tetanus, diphtheria

•

Start to Stop smoking

•

Tdap (tetanus,

cessation •

TB testing

•

Weight loss program

rubella)

Health Condition Monitoring: • A1c check • Diabetes • High blood pressure • High cholesterol

Potential Additional Services

retail medical clinics

Opportunities for future services: •

Perform simple procedures (biopsies, sutures)

•

Sprains, strains + fractures

•

Lacerations

•

Pain medication (migraine or otherwise)

diphtheria, pertussis)

31

HOW + WHERE CARE HAPPENS exam room functionality 34 telemedicine 60 infusion therapy 70

33

EXAM ROOM FUNCTIONALITY This research aims to develop a better understanding of a typical exam room in a CVS Health MinuteClinic. The research has culminated in an understanding of the existing equipment, storage, and supplies in an exam room, and the spatial arrangement relative to these. This research also proposes methods for how the CVS Health MinuteClinic can be more efficient with space to enhance storage and productivity, while also, prospectively expanding upon it’s care-giving services.

34

how + where care happens / exam room functionality

EXAM ROOM EXISTING CONDITIONS

Two 2’ x 4’ ceiling lights

Germ Guardian

ADA Accessible Sink

Task Chair Guest Chair Exam Bed

36

retail medical clinics

1. Exam Table 2. Blood Pressure Monitor 3. Otoscope 4. Storage

1. Sink 2. Refrigerator 3. Bio-waste/Sharps collection 4. Basic First Aid/Exam Resources 5. Hand Sanitizer

1. Computer 2. Storage 3. Brochures/Pamphlets 4. Phone 5. Office Supplies

37

how + where care happens / exam room functionality

Sink + Emergency Eye Wash Station Hazard Box / Blade Storage Refrigerator

38

Patient Chair Computer

Telephone

retail medical clinics

Eye Exam Chart Height Chart

Exam Bed

Stethoscope Otoscope

Blood Pressure Monitor

39

how + where care happens / exam room functionality

1’ Exam Room Storage This study shows the components that make up all the equipment and storage in a typical CVS Health MinuteClinic exam room.

2’

x3

6” 1’ 8”

1’ 8”

x5

6” 1’ 5” 2’ 6”

x4 2’ 6”

1’

2’ 6”

3’

Upper Storage Space 40

x1

1’ 7”

1’

1’

x4

2’ 3”

2’

2’ 11”

Base + Lower Storage Space

x1

retail medical clinics

2’

4’ 6”

x1

2’

x1

6’ 6”

Flat Surface Storage Space 41

how + where care happens / exam room functionality

Exam Room Component Spectrum This diagramming study arranges the equipment and furniture of an exam room along a spectrum relative to their function, and importance of proximity to one another.

Treatment Grouped by importance of proximity 42

Treatment & Storage

retail medical clinics

Storage 45 sqft (cubic square foot) of overhead and base cabinets 43

how + where care happens / exam room functionality

44

Exam Room

Wasted Space

Subtracted Equipment

Additional Equipment

Current Exam Room

Current Exam Room - Exam Table + Wasted Space

The volume is 10 ft. x 10 ft., with an approximate 8 ft. ceiling height. All of the walls are covered with various cabinets or exam equipment.

The removal of the bulky table would remove services, but lend more space to the store.

retail medical clinics

Current Exam Room - Provider Work Station

Current Exam Room + Additional Equipment

Some nurse practitioners enjoy the desk while others believe it takes up too much room and can be replaced with a more flexible and portable station.

The additional equipment may include an EKG machine, an x-Ray machine, additional mini fridge, and additional patient chairs.

45

how + where care happens / exam room functionality

EXAM ROOM MODIFICATION STUDIES This diagramming study progressively updates the exam room furniture and equipment, based on feedback from research and interviews with Nurse Practitioners. To show the maximum impact the exam room has been updated within the existing 10’ x 10’ constraints of the typical exam room.

46

retail medical clinics

Extend or increase storage to store more supplies and potentially expand upon services.

47

how + where care happens / exam room functionality

Replace typical built desk with rolling stool and mobile work station to increase floor space, and NP’s connection to patients.

48

retail medical clinics

EKG Machine Addition to increase service scope.

49

how + where care happens / exam room functionality

Existing Exam Room Spatial Analysis

50

retail medical clinics

Modified Exam Room Spatial Analysis

51

how + where care happens / exam room functionality

Inclusive Design The following clinic layout design manipulates the current fit out clinic dimensions of two 10’ x 10’ clinic rooms, so a total area of 200sqft. This design in based on research collected by peer-reviewed sources and interviews with users, and nurse practitioners. This design includes an accessible lift designed by Prism Medical to aid handicapped patients; allowing them to receive medical check ups on the exam table including physicals by the nurse practitioners, which previously could not have been done.

20’ 12’

52

8’

retail medical clinics

8’

10’

12’

8’

53

how + where care happens / exam room functionality

54

retail medical clinics

55

how + where care happens / exam room functionality

In the existing set up the Nurse Practitioner has a long distance to move and can only get to these places by standing up and walking to these spots.

Currently, the chair is also quite big and bulky, not allowing agile mobility.

56

The new proposal allows the Nurse Practitioner to move around the room fairly quickly while still being seated on the stool. It also enables the nurse practitioner to treat a patient while they are in a stool even if the patient is on the exam bed.

retail medical clinics

The new proposal allows the Nurse Practitioner to move around the room fairly quickly while still being seated on the stool. It also enables the nurse practitioner to treat a patient while they are in a stool even if the patient is on the exam bed.

Furthermore, it allows a physically disabled patients to receive medical examinations with the assistance of a lift, that could also lift the patient to the sink.

57

how + where care happens / exam room functionality

Jain Malkin “ The design of healing environments quickly became an industry buzzword after publication of Jain Malkin’s book Hospital Interior Architecture in 1992 which promoted the concept of research-based design. Jain has guided thousands to the ideas of “designing the patient experience”” Case Study: Scripps Center for Integrative Medicine: “A Healthcare design based on a sacred geometry becomes a physical expression of the mindbody-spirit harmony that is the goal of integrative medicine. Golden ratio represents a mathematical relationship known to create feelings of harmony and comfort.”

58

retail medical clinics

Sight-lines Alan Rheault in his research states, “ information on a computer or handheld device are limited to only the physician, which compromises the powerful potential of technology as a tool for teaching and learning. Teaching and learning goes both ways – patients and family sharing with physicians, physicians sharing with patients and family, and the configuration of space is fundamental for supporting that. In many exam rooms today, fixed, bulky furniture makes movement difficult, limits in-the-moment reconfiguration, and hinders active learning modes. Making technology and tools mobile can support a more dynamic flow.”

59

TELEMEDICINE Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, e-mail, smart phones, wireless tools and other forms of telecommunications technology.

60

61

how + where care happens / telemedicine

GROWTH AND USE

STARPAHC was developed by NASA to deliver health care to the isolated Papago Reservation in Arizona. Portable diagnostic equipment was linked to a two-way microwave transmission 62

The development and widespread access of the internet encouraged a boom in the use of telemedicine

Over 130 telemedicine research sites, the majority of which use two-way interactive audio-visual technology

200 telemedicine networks, over 3,500 service sites, hosting 500,000 interactions in 2012 by top three networks alone

2015

Over 1 million Americans wearing remote cardiac monitors

2000

First international “American telemedicine project, Telemedicine offering medical consulAssociation” tations from doctors in was estabthe U.S. after an earthlished to quake in the Soviet provide guideRepublic of Armenia. lines and best practices for telemedicine

1985

NASA study to determine the minimal television system requirements for accurate telediagnosis

1970

1955

In the early 1960’s, NASA measured physiological measurements of astronauts during space flights

retail medical clinics

Telemedicine can be used in different forms to provide care in a variety of ways. Each use requires the use of equipment to exchange information, although the complexity of the tasks vary. The following are ways that telemedicine is currently being practiced in the United States: Monitoring-remote patient monitoring uses devices to remotely collect and send data to a home health agency or a remote diagnostic testing facility for interpretation. Such applications might include a specific vital sign or a variety of indicators for home bound patients. This can serve both as early warning systems and treatment compliance monitoring.

Law Adopted Proposed Law Partial Law

Telemedicine Parity Law requires private insurance to cover telemedicine the same as an in-person service.

Diagnosis-this may involve the use of live interactive video or the use of store and forward transmission of diagnostic images, vital signs and/or video clips along with patient data for later review.

Triage-offering the ability to remotely “sort� patients according to urgency Procedures-procedures that can be undertaken remotely

Technical Complexity

Virtual Visits/Consultations-primary care and specialist referral services may involve a primary care or allied health professional providing a consultation with a patient or a specialist assisting the primary care physician in rendering a diagnosis.

Procedures

Diagnosis

Triage

Monitoring

Virtual Visit/ Consultation

Potential Benefits of Use 63

how + where care happens / telemedicine

BENEFITS AND POTENTIAL According to the Association of American Medical Colleges, by 2020 the U.S. is projected to have 91,500 fewer doctors than needed. Telemedicine has the potential to provide services to relieve the strain of a care provider shortage by providing increased access. Not only does telemedicine improve access to patients, but it allows physicians and health facilities to expand their reach beyond their own offices.

Patients also have the potential to benefit from virtual care. Telemedicine technology has the potential to reduce travel time and other stresses for the patient, when having to physically go to get care.

Such services can offer patients access to providers that might not be available otherwise to them.

Telemedicine can be a cost efficient, both for the patient and the health care system. The average cost of a virtual “e-visit” costs $35-$50 dollars, in comparison to $133 on average for an in-person visit at a primary care physician’s office. Reducing the cost of health care is one of the most important reasons for funding and adopting telehealth technologies. Telemedicine has been shown to reduce the cost of health care and increase efficiency through better management of chronic diseases, shared staffing, reduced travel times, and fewer or shorter hospital stays.

64

Equipment for telemedicine practice depends on the extent of communication. Common equipment for remote diagnosis, consultations, and treatment include the following: -Store & forward technology for obtaining and transmitting data to a remote site through the use of a computer with a secure system -A high-speed internet connection if videoconferencing is involved -Telemedicine practitioner’s cart, including a monitor, computer, and camera -Additional instruments include a digital stethoscope, otoscope, ophthalmoscope, and total exam camera

69.5%

in

en

g

th er

t

ns

Te s

tio

O

La b

za

?

Sc re

un i

m

al s

?

Im

sic

?

Ph y

s

es

ln

s

rie

In ju

?

W el

or

s

on

Co nd iti

in

M

Sk in

in a

n

tio

er

O th

ce

Pr o

lP ai n du re Jo Fo in llo t/ w Ba Up Vi c k ra Pa lI ll i G nes n en s er Ey al A e dv Ea Pro ice r I ble /R nf m efi ec lls tio n

m

ss

Illn e

rI nf ec

de

Bl ad

do

Ab

I/

UT

ry

to

ira

sp

Re

retail medical clinics

Reasons for E-Health Visits

Reasons for Retail Clinic Visits

30.5%

Retail clinic services that could be offered through telemedicine 65

how + where care happens / telemedicine

SPATIAL IMPACT OF TELEMEDICINE IN A RETAIL CLINIC Option 1 Treat most patients remotely from their homes, but still have capability to provide immunizations and health screenings in the location of the nurse practitioner’s office.

-0 exam rooms -1 nurse practitioner’s office -1 nurse practitioner on site Pros-does not require a full exam room but most of the services currently offered could still be provided.

Cons-must refer patients to a physicians office if they cannot treat them remotely because they are not equipped to treat them in the retail location.

Cannot provide physicals or other procedures that require an exam table.

66

5’

retail medical clinics

Option 2 Treat patients remotely first, but keep an exam room to treat patients that you cannot be remotely treated and to provide patients with immunizations, screening tests, physicals etc.

-1 exam room -1 nurse practitioner on site Pros-can provide all services that are currently being offered at retail clinics using less physical space for the clinic.

5’

Cons-Limited number of patients could be treated with one care provider attending to both physical patients and remote ones

67

how + where care happens / telemedicine

Option 3 Keep an exam room to treat patients that cannot be treated remotely and to provide immunizations, screening tests, physicals etc. Also provide a virtual portal to treat overflow patients with a nurse practitioner at a remote retail location.

-1 exam room -1 virtual portals -1 nurse practitioner on site Pros-when there is a surplus of patients, the patient can remotely contact a nurse practitioner at a sister location. In this way, the locations of the clinics reach more areas, with a staff that can be shared between them for efficiency. The portal also allows patients to have access to digital diagnostic equipment that they may not have at home.

Cons-more space is used than in other options. If there is not a surplus of patients, the nurse practitioner and the portal are not both needed and one of the rooms will not be occupied.

68

5’

5’

retail medical clinics

Option 4 Provide only patient portal(s) at certain locations with necessary equipment for a remote diagnosis from a nurse practitioner at another retail location, which may or may not include a full exam room.

-1 or 2 virtual portals -0 nurse practitioners on site Pros-allows fewer clinics to reach more areas and patients with fewer care providers. The portal also allows patients to have access to digital diagnostic equipment that they may not have at home.

Cons-must refer patients to a physician’s office if they cannot be treated remotely, as there are no care providers on site. Cannot provide physicals or other procedures that must be given in person.

Immunizations may take place at pharmacy (as in many current retail locations).

5’

5’

69

INFUSION THERAPY Typically infusion therapy is medication administered intravenously through a needle or catheter, but can also be provided through intramuscular injections and epidural routes. These medications are often prescribed when a patient’s condition is so severe that it cannot be treated effectively by oral medications.

70

how + where care happens / infusion therapy

USE AND BENEFITS Infusion therapy can be provided via a hospitalbased infusion clinic, a physician-based infusion clinic, or an ambulatory infusion suite (AIS) of a home infusion therapy provider. These are most commonly staffed with RNs and registered pharmacists who have had special training in infusion and specialty drug administration. Obtaining the therapy through a service at a patients home or at an infusion suite results in a much lower cost, as the patient is not staying at a hospital, and allows the patient to be discharged and return to their lifestyles at their homes.

Infusion times range from 30 minutes to 6 hours depending on the physician’s prescription and the rate at which an individual absorbs the medication.

Some patients may need infusion therapy daily, while others may only get it periodically or when prompted by symptoms.

After hour and weekend appointments are sometimes offered to provide a flexible care schedule.

72

illness • infections that are unresponsive to oral antibiotics • immune deficiencies • cancer • dehydration • chronic pain • gastrointestinal diseases • hemophilia • anemia • congestive heart failure • hormone deficiencies • autoimmune disease • multiple sclerosis • rheumatoid arthritis

medication TYPICAL: • antibiotics • antifungal • antiviral • chemotherapy • hydration • pain management • parenteral nutrition SPECIALTY: • blood factors • erythropoietin • inotropic heart medications • growth hormones • immunoglobulin • natalizumab • corticosteroids • infliximab

retail medical clinics

4+ Coram ambulatory infusion suites 1-3 Coram ambulatory infusion suites no Coram ambulatory infusion suites

Duration of Therapy Session

12:00

1:00

2:00

3:00

4:00

5:00

6:00

average length of infusion session

73

how + where care happens / infusion therapy

SERVICES

Clinics require infusion pumps and poles, IV sets, and syringes

74

wireless internet

Amenities for Patients

Infusion therapy clinics are responsible for ensuring that the infusion drugs are: • compounded in a sterile environment • maintained in appropriate conditions to ensure sterility and stability • administered at exactly the right dose and on the right schedule • administered using the appropriate vascular access device (often a long-term device), which is placed in the correct anatomical location based on the expected duration of therapy, the pH, osmolarity, and osmolality of the medication (Picc lines, Q Ports) • administered using an appropriate drug delivery device • flushed with the proper flushing solution between doses • monitored for adverse reactions and therapeutic efficacy

television

food + drinks

blankets

retail medical clinics

table

ability to recline

IV pole and infusion pump

guest seat(s)

comfortable chair

foot rest

75

how + where care happens / infusion therapy

THERAPY SPACE non-private

7’-0” 10’-6”

Goldschmidt Infusion Center, Jefferson City MO

76

retail medical clinics

semi-private

8’-6”

7’-6”

Seidman Cancer Center, Cleveland OH

77

how + where care happens / infusion therapy

semi-private

El Camino Cancer Center, Mountain View CA

78

9’-6”

7’-6”

retail medical clinics

private 9’-6”

8’-0”

Brooklyn Infusion Center, New York, NY

79

WAITING + PRIVACY psychology + management tactics 82 precedents 94 variable to consider 108 identifying patterns 136

81

PSYCHOLOGY + MANAGEMENT TACTICS Waiting rooms set the tone for the medical experience. Patients' perception of how long they have waited can greatly affect their satisfaction of the overall visit. Therefore, it is important to provide for choice within the design. Patients will likely have some level of anxiety, and, according to their psychological make-up, they will have a varied response regarding a need for personal space and privacy.

82

waiting + privacy / psychology of wait

PSYCHOLOGY OF WAIT “Waiting is frustrating, demoralizing, agonizing, aggravating, annoying, time consuming and incredibly expensive.”

According to David Maister in “The Psychology of Waiting Lines,” the truth of this assertion cannot be denied: there can be few consumers of services in a modern society who have not felt, at one time or another “Products are consumed, services are experienced.” Accordingly, if managers are to concern themselves with how long their customers or clients wait in line for service (as, indeed, they should), then they must pay attention not only to the readily-measurable, objective, reality of waiting times, but also how those waits are experienced.

“If they sit down in a good mood, it’s easy to keep them happy. If they sit down disgruntled, it’s almost impossible to turn them around. They’re looking to find fault, to criticize.”

COST

84

ATTENTION

TIME

PROFIT

First law, Satisfaction= Perception -Expectation The point, of course, is that both the perception and the expectation are psychological phenomena.

They are not the reality. In a benevolent world, both the perception and the expectation will have some connection to reality, but they are not reality.

If you expect a certain level of service, and perceive the service reviewed to be higher, you are a satisfied client. If you perceive the same level as before, but expected higher, you are disappointed and, consequently, a dissatisfied client.

Second law is that it’s hard to play catch-up ball.

The corollary to this law is the proposition that there is a halo-effect created by the early stages of any service encounter, and that if money, time and attention is to be spent in improving the perceived quality of service, then the largest payback may well occur in these early stages.

retail medical clinics

Perception

EXPECTATION

PERCEPTION

Satisfied

=

Dissatisfied

CUSTOMER SATISFACTION

Delighted

Expectation

Expectation Perception

Expectation Perception

Perceptions - Expectation = Satisfaction 85

waiting + privacy /managing tactics

MANAGING TACTICS People Want to Get Started.

According to David Maister in “The Psychology of Waiting Lines,” this is why restaurants give you a menu while you wait, and why doctors put you in the examination room twenty-five minutes before your examination actually begins. One of the other virtues of handing out menus, providing a drinks bar and other methods of service-related time-fillers is that they convey the sense the ‘service has started: we know that you are here’. Many restaurant owners instruct their service staff to pass by the table as soon as the customers are seated to say “I’ll be with you as soon as I can, after I’ve looked after that table over there”. In essence, the signal is being sent: ‘We have acknowledged your presence.”

86

Anxiety Makes Waits Seem Longer If you think you’ve chosen the slowest line, or you’re worried about getting a seat on the plane, the wait will seem longer. Maister noted a large part of the concern that we feel to ‘get started’ is due to anxiety. The anxiety was about whether or not one had been forgotten. Anxiety can come from other sources. Nearly everyone has had the experience of choosing a line at the supermarket or airport, and stood there worrying that he had chosen the wrong line. As one stands there trying to decide whether to move, the anxiety level increases and the wait becomes intolerable. This situation is covered by what is known as Erma Bombeck’s Law: “The other line always moves faster.”

retail medical clinics

Occupied Time Feels Shorter Than Unoccupied Time.

As William James, the noted philosopher observed: “Boredom results from being attentive to the passage of time itself.” When you have something to distract yourself, time passes more quickly. Some hotels put mirrors by the elevators, because people like to look at themselves. Maister declared that the truth of this proposition has been discovered by many service organizations. In various restaurants, it is common practice to hand out menus for customers to peruse while waiting in line. This suggests that the activity provided to ‘fill time’ should (a) offer benefit in and of itself, and (b) be related, in some way, to the following service encounter.

Solo Waits Feel Longer than Group Waits The more people engage with each other, the less they notice the wait time. In fact, in some situations, waiting in line is part of the experience.

Maister noted in his article that one of the remarkable things to observe in waiting lines is to see individuals sitting or standing next to each other without talking or otherwise interacting until an announcement of a delay is made. Then the individuals suddenly turn to each other to express their exasperation, wonder collectively what is happening, and console each other. What this illustrates is that there is some form of comfort in group waiting rather than waiting alone.

87

waiting + privacy /managing tactics

Uncertain Waits Are Longer than Known Finite Waits People wait more calmly when they’re told, “The doctor will see you in thirty minutes” than when they’re told, “The doctor will see you soon.” Maister gives an amusing illustration of a phenomenon that anyone might experience: if you arrive someplace thirty minutes early, you will wait with perfect patience, but three minutes after your appointment time passes, you start to feel annoyed. “Just how long am I going to have to wait?” You would think.

Similarly, the pilot who announces “only a few more minutes” adds insult to injury when the wait goes on and on. Not only are the customers being forced to wait, but they are not being dealt with honestly.

88

Unfair Waits Are Longer than Equitable Waits People want their waits to be fair. You get anxious, for instance, when you are waiting on a crowded subway platform, when there’s no clear, fair way to determine who gets on the next car. The “FIFO” rule (first in, first out) is a great rule, when it works.

But sometimes certain people need attention more urgently, or certain people are more valuable customers. Then it gets trickier. Often, when people are treated out of sequence, it’s helpful to have them be served elsewhere, for example people giving customer service by phone shouldn’t be in the same room as people giving service in person.

As Sasser, Olsen, and Wycoff note, one of the most frequent irritants mentioned by customers at restaurants is the prior seating of those who have arrived later. They observe: “The feeling that somebody has successfully ‘cut in front’ of you causes even the most patient customer to become furious. Great care to be equitable is vital. Instead of being able to relax, each individual remains in a state of nervousness about whether their priority in the line is being preserved. As already noted, agitated waits seem longer than relaxed waits. It is for this reason that many service facilities have a system of taking a number, whereby each customer is issued a number and served in strict numerical order.

retail medical clinics

Unexplained Waits Are Longer than Explained Waits We wait more patiently for the pizza guy when there’s a thunderstorm than when the sky is clear.

We wait more patiently on the plane when we know that there’s another plane at the gate. Maister illustrates if a doctor’s receptionist informs you that an emergency has taken place, you would wait with greater equanimity that if you do not know what is going on. Airline pilots understand this principle well; on-board announcements are filled with references to tardy baggage handlers, fog over landing strips, safety checks, and air traffic controllers’ clearance instructions. Naturally, justifiable explanations will tend to soothe the waiting customer more than unjustifiable explanations.

The More Valuable the Service, the Longer the Customer Will Wait You’ll wait longer to talk to a doctor than to talk to a sales clerk. You’ll stand in line longer to buy an iPad than to buy a toothbrush. Maister points out that the example of the supermarket express-checkout counter reminds us that our tolerance for waiting depends upon the perceived value of that for which we wait. Special checkout counters were originally provided because customers with only a few items felt resentful at having to wait a long time for what was seen as a simple transaction. Customers with a full cart of groceries were much more inclined to tolerate lines.

89

waiting + privacy /managing tactics

Plan your wait with a text update!

Inline

Nobody likes spending hours and hours sitting around a crowded waiting room, not knowing who will be called next. So imagine if patients and families could be notified via text message about the number of patients ahead of them while grabbing a bite to eat or going for a walk?

According to Jenny Fillippetti on design boom “ ‘Inline’ is designed as a dynamic, smart phone equivalent to the information presented by ‘folio’. One’s current number in queue is updated in real-time, users can take notes and access medication records, and health tips can be studied through applications with an intuitive interface.”

According to McGill University Health Centre, Patients and families visiting the Montreal Children’s Hospital’s Emergency Department (ED) can sign up via their smart phones or by registering at a kiosk located just outside the ED’s triage area. The service lets them “wait” in a virtual waiting room rather than a physical one with the help of their cell phones–something that’s sure to please more than a few stressed-out parents.

90

Features Suggestions are offered for healthy activities in your area.

Make healthcare appointments online.

Get directions to the consultation room.

Patient queue is updated in real-time.

Keep notes and medication records to prepare for consultation.

retail medical clinics

Choose A Doctor Based On Whose Available When You Need Them

Schedule Appointment

Main Menu

Wait

Navigation

Travel

Receive Text Alerts When Time Slot Nears

Enter

Wait Queue

Self Check-In Shop While Exam RoomSee Medical Kiosk Waiting Staff

Take Notes

Medication Support

Exit

Health Activities

91

waiting + privacy /managing tactics synthesis

Tactics Shortens wait time

Tactics Affect on Perception

Explain

Starting

Anxiety

Group

Fairness

Occupied

Certainty

92

Value

Apps

Tactics manages perception

Explain

Tactics manages expectations

Group

Tactics Association

Starting

Occupied

Certainty

Anxiety

Fairness

Apps Group Fairness Anxiety Occupied Apps ExCertainty

retail medical clinics

Psychological tactics and Customer Satisfaction

76%

Customer satisfaction is improved by 76% if they perceived that the wait time they expected, became shorter. By applying the tactics mentioned, better experiences will be felt.

50%

Good Experince

Bad Experince

Customer dissatisfaction is more likely to be experienced by 50 %, if non of the psychological tactics were applied.

93

PRECEDENTS Looking both at typical examples of precedents as well as new innovative waiting experiences, one can understand a broad view about the factors that determine a patient's comfort and privacy while waiting. Taking into consideration factors such as density of occupancy, dedicated space for waiting, and adjacencies to a waiting area, a broader understanding of waiting and privacy can be obtained.

94

waiting + privacy / precedents

CONVENTIONAL PRECEDENTS Density of occupancy

Dedicated space for waiting

Bus Stops Stops typically provide shelter, seating, bus schedules, and route information. Standing and sitting areas are usually both provided.

Advertisements are often incorporated into the walls of the shelter.

96

Waiting Area

Bus

retail medical clinics

Density of occupancy

Dedicated space for waiting

Shoe Shine Stands Shoe shine stands unlike shoe shine boxes, which are more portable, are often in established locations. They are typically elevated and provide storage below. The stand is often set against a wall or has a back to provide comfort for the customer.

The waiting and servicing experience doesn't require the customer to move. The customers are often passerbys. The entire process can take from 15 to 20 minutes for both shoes. The customer can read a paper or magazine while waiting.

Waiting Area

97

waiting + privacy / precedents

Density of occupancy

Dedicated space for waiting

Autoshops Back to back sociofugal seating arrangements are typically seen in autoshops. Customer seating is often in close proximity to the reception area.

The staff working at the counter can usually see the waiting area from behind the desk. Reading material is often provided.

Waiting Area

WC Recept.

Entry

98

Staff

Works

retail medical clinics

Density of occupancy

Dedicated space for waiting

Airports Rows and rows of side by side seating are frequently seen in airport terminals. Efficiency is usually considered before comfort. Armrest spacing varies to accommodate people of different sizes.

Seating is typically adjacent to the tarmac so that those waiting don't have to go far once the plane is ready for loading.

Waiting Area

CheckIn WC

Shop

Dining

Security

Entry

99

waiting + privacy / precedents

INNOVATIVE PRECEDENTS Density of occupancy

Dedicated space for waiting

Curitiba Bus Rapid Transit System Bus Stop Passengers at stops are alerted to bus wait time.

The platform height matches that of bus access.

Fares are prepaid, and buses travel in their own lanes. This has resulted in reduced travel time.

Waiting Area

Bus

Entry

100

retail medical clinics

Density of occupancy

Dedicated space for waiting

Estudio Arquitectura Hago Dental Office The clinic has been designed as a complete space rather than as separate areas. There is a resulting linear flow from the moment of arrival until completion of the dental services.

Waiting Area

WC

Exam

Offices

Recept.

Entry

101

waiting + privacy / precedents

Density of occupancy

Dedicated space for waiting

Apple Store - Fifth Avenue Retail Seating in this underground store is centrally located. Seating is intended for family and friends of shoppers. Seating is arranged adjacent to the main architectural element. Customer payment utilizes a handheld EasyPay system.

Waiting Area

Retail

Entry

102

retail medical clinics

Density of occupancy

Dedicated space for waiting

Etihad Airplane These innovative airline seats offer control, comfort, and flexibility. A dividing screen is provided in the middle aisle to create isolation from the other passengers as well as a sliding door along the aisles. When the dividing screen is down, a shared center table is activated allowing shared interactions between two people.

Waiting Area

WC

Board

103

waiting + privacy / precedents

Density of occupancy

Dedicated space for waiting

Walgreens Two distinct waiting areas are realized here in the Walgreens model. For brief questions a customer can obtain help at the information desk. If the information demands are greater, seating is provided near an additional customer service area.

Waiting Area

Pharm.

Retail

Entry

104

WC

Clinic

retail medical clinics

105

waiting + privacy / precedents

PRECEDENTS SYNTHESIS ANALYSIS Organization of the chart is based on two variables: dedicated space to waiting and density of occupancy. The third variable is the spatial sequence of each precedent which is represented by the size of the circles. The shortest sequence with the highest dedicated space for waiting and density of occupancy is the shoe shine stand because the services and waiting space are unified as one component. A typical airport and airplane waiting experience usually revolves around waiting as is needed for the service provided. The Walgreens store offers two different options for the customer which can either decrease or increase the spatial sequence. The typical autoshop and dental office experience are similar in their offerings for waiting. The Curitiba Bus Rapid Transit System does not require as much seating because its efficiency allows patrons to be serviced faster due to its rapid turnover. The Apple Store's innovative new shops work to keep the potential customers occupied or have a dedicated salesman ready to answer any questions. The business model is to not keep any customers waiting.

Density of occupancy

Dedicated space for waiting

Waiting Area

Pharm.

Retail

Entry

Spatial Sequence Low To High 106

WC

Clinic

retail medical clinics

Shoe Shine Airplane

Dedicated Space for Waiting

Airport

Walgreens

Autoshop Dental Bus Stop Inn. Bus Stop Typ. Apple Store

Density of Occupancy 107

VARIABLES TO CONSIDER A combination of variables set the tone for the waiting experience and a sense of privacy. Variables include seating arrangements and types, the level of exposure or isolation, the level of control and types of lighting, exposure to noise, and visual stimulation as well as positive distractions.

108

109

waiting + privacy / variables to consider

SEATING ARRANGEMENTS

Shorecare Accident & Medical Sociofugal Arrangement Sociofugal spaces discourage interaction and create privacy within crowded settings. They place patients outside of personal intimate zones. For settings that do not provide enclosed spaces to retreat, sociofugal seating can create a sense of solitude in crowded settings.

110

Sociopetal Arrangement Sociopetal spaces encourage interaction and communication between people. Clustered seating arrangements tend to create sociopetal spaces.

Individuals and groups of all sizes should be considered as patients congregate in different sizes.

retail medical clinics

Steelcase Health Combination A combination of seating arrangements accommodates a variety of groups' sizes and allows patients to choose whether they congregate or separate themselves from others. Instead of lining chairs up in rows along a wall, people can separate themselves from others, mingle, relax, connect, or absorb information. With a few adjustments, a patient can be offered features that make better use of their time and create positive distractions.

The furniture offers easy access to power outlets and several other integrated features. The Regard furniture line by Steelcase allows patients to access medical

information while waiting, creates privacy, and offers these technology supports.

111

waiting + privacy / variables to consider

The Mother Baby Center Grid A rigid placement of seating in alignment to adjacent programs can offer an efficient use of square footage while still allowing for a combination of seating arrangements. The configuration of furniture usually follows the patterns created by the architectural elements.

112

Pediatric Clinic Organic An organic configuration with curved walls, floor thresholds, or furniture arrangement can contribute to a relaxed environment while offering a combination of options for different seating comforts based on the patients' varied response regarding a need for either personal space or sociability.

retail medical clinics

Frankfurt Airport 113

waiting + privacy / identifying patterns

TGV Flexibility of Seating in Limited Space Folding tables help to save seating space. Seating could be rotated 180째 to guarantee that it is facing in the direction of travel. Group travelers can sit face to face to enjoy more intimacy. This could enable healthcare institutions with limited waiting space.

Typical

114

Unfolded

Folded

High Speed Train, China

retail medical clinics

Air New Zealand's Spaceseat 115

waiting + privacy / variables to consider

MODULAR SEATING

Steelcase Health Integrated Seating Often a patient's time is wasted doing nothing because waiting rooms only provide places to sit.

The waiting space can integrate more opportunities to work, snack, watch TV, or provide charging stations for personal electronics. Patients would then be given several opportunities to spend their time more valuably to promote waiting productively.

The modular seating arrangements can create both private and communal seating configurations. The colors and walls integrated into the design also create a way-finding element. The flexibility in the design takes into consideration seating for people of various sizes and physical abilities.

116

The modular furnishing also makes it possible to reconfigure the components for future needs. Seating arrangements can also provide a comfortable setting for families and clinicians to meet. Wall panels adjacent to seating areas reduce noise and other distracting stimulations.

retail medical clinics

Arm rests can be relocated for extra-wide seating to accommodate people of different sizes.

A privacy screen can be added which creates a greater sense of seclusion.

Touchdown spaces are provided which could be utilized for check-in, to look up health tips, or use laptops for work.

Cubbies create space for magazine racks, a place for backpacks, or shelving to keep personal belongings off floors.

Frame extensions create great flexibility for reconfiguration to allow for future needs and offer easy replacement of parts.

Power outlets, armrests, and surfaces for holding beverages are combined in modular units that can be located where needed.

117

waiting + privacy / variables to consider

Couch A planted back provides a freestanding seat with some privacy, and adjustable armrests can be rearranged to suit people of different sizes.

Multi-Functional Seating Regard's modular seating can be combined to serve purposes for several different occupants' needs. An end seat allows sole individuals to sit comfortably by themselves, while the couches provide an intimate seating arrangement for those looking to interact with others. The other end offers a work space that can be used for signing in or working. An end panel creates separation and can be used alternately as a wayfinding element.

Loveseats Offer an intimate seating arrangement for family and friends. Can be arranged for a social setting.

Freestanding Chair & Table A freestanding chair and table allows flexibility for seating to be arranged for individuals to sit by themselves or for groups to add additional seating to a fixed arrangement. An additional table can create a comfortable social distance and function for several needs.

Ottomans A cushion provides comfort while the small size allows for easy rearrangement. Allows for patients to sit in any direction which is comfortable for the occupant.

Bench Seat Allows for several occupants to sit comfortably for an extended period of time. The shared table can be used for work, meals, or play. The side of the table can be used for an additional seat if needed.

118

retail medical clinics

Steelcase Health 119

waiting + privacy / variables to consider

WAITING ROOM BOUNDARIES

American-Sino Hospital Completely Open Often reception desks are oriented to face seating and circulation in order for the patients to be able to see where they are in line. The reception area becomes a major focal point in this arrangement which can provide a sense of security for the patient. They can be reassured they have not been forgotten if they can be seen and are able to see the staff. Setting the reception desk a few feet away from the seating area and creating thresholds in the floor will assist, and separating the queuing line does not interfere with circulation or the waiting area. Setting the start of the queuing line at least four 120

American-Sino Hospital feet from the reception desk will help ensure a patient's auditory privacy. Providing too many seats wastes space, while too few is worse because of the perception of crowding, lack of available choices, and forcing patients to stand or move.

This could cause additional stress or discomfort for patients. It is important to find a balance between the need for peak demands and conserving space. Seating should accommodate a wide range of users, groups' sizes, social interactions, and distractions for passing time. A flexible grouping to allow for an additional chair should be considered.

retail medical clinics

Structural Grid

er Low

ing

Ceil

Rece

ar

im

Pr

ption

n

tio

ula

irc

yC

PCC Austin Family Health Center 121

waiting + privacy / variables to consider

122

Tenteki 10 Omotesando

L2ds Women's Medical Clinic and MRI Center

Separation at Seating If patients wish, they should be able to avoid the gazes of others. Therefore, not all seating should be oriented face to face. People typically prefer having their backs against a wall or divider. Typical side by side arrangements inhibit social interaction which may be desirable. Seats with armrests provide some sense of separation from the neighboring seats. A patient's needs for privacy varies for each individual.

A patient might seek solitude for contemplation or a personal connection with family, friends, or with the medical staff. They also may need to be able to protect their personal information about

themselves from strangers. It is in violation of HIPAA guidelines and a threat to a patient's privacy to discuss a patient's condition within earshot of others. Therefore, it is critical to provide some separation between the exam room and the waiting area. Two significant factors in reducing unwanted sound are adjacency and materials. Providing walls around a seating area with sound absorbing materials can reduce unwanted noise as well as increase speech intelligibility. At the same time, this would serve to reduce any potential violations of speech privacy.

retail medical clinics

Ce

ilin

g

tion cul a Cir ary Prim

Adjacent Entry

er

Implied Boundary

Lo w

Obata Clinic 123

waiting + privacy / identifying patterns

Grace Hill Neighborhood Health Center Walls & Curtains Private areas should be differentiated from more public areas through the use of implied or real thresholds and features such as lowered ceilings, changes in floor level, floor/wall/ceiling materials, and variations in lighting. This could be accomplished by utilizing a half wall, opaque glass, columns, level changes that are ADA compliant, or alcoves. Locating bathrooms or other rooms between waiting and exam rooms will give isolation from corridors or larger function areas. A waiting area that is entirely open to the space around it, that is just distinguished by the floor, ceiling, or seating 124

arrangement, is typically not comfortable for patients who are completely exposed. Finding a balance between a completely exposed area and a completely enclosed room is ideal. By creating a semi-private space, patients can observe everything around them while still maintaining privacy. To accommodate varying degrees of visual and acoustic privacy that can be adjusted, provide elements such as movable screens, dividers, and curtains. Provide furniture that can be rearranged and a space that can accommodate different arrangements. Provide lighting, television, and control of music.

retail medical clinics

g

tin

te

ra

S

a ep

h Lig

d

plie

Im

ld

sho

re Th

Primar

y

Seco

ndar

y

Regent Insurance 125

waiting + privacy / variables to consider

99c Company Complete Enclosures It is uncommon for healthcare facilities to completely enclose patients in a separate room because the staff would have less visibility of their patients. However, complete enclosures offer great auditory privacy from circulation paths and other programs. Healthcare clinics are impacted by noise, speech privacy, speech intelligibility, and music.

Noises can be masked or canceled out through ambient sound generated electronically. These noise canceling devices can be integrated so as to be unnoticeable. Architectural elements such as dropped ceiling baffles and additional acoustic

126

material can further control voice levels. Music can also contribute to acoustical privacy as well as having a positive effect on a patient's health.

retail medical clinics

Lower Ceiling

vels

ht Le

Imp

lied

Thr e

ating

ary

d Se

Prim

Fixe

Circ u

latio

n

Adjustable Divider

r Lig Lowe

sho

ld

Barcode Office 127

waiting + privacy / variables to consider

ENVIRONMENTAL FACTORS

Schiphol Airport Artificial Lighting Private areas should have lower light levels.

Patients who feel they have no control over their waiting time and left with nothing to keep themselves busy may perceive their quality of care more negatively. Another way for patients to have control over their environment would be to provide them with adjustable task lighting. Innovative lighting systems at Schipol airport have been implemented which automatically dim or turn off when the boarding process is underway or the gate is not in use.

128

Natural Lighting Where possible, natural lighting should be provided.

A shading device should be accessible to patients so that the amount of light can be adjusted.

Patients will generally feel more positive about their experience and well being if they have a sense of control over their physical surroundings. Waiting without any distractions or activities to keep oneself busy creates a sense of powerlessness.

retail medical clinics

Werribee Mercy Hospital 129

waiting + privacy / identifying patterns

Children's Hospital of Alabama Designated Colors Vinyl floor finishes perform well with regard to stain resistance, underfoot comfort and safety, low maintenance, durability, and good acoustics.

Multiple colors are used in floors to enrich design features and meet patients' psychological needs.

Meandering designs on corridors are architectural elements for guidance regarding patient flow. The circular space at the nurse station and waiting area create a stop point for patients with hints of personal boundaries to be respected.

130

Centrifugal seating arranged adjacent to the main architectural element is intended for strangers to reduce eye contact and contagion risk.

retail medical clinics

The Royal Children's Hospital 131

waiting + privacy / identifying patterns

Children's Hospital of Philadelphia Natural Elements Windows with views of nature can provide a form of distraction to those who enjoy viewing pleasant natural scenes. Attractive views provide the patients relief and pleasure. Indoor natural elements such as atriums, greenhouses, planters and window boxes also allow for the users to benefit from the natural view without leaving the building.

132

The Royal Children's Hospital Children's hospitals are adopting family friendly policies to make an often painful experience less traumatic for parents and children. An aquarium in the waiting space of The Royal Children's Hospital affords a good distraction.

retail medical clinics

The Royal Children's Hospital 133

waiting + privacy / identifying patterns

Nationwide Children's Hospital Arts for Healthcare Nature could also be represented in the waiting room in the form of interior-design elements, such as color, furniture, carpet, and painting.

Art, including scenes of natural elements, could help to reduce stress and anxiety. Nationwide Children's Hospital in Columbus, Ohio, has a 'Magic Forest' in the main lobby. The arts are recognized as a powerful tool to aid patients and families dealing with challenging circumstances. The Society for the Arts in Healthcare reports that roughly half of US hospitals are using the arts to support the well being of patients, families, and staff, to create a healing 134

The Royal Children's Hospital environment, and to lower stress and anxiety. A variety of art works such as sculpture, glass, kinetic and lighted works fill the hospital with visual delight.

In clinical settings, art work is used by staff to help distract and relax patients so that procedures go more smoothly.

retail medical clinics

Nationwide Children's Hospital 135

IDENTIFYING PATTERNS The physical setting affects a patient's health.

Reduced stress results in improved healing.

This comes from a sense of control over one's environment with a key component being confidence in the privacy offered in rooms where medical questions are asked and care is administered. An added benefit is that less stressed patients will contribute to less stressed staff.

136

waiting + privacy / identifying patterns

PATIENTS’ SATISFACTION IN WAITING For patients’ satisfaction, healthcare givers such as CVS Health MinuteClinic should synthesize both their physical and psychological needs. For the physically handicapped, MinuteClinic should guarantee wheelchair access, have the text on signage and computer screen easy to read, and have the appropriate tilt angle of the computer screen for people in wheelchairs. Wheelchair seating should be offered in waiting areas, and the bathroom should meet the needs of ADA. The majority of patients congregate in groups such as parents with children.

When patients walk into the MinuteClinic, they should feel comfortable in the environment.

Amenities are important, but an emotional connection as well as a physical connection must be made. When receiving the next patient in the waiting area, the NP could come and greet the new patients at their seats by saying, “I will be with you soon.” It conveys the sense that “We know that you are here.” For those who have chronic medical conditions, their relationship with the NPs are more prolonged, and they will be more satisfied if they feel the NPs are compassionate.

138

retail medical clinics

Privacy and Data Security Given the rapid digitization of sensitive information, privacy and data security is a universal concern.

They have become the new drivers of brand and reputation for healthcare suppliers. In order to retain current patients and attract new ones, businesses must demonstrate that they are engaged with the issue on a daily basis and in a meaningful way.

A patient’s needs for privacy varies for each individual. Some people think installing video surveillance cameras in public places is a good idea because they may help security. Other people think this a bad idea because surveillance cameras may infringe on people’s privacy rights.

A majority of people report either no change in the security of their data or that their data is less secure than it was five years ago.

57% 43%

No change or less secure

More Secure

People’s attitude towards video surveillance cameras 63%

Visual privacy also impacts willingness to disclose sensitive information. When answering a questionnaire, those who value privacy passed on nearly 2x more sensitive questions when they did not have a visual privacy on a computer compared to those who did.

Good Idea

19%

18%

Bad Idea

Not Sure

Who values visual privacy more?

50 61 % Men % Women

WITH WITHOUT with without VISUAL privacy PRIV ACY VISUAL ACY visual visualPRIV privacy

5.5 9.2 Passed Questions

%

49 52 61

AGE 18-26 26-35

36-45

59 46-55

65 55+

139

waiting + privacy / identifying patterns

WORKING ENVIRONMENT % of the most highly engaged employees value work environment that allows them to:

98%

97%

concentrate easily

88%

When we try to work on a project, we get interrupted every 11 minutes (on average).

140

97%

feel relaxed, calm

the consequences of distraction:

MIN FOR INTERRRUPTIONS

work in teams without being interrupted

95%

choose where to work within the office, based on their task

11

95%

greely express and share ideas

23

MIN TO RETURN TO FLOW When we get interrupted, it takes us up to 23 minutes to get back into FLOWthe state where we are deeply engaged.

feel a sense of belonging to their company and its culture

5

IQ POINTS FOR MULTI-TASKING When women are multitasking cognitive capability is reduced to 5 IQ points

11

IQ POINTS FOR MULTI-TASKING When men are multitasking cognitive capability is reduced to 15 IQ points

retail medical clinics

Ideal Working Environment A survey conducted by the global research firm IPSOS shows a strong correlation between employee satisfaction with their work environment and their level of engagement.

Only 11% of respondents were highly satisfied with their work environment; they were also the most highly engaged. These respondents agree their workplace allows them to: Viewable angle 140o

Display

The Consequence of Distraction Researchers’ work has proven that any belief that people can successfully multi-task is essentially wishful thinking. Humans can give controlled, full attention to just one thing at a time. When we try to pay attention to any two memory-dependent tasks at once, we’re easily distracted and end up doing neither one well.

Problems of the “Open Door Policy” Without question, successful interaction between patients and NP requires easy access to each other. But it also requires giving NP the time and place to focus. Having NPs back and computer screen exposed to the corridor shows neither welcome patients nor delivery enough privacy for NP as necessity. It may also leave patients’ personal information vulnerable to unwanted prying.

141

waiting + privacy / identifying patterns

CASE STUDIES

Medway. MA 142

retail medical clinics

Wellesley, MA 143

waiting + privacy / identifying patterns

COMPONENTS COMPONENTS Here is a comparison between MinuteClinic waiting rooms primary components to a typical healthcare Comparing a Minute waiting room’s primary facility’s waiting area Clinic components.

First, note the components to a typical healthcare facility’s diagrams below showing the average spacewaiting given area components. First, note the diagram at the left to a waiting area in a CVS Health MinuteClinic shows the average space given to a waiting area and a typical healthcare facility. The diagram to in a CVS Minute Clinic. In addition to the average the right shows a comparison between these two number of visitors. Same info provided for a typical models. At the top of the red line, you can see the health care facility. provided (quantity) for each particular component The diagram to the right shows a comparison at a typical healthcare facility. To the bottom of the between these two models. At the top of the red line is the quantity provided for each component line, you can see the provided (quantity) for each at a MinuteClinic waiting room. Seating, restrooms, particular component at a typical health care reception, kiosk and entertainment arequantity the facility. To the bottom of the line is the components considered in this analysis. provided for each component at a Minute Clinic waiting room. Seating, restrooms, reception, kiosk, and entertainment are the components condsidered in this analysis.

Dedicated space for waiting in CVS minute clinic

Didicated space for waiting in CVS minute clinic

144

Avg. Healthcare Wait Minute Clinic Wait

Seating In an average health care facility, 15+ proSeating vided for visitors.

In an average health Where in Minute care facility, 15+ provided for visitors.

Clinic provide at Where in Minute Clinic max 4-5 seats provide at max 4-5 for visitors. seats for visitors.

Ave. Healthcare Wait Minute Clinic Wait

Reception In an average health care facility, reception Entertainment Restrooms Reception desk Entertainment provided In an average average health In Inanan average In an average health care care facility, facility, TV providedhealth for care health care facility, for visitors. reception desk visitors. visitors. Where in Minute facility, TV gender Specific provided for visitors.

Clinic very minimal provided for restrooms, 2+ pro visitors. entertainment provided. visitors. Where vided for visitors.

Where in MinuteKiosk in Minute Clinic in a minute clinic a very minimal Clinic provide at kiosk replaces the max 1 bisexual need for a reception entertainment provided. restroom provided desk. for visitors.

Dedicated space for waiting in a avg hospital

Didicated space for waiting in a ave hospital

retail medical clinics

Wellesley, MA Wellesley

145

waiting + privacy / identifying patterns

WALKING DISTANCE Here is a comparison between the waiting room travel distance to the Clinic surrounding in a Comparing a Minute waitingfunctions room traveled CVS Health MinuteClinicfunctions and a typical healthcare distance to surrounding to that of a facility.

First, note the diagrams below that show at typical healthcare facility.

First, note the diagrams the left average space given tospace a waiting area a CVS shows the average given to ainwaiting Health addition to the average areal inMinuteClinic. a CVS MinuteInClinic.

In addition to the number visitors.ofSame information providedfor average of number visitors.

Same infoisprovided for a typical health-care facility. The diagram to a typical health-care facility. the shows in green, the distance traveled to The right diagram to the right shows in green distance nearby a CVSfrom Health MinuteClinic traveledfunctions to nearbyfrom functions a CVS minute and light showing the same but from clinicthe and thegray lightisgray is showing the same but a typical healthcare facility waiting area. area. from a typical healthcare facility waiting For instance the diagram illustrates how far the distance traveled to an outdoor view which is very furthest in a Minute Clinic compared to a very small distance from the wait area in a regular healthcare facility to an outdoor view.

Didicated space for waiting in CVS minute clinic

146

Didicated space for waiting in a ave hospital

retail medical clinics

147

waiting + privacy / identifying patterns

148

Signage, ceiling and lighting change

Partial screen wall and half wall

Floor change

Signage and tall vertical screens

retail medical clinics

Privacy Curtain Privacy curtains are simple devices providing a measure of visual privacy on a temporary basis. The privacy curtains are frequently contaminated with potentially dangerous bacteria. There are several strategies to help deal with this issue:

1. Ensure the NP would have hand washing after pulling the curtain and before seeing the patient 2. More frequent disinfecting. The edges of privacy curtains with frequent hand contact should be cleaned and/or disinfected more frequently.

3. Using microbial resistant fabrics, and guarantee the polyester fabrics comply with the required NFPA 701 fire code

149

waiting + privacy / identifying patterns

1 1

4 4

2

3

Medway

150

1. The pharmacy counter and retail shopping are directly adjacent and provide no separation.

3. Refitted exam rooms bump out into the retail area leaving no dedicated waiting area.

2. Exam room walls create clear separation between patients and the rest of the store.

4. The kiosk faces the retail shopping space and provides no separation from the public

retail medical clinics

6

2

7

1

4

33

55

8

Wellesley 1. Tall vertical screens perpendicular to patients direct conversation to those behind the counter.

5. The pharmacy waiting area is bounded by the back of a shelving unit

2. Diagonal walls to retail shopping implies directionality for private conversations.

6. Walls 90 degrees to path beyond waiting area creates implied space dedicated to seating.

3. Shelving set parallel to the pharmacy creates implied threshold of counter service privacy.

7. Doors adjacent to seating creates potential for exam room conversations to be overheard

4. Change in material on floor separates retail

8. Partial screen wall creates flanking path 151

waiting + privacy / identifying patterns

PATIENTS’ EXPERIENCE

Medway The “L” shaped healthcare department have MinuteClinic adjacent to pharmacy. However, the different decoration style and color coding isolate one from the other. Privacy of check in and waiting is limited. Only some visual privacy could be achieved by unaware block of sightline by shelves.

152

retail medical clinics

Wellseley The healthcare department have unified decoration style. Curved ceiling with the same headroom help defining the space underneath. One more threshold from retail store to MinuteClinic is created by floor material change and a partial screen wall to guarantee more privacy for the patients.

153

waiting + privacy / identifying patterns

Medway Personal Space The amount of personal space we need varies from person to person, relationship to relationship, culture to culture. Psychologists say that we begin to develop our elbow-room preferences by age 3 or 4, and they’re cemented in adolescence. We actually have four space preferences: intimate - within 1.5 feet (family, close friends) personal - 1.5 feet to 4 feet

(friends and acquaintances)

154

retail medical clinics

Wellseley Over Exposure of Personal Information social - 4 to 12 feet

(strangers and new acquaintances, for

routine social interaction) public - beyond 12 feet Patients need to be able to protect their personal information fro strangers when check in. However, visual privacy could not be guaranteed just by keeping waiting distance. Taller people could easily see the screen over the shoulder of those standing in the front.

155

waiting + privacy / identifying patterns

Medway People Pass Through There are no clear boundaries between the retail and the MinuteClinic in Medway CVS Health, and due to the mixed-use of space, there is chaos of retail customer flow passing through check in and waiting space. Retail customers and MinuteClinic patients have their activities violate by each other.

Furthermore, people who would like to read the notice board would have also have to intrude the “intimate� space of the checking in patient.

156

retail medical clinics

Wellseley Expose to Waiting The Wellesley MinuteClinic has its waiting seats at the back of check in kiosk, which increase the exposure of personal information. The MinuteClinic is independent of the other departments. The flaws of streamline are: staff and retail clients would have to pass through the check in and waiting area to bathroom. waiting would be disturbed if there is a long queue for check in, to receive patients, the NP would have to interrupt the line of waiting.

157

waiting + privacy / identifying patterns

Medway Pharmacy The pharmacy waiting area in Medway CVS Health is bounded by the floor material change and ceiling height adjustment. Waiting seats are arranged against the wall of the storage and are exposed to people come and go. Shift of floor materials help created a waiting line to have people take a queue behind.

158

retail medical clinics

Wellseley Beside the hints of decoration elements, the Wellesley CVS Health has low shelves to help emphasis the boundary and have sitting patients embraced with side boards. The seats are rotated to avoid direct eye contact of sitting and standing patients. Another new element involved to express boundary is signage.

159

waiting + privacy / identifying patterns

SIGHTLINE PRIVACY ANALYSIS SIGHTLINE PRIVACY ANALYSIS

Medway, MA Medway

160

retail medical clinics

Wellseley, MA Wellesley low to low tohigh high 161

waiting + privacy / identifying patterns

PERCEPTION OF PRIVACY

Medway, MA Medway 162

retail medical clinics

Wellseley, MA Wellesley low to high 163

BRAND + PLACEMAKING + ENVIRONMENTS brand blend 166 interior environment design 190 graphic design + wayfinding 220

165

BRAND BLEND The implementation of retail medical clinics requires a branding strategy to mediate between retail and clinic. How do these stores blend two different programs using branding, signage, and environment?

This section covers the current state of the CVS Health marketing image, its evolution of graphics and signage, the blend of retail to clinic (both CVS Health and comparable clinics), and an analysis of brand psychology.

166

167

brand + placemaking + environments / brand blend

CVS HEALTH MARKETING IMAGE CVS Health MinuteClinic focuses on making basic medical attention easy and simple. It is advertised as “your neighborhood medical clinic” on CVS Health.com. Patients’ personal schedules and convenience are emphasized by making available walkins, online scheduling, and easy-to-use interfaces; the website states “quality medical care on your schedule”. MinuteClinic also focuses to payment easy, allowing the use of most health insurance plans.

The marketing image is coupled with a wellness initiative throughout CVS Health. Store signage emphasizes quitting smoking and promotes diets. Use of the MinuteClinic is also encouraged by associ-

168

ated shopping promotions throughout the store.

In CVS Health signage, Nurse Practitioners are portrayed in a very professional and friendly medical light. They are pictured wearing stethoscopes around their necks and white lab coats with blue button-downs underneath. The focus with this signage is to stress patients’ access to real people and faces; a very welcoming professional image.

MinuteClinic was originally seen as an add-on to CVS Health stores spatially and via signage and branding. It is now trying to integrate more seamlessly with the pharmacy. In addition, it is being distinguished from the other “departments” such as vitamins, food, and cosmetics.

retail medical clinics

169

brand + placemaking + environments / brand blend

CVS Health is comparable to many different types of stores. Their types of services overlap with other pharmacies, many department stores, and even well-known convenience stores.

Types of Services clinic CVS Walmart Target Walgreens Rite-Aid Tedeschi 7-11 Wawa

170

food

snacks

toiletries

lottery

pharmacy

medication

retail medical clinics

CVS Health = “Convenience” CVS Health has obtained a “convenience” reputation over the course of their existence. It is the quick and easy place to go for simple groceries, toiletries, and medication. They offer more services than a classic convenience store like 7-11, and in a higher quality environment.

How could this branding strategy be maximized?

The idea of a convenience store often times has a negative connotation because these stores are often dirty, cramped, and messy. However, the best part of these stores is how quickly one can go in and out of the door with their desired purchase. By placing a different type of display close to the counter, customers have a “grab-n-go” area. The larger back-of-store layout remains for longer shops. The new displays can have a grocery store feel where common wellness products are easily accessible.

slower back-of-store layout

proposed “grab-n-go” front layout shortest distance from product to purchase to exit

171

brand + placemaking + environments / brand blend

Character of Healthcare Brands CVS Health has placed all their retail and special service divisions underneath the new umbrella of CVS Health Health. The new logo is being integrated into much of the new marketing materials and interior retail signage. The red heart logo evokes good health and personal care. The “health� text seemingly tries to appeal to all users in a playful manner.

172

Other major healthcare brands such as Blue Cross Blue Shield, Cleveland Clinic, Partners Healthcare, Spaulding Rehabilitation, Athena Health, or even Massachusetts General Hospital all vary in their own brand character. A common theme between healthcare brands is the blue-dominated color scheme. Some brands, like CVS Health, are branching out.

retail medical clinics

blue-dominated color scheme

other colors introduced

173

brand + placemaking + environments / brand blend

EVOLUTION OF GRAPHICS AND SIGNAGE CVS Health Health has a new corporate logo as noted previously; it is the umbrella organization for more recognizable logos such as CVS Health/pharmacy and CVS Health/MinuteClinic. MinuteClinic was acquired by CVS Health in 2006, the familiar logo began in 2002 when the name was changed to MinuteClinic. In 2006 the “pill and cross” logo was introduced and the red and blue color scheme continued. In 2009 the firm ImageHaus Branding created the “think MinuteClinic” logo. Finally, in 2013 a logo visually congruent with the CVS Health/pharmacy logo was introduced. It is all red and of the same font.

174

There is an explicit written connection between MinuteClinic and CVS Health/pharmacy in the logo.

Later on, the “pill and cross” logo morphed into the current CVS Health Health squared heart. The images on the right show an airport advertising campaign utilizing CVS Health Health’s new logo scheme.

retail medical clinics

175

brand + placemaking + environments / brand blend

Older signage example:

176

retail medical clinics

New test stores in-store signage began as hanging triangle signs identifying aisle numbers, products, and contained MinuteClinic advertising. New store designs employ “pavilions” for each “department” with small color-coded signage on top of shelving.

This effectively eliminated hanging signs in the newer stores. The department store aesthetic continues with larger department lettering on the walls rather than hanging signs.

Newer signage examples:

177

brand + placemaking + environments / brand blend

Exterior Experience The CVS Health brand is first encountered physically from the exterior. The enlarged acronym text helps to make CVS Health stand out from the surrounding brand habitat. It is quick and easy to read, aiming to be the first thing seen before other brands. CVS Health will often have its own standalone sign to create a presence on the street in setback situations. The retail exterior also has its own hierarchy of branding, where the MinuteClinic and the sub-sections of the store (beauty, liquor, etc) are expressed through signage. In addition, CVS Health branding is able to somewhat seamlessly fit into situations with mandated style.

178

retail medical clinics

179

brand + placemaking + environments / brand blend

RETAIL TO CLINIC BLEND

180

CVS Health

Other Clinics

As noted previously, MinuteClinic has new signage in congruence with CVS Health/pharmacy, distinguishing itself from retail sections of the store. The clinic area is around 400sf (exam rooms and waiting area). Given the total store area of 12,000sf, this gives 3.3% of the store to the clinic. Using the CVS Health Dedham store as an example, the percentage of signage for the MinuteClinic is higher than its area. Of the 21 total signs inside and outside the building, 7 of them are clinic signs, raising the clinic’s percentage of total store signage to 33%. In addition, the current MinuteClinic logo describes the clinic as “the medical clinic in CVS Health/pharmacy”, giving it a clear connection to the retail portion. The MinuteClinic is also connected to the retail through in-store shopping promotions for clinic users.

Other retail clinics are located in prominent stores such as Target, Walgreens, and Walmart. The Target Clinic was branded in 2006, fully integrated with Target’s logo.

Walgreens acquired “Take Care Health Clinic” in 2007. It was rebranded as “Take Care Clinic at select Walgreens”, using “at select” to associate but not combine the brands. It was rebranded again in 2013 as “Healthcare Clinic”, the logo disassociating from the Walgreeens logo.

In 2007, Walmart announced “The Clinic at Walmart”. The original logo included the Walmart logo, using the word “at” to associate the brands. In 2014, Walmart rebranded it as “Walmart care clinic” with the tag line “quality healthcare at an everyday low price”. The 2014 branding includes a new stethoscope logo with the Walmart logo inlaid.

retail medical clinics

181

brand + placemaking + environments / brand blend

Character of Spaces Target, Walgreens, and Walmart all have clinics that are in some way distinguished from the main store.

Their signage, images, and materials share some similarities with CVS Health MinuteClinic.

Target Clinic images of nurse in lab coat similar to CVS Health and Walgreens color scheme and architecture fit nicely into existing store design

frosted glass gives privacy feel

182

retail medical clinics

ominous back door facing entrance; limited barrier from rest of store

The Clinic at Walmart

Healthcare Clinic (Walgreens)

same nurse representation; general clutter of signage

wood flooring designation

183

brand + placemaking + environments / brand blend

BRAND PSYCHOLOGY Brand Psychology can play a key role in the portrayal and acceptance of a brand in the eyes of the consumer. CVS Health uses Helvetica Black for their text. It is known for its sleek lines and modern sensibilities. Historically, it has been used by companies who were looking to remake their identities.

It is known as a very “safe� font with little impact by itself. Many prominent companies use Helvetica Black, including Panasonic and American Apparel.

Helvetica Neue Designer: Max Miedinger Classification: Sans Serif

184

retail medical clinics

185

brand + placemaking + environments / brand blend

Along with the original CVS Health red, MinuteClinic uses a cyan blue. Green is also being introduced throughout the CVS Health retail environment. Red has characteristics of action, power, energy, and speed. It is attention-getting, motivating, stimulating, and energizing. This is a color which encourages buyers to take action and make a purchase. Blue evokes loyalty, trust, integrity, as well as peace and calm.

Light blue relates well to the health and wellness industry, as well as to travel and relaxation. Green is known to be sympathetic, compassionate, and nurturing. It is an ideal color to promote natural and safe products.

186

retail medical clinics

Colors deployed by CVS Health MinuteClinic:

Color psychology is the study of color as a determinant of human behavior

- Action, power, energy, speed

- Loyalty, trust, integrity

- Attention-getting, motivating, stimulating, - Tactful, caring and concerned and energizing - Reliability and responsibility - Driven and determined - Conservatism and perseverance - Exciting, warm, assertive and confident - Peace and calm - This is a color which encourages buyers to take action and make a purchase - Often used as a warning sign, it is best used as an accent color too much red can overwhelm

- Recommended for business involved in the area of cleanliness - Light blue relates well to the health and wellness industry, to travel and relaxation

- Sympathetic, compassionate and nurturing - Emotionally balanced and calm - Adaptable and flexible - Reliability and dependability - Green is beneficial for anything to do with health and healing - An ideal color to promote a natural and safe products - Suggests something ‘new’ and fresh

187

brand + placemaking + environments / brand blend

If CVS Health Stood Alone Like many stores, CVS Health has its own “generic” brand of almost every product, from medicine to water. Much of the strategy for this branding lies in the pricing and placement in comparison to the “name” brands on the shelves. Many customers purchase this generic brand due to the price point and similarity to the name brands. They are, however, seen as of lesser quality in comparison.

What if the CVS Health brand stood alone? Would it gain a better reputation or newfound sophistication? Or is it too close to the competition?

“Name” brand vs. CVS Health brand:

188

retail medical clinics

189

INTERIOR ENVIRONMENT DESIGN The interior environment design of a space is what gives the user the ability to easily and effictivley use the space. The overall design for CVS Health MinuteClinic’s signage and wayfinding system is incredibly important for not only the general circulatory scheme of each clinic, but to the identity of CVS Health and its patients. Key organizations, like the SEGD, award designs that promote the use of expieriental and environmental design tactics in order to create a more pleasant expierence for their users.

190

191

brand + placemaking + environments / interior environment design

COLORS AND HOSPITAL INTERIOR DESIGN PSYCHOLOGY Human Response to Color: The response of the body and mind to color is influenced by cortical activation, the autonomic nervous system and hormone activation.

Color evokes emotional responses that produce feelings of serenity or agitation that can aggravate or alleviate stress. Color can also affect an individual’s emotional state, inducing cheerfulness, agitation, or calmness.

Effect of Color on Human Health: 1. Colors Possess arousing or calming properties 2. Colors have advancing or receding properties 3. Colors affect the sense of spaciousness 4. Colors affect the psychophysical judgment of time passage 5. Colors affect thermal comfort 6. Colors affect other senses Color and Health: Color can affect our brainwaves, emotions, and biological systems. Colored surfaces and colored light have the ability to increase and decrease heart rate, blood pressure, respiratory rate, and body temperature, and can be used to treat cancer, depression, and bacterial infections. Color therapy, or chromo therapy, is the “practice of using colored light and 192

color in the environment to cure specific illness and in general to bring about beneficial health effect”.

Historically, ancient Egypt and certain Asian cultures’ use of colors as a healing too were common.

Our bodies are like prisms; we absorb white light and, thus, all colors. Difficulty in breathing can be offset by natural light filtered through yellow glass.

Migraine headaches can be treated with sunlight filtered through blue glass. Depression has been known to be treated with red light, and nervousness and irritability with blue light. A sore throat can be eased with the use of green light. Individual who has lost their sight can have their mood affected by the transmission of colored light, releasing a hormone in the hypothalamus that controls mood.

retail medical clinics

Design Based Principles

Pre-EBD

No privacy Neutral colors Lack of control No stimulation Formal environment

Materials with poor Comprehensive Performance

Experience Based Design EBD

Privacy Light colors Environmental control Stimulation Connection to nature

Materials with good performance in acoustic, antibacterial, stain resistance

Post-EBD

Individuality Stimulation Environment control Bright and engaging Themed design Technology Materials have good physical performance and have psychological needs in concern 193

brand + placemaking + environments / interior environment design

Hospital Room

Pre-EBD

Plastic Furniture Neutral tile floor and white panel wall

Experience Based Design EBD

White Furniture Light wood floor and wall cover

Color palette and materials are opposite in these exmples while the plan layout is somewhat similar 194

Post-EBD

Dark Furniture Dark wood floor and wall cover

retail medical clinics

Wall and Ceiling Finish in CT Room

Pre-EBD

Neutral floor tile Neutral wall color Fluroresent Lights

Experience Based Design EBD

Storage place like cabinet in the kitchen. Wood floor and latex paint walls make patients feel like home

Post-EBD

Photo murals of nature scene.

Sand-colored vinyl flooring helps mimic the feeling of being in nature

The EBD example is trying to create a home-like environment, and the Post-EBD is inteded to mimic nature. Their targets are to relief patients.

195

brand + placemaking + environments / interior environment design

Floor Finish of Corridor Experience Based Design EBD

Pre-EBD

Neutral tile floor Neutral wall colors Tiled ceiling pieces.

Grey colored vinyl flooring helps soothing atmopshere, subtle coolness

Post-EBD

Multiple colors are used to enrich design features and meet patients psychological needs

Advantages of vinyl floor in hospitals: Underfoot comfort and safety, good acoustics, durability, low maintenance and resistance 196

retail medical clinics

Lighting in Patient Rooms

Pre-EBD

Plastic Furniture Neutral tile floor and white panel wall

Experience Based Design EBD

Circadian rhythm lighting supports each patient’s circadian rhythm

Post-EBD

Red light helps recovery and blue light helps reduce inflammation

Except its physical functions, lighting would also help healing the patients.

197

Hotel

Spa

Traditional Hotel

Contemporary Hotel

198 tro

24 h

te

Ro

yee

s

e

t/

te

ois

eN om

Wh it

r. E mp lo

Pri va

c/

ligh TV

ver

s

Pa lle

che

lor

en

lo

Co

tS cre

no

Mu si

Fla

Co

ing

Va ry

nts

t

s

ne

he

ter

l

ou

/C

s In

les sk Pla

De

Wi re

/P oo

ice

lS erv inis

r. M ea tur al F m

Gy

Na

24 h

tem pe

rat u

re

brand + placemaking + environments / interior environment design

Room Amenities

retail medical clinics

“Fancy”

Clinic/Lab

Healthcare

Hospitality

“Not Fancy” 199

brand + placemaking + environments / interior environment design

SIGNAGE + SEQUENCE The sequential order in which an individual sees the wayfinding signage is critical for accessability and general circulatory ease of a space. Specifically with CVS Health and MinuteClinic, there are key locations in which signage is also placed in order for the user to better understand their surroundings.

In the following pages, the Medway CVS Health and MinuteClinic will be examined to identify these major wayfinding points. As with the entire CVS Health brand, the user is immediatley drawn to the bright red color and sleek typeface, Helvetica Bold, that make up the CVS Health brand. Starting from the street and parking lot, there is a large scale sign which allows cars and pedestrians to know the CVS Health location from a distance. As you walk through the store there are sequential signs, ranging in size, that will you see which emphasize the location of the MinuteClinic and the overall healthy ideals that CVS Health has recently adopted. The overall concept is to attempt to put signage on all surfaces in order for the user to have a better chance to see them and become more easily guided throughout the store.

200

retail medical clinics

8 7

6 5

4

3

2

1

201

brand + placemaking + environments / interior environment design

1

202

2

retail medical clinics

3

4

203

brand + placemaking + environments / interior environment design

5

204

6

retail medical clinics

7

8

minute clinic

205

brand + placemaking + environments / interior environment design

AISLE TYPOLOGY

In old CVS Health models, along the edge of the stores was a single aisle against the wall with rows of parallel aisles running perpendicular to it. In this context, the user would walk the perimeter of the store, sometimes ignoring the interior aisles.

206

retail medical clinics

In old CVS Health models, aisles were laid out in such a way that the user would walk between two and end up at a dead end of another aisle, unaware of what occurs behind in.

207

brand + placemaking + environments / interior environment design

In new CVS Health models, aisles are not laid out directly parallel to each other, but some of the new health stations are located perpendicular to the aisles. This change in directions allows for a new line of site that becomes intriguing to the user and draws them in that direction.

208

retail medical clinics

In new CVS Health models, aisles are not laid out directly parallel to each other, but some of the new health stations are located perpendicular to the aisles. This change in directions allows for a new line of site that becomes intriguing to the user and draws them in that direction.

209

brand + placemaking + environments / interior environment design

EXPERIENTIAL GRAPHIC DESIGN Environmental graphic design is a design field in which practitioners are concerned with the visual aspects of wayfinding, communicating identity and brands, information design, and shaping a sense of place. Excerpts from the Architects Handbook of Professional Practice allow clear guidelines of what environmental graphic design, or EGD, is: - Integration of communications and architecture professions - Understanding how people move through and perceive space - Why a client may need these services:

- To create a strong visual theme and

brand identity

- To establish visual ties throughout a

complex or community

- To modify, correct or enhance existing

signage

- To create wayfinding systems - Knowledge of human factors include:

- Visual and lighting requirements

- Color perception

- Behavioral psychology

- Universal design principles - Healthcare clients are concerned about

- Communicating

- The image of comfort and quality

of care

- Memorable, enjoyable and easy

to navigate 210

retail medical clinics

211

brand + placemaking + environments / interior environment design

212

retail medical clinics

San-Ai Clinic Color and Signage Design MED Kagoshima Prefecture, Japan Dark blue walls in the reception area evoke a sense of reliability and are calming counterpoints to the brighter colors within System of simple vinyl letters and room numbers applied directly to the walls as a wayfinding system Chartreuse and orange were used in the rehabilitation rooms to exude feeling of healthfulness and energy Details like a painted clock and pushpins evoke happiness and smiles from patients Free of elaborate decorations Open space, high ceilings, no partitions Space divided into 12 functional areas - patients can move freely from one area to another Offset the clinical white walls and alleviate harshness and drudgery of physical therapy Using color, light and simple, playful graphics to instill “the will to continue the struggle�

213

brand + placemaking + environments / interior environment design

214

retail medical clinics

Randall Children’s Hospital ZGF Architects Portland, Oregon Overarching goal was to create a place full of inspiration, with a sense of unexpected discovery and thoughtful distractions Corian was selected as a base material for the interior design, providing a pure white backdrop that could incorporate curving forms as well as be durable and hygienic Four regionally inspired color palettes for interior finishes are used throughout the hospital to represent geographic diversity of the Oregon and Washington regions it serves.

Palettes were applied based on function of space: the neonatal intensive care unit reflects a tranquil coastal palette, while the emergency department uses an active desert palette Large-scale topography and iconography used to animate the space and aid navigation. Each hospital floor is assigned an indigenous animal an is repeated throughout the floor in a variety of materials Eco-friendly architectural glass includes whimsical pictograms to help with wayfinding and appear in surprising places such as at eye level of a toddler 215

brand + placemaking + environments / interior environment design

ASICS Australia HQ THERE Design Eastern Creek, Australia Highlight the company’s dual focus on movement and technology Layered large-scale imagery of athletes with technical data, sports terminology, and graphic abstractions of shoe soles to create an organic but “technical looking” graphic overlay Provide a stimulating environment while reminding staff and visitors of the company’s core brand values 3,000 sq-meter office with gym, Japanese garden, VIP luxury lounge, mini football field, running track, table tennis court, game room and five sportsthemed meeting rooms Harmonious integration of color, type, imagery. form and space

216

retail medical clinics

Adidas Laces kadawittfeldarchitektur Herzogenaurach, Germany Nicknamed “Laces� to describe the suspended walkways that crisscross its vast atrium, connecting departments and bringing employees closer together for collaboration and creativity.

Functional black-and-white color palette that offers a neutral canvas for the company’s colorful products.

In meeting areas on the upper floors, the white lettering appears to have been frozen in mid-movement, forming a mural relief Turbocharged typography runs through the design center - Words Identify places and become colored surfaces, reliefs and sculptures A colorful wayfinding system is integrated on white walls in blue, red, yellow, green and black The letters are sometimes 2D, sometimes 3D, sometimes surface mounted and sometimes freestanding

217

brand + placemaking + environments / interior environment design

Wal-Mart Retail Environment Lippincott Jacksonville, FL Departments are identified by a combination of large signage components and lifestyle imagery representative of the merchandise New store was created to improve customers’ in-store experience through a more consistent and less cluttered brand expression.

Clearly delineate grocery from general merchandise and to establish strong sightlines into key departments Through the addition of color to the walls, a more branded experience was created while also becoming friendlier and more approachable Graphics, information and price identification signage are used at the fixture level to merchandise products and communicate with customer Blue delineates general merchandise from grocery and reinforces the brand A kit-of-parts cornice elements throughout key departments changes out quickly and easily to make communications relevant and up-to-date.

218

retail medical clinics

Home Depot Design Center Little Charlotte, North Carolina Tall, numbered navigational pylons at important decision points along the racetrack provide visibility across the store By removing some of the perennial building and construction products the merchandise assortment evolved to accommodate products with design flair The graphic system emerges from the most recognizable shape in the Home Depot identity: the orange square The color palette was softened to reflect a more residential feel while at the same time remaining compatible with existing Home Depot colors Department signs incorporate internally illuminated icons accompanied by sepia-toned black-and-white photos printed on self adhesive vinyl Traditional departments such as hardware and paint have been supplemented with new showrooms arranged along a circular racetrack to enhance shopability

219

GRAPHIC DESIGN + WAYFINDING Wayfinding encompasses all of the ways in which people orient themselves in physical space and navigate from place to place. Information systems help to guide and enhance the visitors’ understanding and experience of a space. Graphic design is the methodology of visual communication and problem solving through the use of type, space and image.

220

221

brand + placemaking + environments / wayfinding + graphic design

low quantity

LOW QUANTITY

quantity of products

QUANTITY OF PRODUCTS

high quantity

HIGH QUANTITY

BRAND LOGIC

LOWvisibility VISIBILITY low

222

VISIBILITY visibi

OF of SIGNAGE ility signage

retail medical clinics

HIGH highVISIBILITY visibility

223

brand + placemaking + environments / wayfinding + graphic design

TRUE VALUE

True Value is the direct opposite of Apple on both axes. Signage extends to all surfaces of the space.

Along with the plethora of products offered and quantities of those items, the customer is bombarded visually. Like CVS Health it requires a degree of customer assistance for more specialty items like hardware and paint.

224

retail medical clinics

The newest CVS Health interior model falls on the lower left end of the spectrum. CVS Health offers a high variety of products as well as a high volume of stock on the shelves.

give the customer a panoramic view making the products more visible and easier to find. Signage takes place with in the user zone, similar to Barnes and Noble.

The store is based on convenience and a grab and go mentality. Customers do not require any assistance from the moment the walk through the door to the moment they check out if they choose to do so. Aside from specialty departments such as the pharmacy, photo or MinuteClinic, the store is completely self serve.

Lower shelf heights through the middle of the store 225

brand + placemaking + environments / wayfinding + graphic design

BARNES & NOBLE BARNES &&NOBLE BARNES NOBLE

Barnes and Noble falls in the middle of the spectrum on both axes. Signage is visible but not to the extent of the lower end of the spectrum. Large signs hang from the ceiling to mark the specialty departments not associated with the store’s main product, books. All other signs are mounted on the wall or book shelves just above the top of the shelf.

As the specificity of the signage increases the proximity to the user also increases similar the new CVS Health model. Unless the item is in high demand such as a best seller or new arrival, limited quantities are presented to the consumer, with extra stock located off the main floor.

226

retail medical clinics SAKS FIFTH AVENUE

SAKS FIFTH AVENUE

Saks Fifth Avenue is a high end department store that carries select merchandise. It falls in the upper right quadrant of the spectrum. While it does offer a wide variety of products, the selection is not as varied as CVS Health and caters to a specific demographic. Less of each item is displayed on the sales floor with a higher number of items only available with the assistance of a store employee.

There is a greater emphasis on the employee helping the customer from the beginning of their experience to the end and less signage to guide the customer on their own.

227

brand + placemaking + environments / wayfinding + graphic design

Coach is a high end store similar to Saks Fifth Ave, but only sells its own brand. The primary products sold in the store are handbags and wallets. The range of products offered are limited and change every season.

Items that are less expensive have higher quantities on the sales floor, while more expensive items on the sales floor are only for display. As with Saks, these items can only be procured from employees.

Unlike Saks there is no signage in the store, making the customer completely dependent on employees for product information and buying merchandise.

228

retail medical clinics

APPLE STORE APPLE STORE

The Apple Store is the extreme example on both axes. Both the interior and exterior of the store offer no signage to the customer.

The retail space is marked by the apple logo that has reached such icon status that the name of the company is not needed. The range of products is very limited and all items on the floor are for display and or trial.

The customer is completely dependent on employees for product information or purchase. The merchandise that the customer takes home is stored off the sales floor.

229

brand + placemaking + environments / wayfinding + graphic design

EXTERIOR LOGIC

120’

21’

42’

240’

20 42’ 240’

21’ 18’

120’ 100’

11’ 60’

18’

Store signage is not only dictated11’by code.60’Wayfindng system rely primarily on the user’s line of sight to convey information. Signage must not only be legible in term of its typeface, it must be appropriately sized to reach its targeted audience and convey the necessary information.

230

100’

Both the exterior and the interior have multiple layers of signage creating a visual hierarchy. The largest and most prominent sign is the store name.

It can easily be seen from long distances and safely read form a moving vehicle. The primary sign marks the location of the store and is placed on the

retail medical clinics

1” 25’ +/-

6” 60’-200’

9” 90’-400’

Primary

exterior facade. Code dictates the size, location, illumination and volume allowed for the sign and can vary greatly from one municipality to the next.

Secondary

Tertiary

signage highlights departments and store services, while the tertiary layer read at a point blank range gives greater detail about programs, store information and current promotions.

As the user moves closer to the store secondary and tertiary signage becomes legible. Secondary 231

brand + placemaking + environments / wayfinding + graphic design

Boston, MA Boston,MA

Huntsville, NC Huntsville, NC

The stores at this end of the spectrum are built in areas with strict building codes regulating the size, type and volume of signage. Signs on this end are usually in historically sensitive areas such as Boston’s Back Bay or are located in small towns where all signs in the area must be of similar size as to not dominate or draw more attention than another. They also tend to be very small, and not visible from long distances. They are geared towards pedestrian traffic rather than vehicle traffic.

232

Brooklyn, NY Brooklyn, NY

Chatham, MA Chatham, MA

Some shopping centers are very strict about the signage allowed. Uniform size, color and sign style create a cohesive appearance. In order to operate a business in one of these centers, brand identity becomes secondary to the identity of the shopping center.

retail medical clinics

Las Vegas, NV Las Vegas, NV

The middle of the spectrum is where the majority of suburban stores fall. Many of these stores are stand alone on their own property or detached buildings in large shopping centers. When the store stands by itself, it does not have to compete with other stores for visual dominance.

New Orleans, LA New Orleans, LA

Signage on this end of the spectrum is enabled because of less regulated codes. These signs are able to happen because of unique circumstances just as in the historic examples.

Las Vegas and New Orleans have large billboard like signs, that illuminate at night. In area where other buildings employ similar tactics, CVS Health must follow suit to stand out and draw in customers.

233

brand + placemaking + environments / wayfinding + graphic design

234

Main Street/Urban Infill

Suburban Box

This typology can be found in urban areas or small town main streets. The store is plugged into an existing building often on the lower level of a large office or residential building. Space is limited and the store must adapt to the conditions of the site.

Many of these are smaller store and only accommodate the highest sources of revenue.

The Suburban box is the largest of the typologies, These are stand alone stores on their own lot or a segregated lot of a larger shopping center. There is usually ample parking to accommodate the car culture of the suburbs. These are usually new construction and the company has the freedom to build whatever they want. In the case of CVS Health these stores are usually prototypes for new layouts and branding techniques.

retail medical clinics

Vernacular

Shopping Center Pie Slice

The vernacular model is a distinct aesthetic typology that can physically manifest itself as either the a stand alone suburban box or the shopping center pie slice. This typology is typically found in the northeastern US and mimics traditional housing styles. Gables, false dormers, and columns help the building blend into suburban neighborhoods where this type is most commonly found.

The pie slice occupies a space in a strip of other retailers in a suburban setting, Like the urban infill model the, slice must adapt to the space its given.

Some shopping centers have strict aesthetic guidelines that all retailers must follow. Exterior signage may be restricted to specific sizes and colors to create a cohesive appearance throughout the shopping center, so that no one store visually dominates another.

235

brand + placemaking + environments / wayfinding + graphic design

INTERIOR LOGIC Interior signage follows the same principles as the exterior. Larger signage placed high on the wall around the perimeter of the store is legible from long distances giving the user the ability to find what they need from across the store.

Primary signage also conveys more general information department locations and gets more specific moving into the secondary and tertiary layers. The secondary layer conveys aisle locations and merchandise categories while tertiary layer points out specific product locations. Moving form the primary to tertiary layer the physical size of the sign shrinks as the distance required for legibility decreases.

Interior signage is not as heavily regulated by building code and therefore is more consistent from store to store. Businesses are able to replicate their interiors much easier than the exterior creating a more cohesive and recognizable brand.

The CVS Health/pharmacy sign is the largest most dominant sign on the interior of the store. In older interior models, the hierarchy among department signs is less clear, the pharmacy sign holds the same weight as the other departments. In the latest model the CVS Health/pharmacy sign becomes dominant, taking precedent over all other signage.

236

retail medical clinics

tertiary

1/2”/12’ +/-

secondary 1”/25’ +/-

primary

4”/40’ +/-

237

brand + placemaking + environments / wayfinding + graphic designv

238

retail medical clinics

P P P Permanent Signage

Permanent Signage are primary signs and required signs by code. Generally, they are the ones closely connected with interior decoration. are primary signs and required signs by code. Generally, they are the ones closely connected with interior decoration.

Permanent Signage are primary signs and required signs by code. Generally, they are the ones closely connected with interior decoration.

Temporary Signage are secondary signs. They are normally freestanding and could easily be replaced by needs.

Temporary Signage are secondary signs. They are normally freestanding and could easily be replaced by needs.

Temporary Signage are secondary signs. They are normally freestanding and could easily be replaced by needs.

Mercantile Signage are tertiary signs. Usually, they help stimulate comsumption or communicate healthy lifestyle.

Mercantile Signage are tertiary signs. Usually, they help stimulate comsumption or communicate healthy lifestyle.

Mercantile Signage are tertiary signs. Usually, they help stimulate comsumption or communicate healthy lifestyle.

239

brand + placemaking + environments / wayfinding + graphic design

CVS HEALTH MODEL A It is important to study the older model because the bulk of CVS Health stores remain in this condition. we need to understand the evolution of the store The shelves are a consistent height through out the entire store and are laid out in an orthogonal pattern at equal distances to one another. The 6’ height of the shelves makes it difficult to see across the store and find your way around.

Department signs are colored banners hung on the wall and coordinate with the markers in the aisles.

The primary wayfinding system consists of signs hung overhead with a number marking each aisle and lists the categories of items stocked on the shelves.

The majority of stores visited during the field study had additional signage attached to the bottom of the aisle signs advertising the MinuteClinic. Within the aisles round markers call out the different products on the shelves. The combination of signage on the wall, overhead and in the aisle create visual clutter making navigation through the store very difficult.

240

retail medical clinics

241

brand + placemaking + environments / wayfinding + graphic design

242

retail medical clinics

product categories aisle number 8’-0” 4-0” 3’-0”

product location 1-6”

0-8” department sign 6’-0”

MinuteClinic advertisement

243

brand + placemaking + environments / wayfinding + graphic design

all wayfinding elements are above eye level

244

retail medical clinics

The signage system happens entirely above the head of the user causing the person to walk around the store having to look up to find their way around.

The primary, secondary and tertiary layers of signage compete for the user’s attention rendering the hierarchy ineffective. There is a disconnect between the zone the user occupies and the zone where graphic elements are placed. The plethora of information in this model can overwhelm the user making navigation through the store and location of desired items very difficult.

245

brand + placemaking + environments / wayfinding + graphic design

CVS HEALTH MODEL B The new CVS Health store design is a dramatic departure from the previous model. The primary architectural element in the store is the pavilion. This is a new technique for the CVS Health brand but not a new idea for other retail stores. The pavilion is used to mark important areas of the store, creating hierarchy among the departments.

The two chosen departments for the pavilions are beauty and health. Aside from the pharmacy these two departments generate the largest revenue.

The beauty department is not only cosmetics and skin care, but includes hair care, dental hygiene and shaving needs. The health section reflects the direction that the new CVS Health Health brand is moving. The focus of the pavilion are health items such as vitamins and supplements that promote everyday wellness. The department also includes medical equipment and over the counter remedies and treatments conveniently located just outside the MinuteClinic next to the pharmacy.

The heights of the shelves vary throughout the store. Around the perimeter shelves are the tallest, usually 6’ tall or above and in the middle of the store surrounding the pavilions the shelves are 4’ tall allowing the visitor to view the entire store.

The shortest shelves are placed at que areas near the checkout at the front of the store and at the entrance to the pharmacy.

246

retail medical clinics

247

brand + placemaking + environments / wayfinding + graphic design

248

retail medical clinics

14’-0”

3’-0”

better

12-0”

0’-8” foot care

0’-5”

foot pain relief & treatment

department sign 4’-6” pavilion product category

department focus

product type

product/treatment description

249

brand + placemaking + environments / wayfinding + graphic design

all wayfinding elements located at eye level or below product/treatment description

250

retail medical clinics

product description

product category

treatment description

251

brand + placemaking + environments / wayfinding + graphic design

appox. 7’-6”

252

appox. 6’-0”

appox. 4’-6”

appox. 3’-0”

retail medical clinics

Perimeter Aisles 7’ +

edge of the store

Interior Aisles 4’-6” to 6’

middle or front of store

Impluse Purchases/Queues 3’

checkout/ pharmacy line

253

brand + placemaking + environments / wayfinding + graphic design

waiting area

MinuteClinic sign signage

254

check-in

advertisement

e

exam

exam room entry

check-in

waiting

retail medical clinics

The MinuteClinic is composed of approximately 300 square feet of wall area. The top 50% of the wall contains only the MinuteClinic sign. In some versions of the store the wall and the sign are composed of multiple layers nad colors, but in more recent incarnations the wall and signage have been streamlined.

Instead of a chair rail, eye level panel and upper signage area, the wall is one uniform surface and color. The signage has been simplified to just the MinuteClinic name. The blue background and red lettering helps tie the brand to the pharmacy and help it stand out in the store.

The lower half of the wall contains all of the fuctional aspects of the clinic. The check in area, waiting seats, exam room entrances, advertisments and legal signage must fit within this area. The placement and size of these elements are dictated by building codes as well as laws for consumer and patient protection.

255

USER EXPERIENCES user types 258 caregiver experience 260 patient experience 270

257

USER TYPES The two users that interact with and play a role in the operations of the CVS Health MinuteClinic can be divided into two types: the caregiver and the patient. These user types operate very differently from one another within the function of the MinuteClinic. Caregivers are primarily made up of nurse practitioners and are responsible for caring for patients and making sure they receive appropriate treatment. Patients typically visit MinuteClinics for vaccinations, check ups, prescriptions, etc. The diagram on the right shows a typical hour for both a caregiver and patient and what events occur during a typical clinic visit.

258

Patient Exam Prescription

Patient Info

1:30 pm

12:30 pm Pharmacy

Wait at Clinic Check-in Arrive at CVS

Lunch Break

Clinic Visit

CAREGIVER

Wait at Pharmacy Receive Medication

PATIENT Depart CVS

CAREGIVER EXPERIENCE As the leader in retail health care, MinuteClinic employs passionate nurse practitioners and physician assistants who want to redefine health care. Their practitioners are leaders, advancing access to quality care in their communities. MinuteClinic’s unique structure and approach to health care offers a rewarding alternative to the traditional patient care practice, one that focuses on autonomy, empowerment, education and patient care.

Practitioners have the opportunity to run their own clinics and treat their own patients, always knowing they have the support of their colleagues and the strength of CVS Caremark behind them.

260

users / caregiver experience

KATE IS A NURSE PRACTITIONER Caregivers at MinuteClinic consist of both nurse practitioners and physician assistants. Caregivers’ main responsibilities are seeing and treating patients throughout the day. Caregivers typically work 3 days per week, 10 hours per shift and the number of patients they see per day varies. The typical patient visit lasts approximately twenty minutes. During that time nurse practitioners enter the patient’s personal information and health insurance information into their computer while consulting with the patient. They then either begin a standard checkup if the patient is sick or if the patient is receiving a vaccination, they clean the area and administer the vaccine to the patient.

Afterwards, the caregiver types up and prints out a summary of the tasks that were performed and if necessary gives the patient a prescription that they can either fill at the CVS Health pharmacy or another pharmacy of their choice. Caregivers and patients both have a similar view of the exam room itself. The main difference is that the patient sits either in a chair or the bed facing the caregiver, while the caregiver sits at the computer and has access to medical storage within the exam room. From the nurse practitioners we have spoken to, there have been mixed reviews about the exam room itself.

Because the room is 10’x10’, space and mobility are very limited. The main complaint is that most desks face away from the patient, so it makes the caregiver-patient interaction more difficult with the caregiver’s back to the patient most of the time.

262

retail medical clinics

TYPICAL WEEK Working Days: 3-4 Off Days: 2-3

WORKING

Monday IDLE DAY Overhead Time: 70% Care Time: 30%

OFF Sunday

CAREGIVER

8:00 am ACTIVE DAY Overhead Time: 43% Care Time: 57%

PATIENT 7:00 pm

CAREGIVER

8:00 am

PATIENT 7:00 pm 263

users / caregiver experience

WHAT DOES KATE SEE?

264

retail medical clinics

265

users / caregiver experience

LINDA IS A PHARMACIST Bringing unrivaled passion and expertise into the communities we serve, the Retail Pharmacy team delivers a promise to reinvent pharmacy. CVS Health pharmacists play an integral role in delivering reliable, accessible and innovative care for countless patients and families. Providing caring expert guidance to patients. Coordinating with health care professionals. Utilizing best-in-class pharmacy workflow and dispensing systems to maximize accuracy and efficiency. Their work makes a genuine difference in people’s lives. They work with highly motivated colleagues in a friendly, collaborative environment that continually challenges them to grow their abilities and advance their careers. Responsible for all aspects of Pharmacy Operations within their store including inventory, personnel and security with emphasis on customer relations. The individual responsibilities are shared equally by all Pharmacists within the store. Pharmacists are also responsible for customer service, inventory management, shrinkage, human resources, merchandising/ presentation, and operations. In additon, there are other marginal functions that pharmacists are responsible for. Pharmacists also typically work 3 days per week, however their shifts tend to be longer, between 12-14 hours. Unlike MinuteClinic, CVS Health pharmacy is more established and a larger focus of the CVS Health brand. For these reasons, pharmacists tend to be busier than MinuteClinic caregivers.

266

retail medical clinics

TYPICAL WEEK Working Days: 3-4 Off Days: 2-3

WORKING OFF IDLE DAY Overhead Time: 59% Care Time: 41%

CAREGIVER 8:00 am ACTIVE DAY Overhead Time: 40% Care Time: 60%

PATIENT 10:00 pm

CAREGIVER 8:00 am

PATIENT 10:00 pm

267

users / patient experience

WHAT DOES LINDA SEE?

268

retail medical clinics

269

PATIENT EXPERIENCE MinuteClinic offers a broad range of services to keep families healthy. In addition to diagnosing and treating illnesses, injuries and skin conditions, they also provide all kinds of wellness services, including vaccinations, physicals, screenings and monitoring for chronic conditions. Their family nurse practitioners and physician assistants provide services for both adults and children, 18 months and older. MinuteClinics provide experienced, caring practitioners, stringent guidelines and focus on quality, and clinical affiliations in communities across the country. Millions of people have chosen MinuteClinic as their source for convenient, high-quality care.

270

users / patient experience

SUZY NEEDS A FLU SHOT The patient visit differs based on who is actually visiting the MinuteClinic. Children are known to have a much different view of spaces than adults do because of their height and interests. Children have a varying perception of time and are typically more impatient than adults. Thus, the waiting room plays an important role when dealing with children.

Most children do not enjoy “going to the doctor”, so the sterile, minimal space of the MinuteClinic exam room is not the most welcoming space for a child.

The experience of a child is characterized by a series of perspectives. The photos pictured represent typical views that would catch a child’s eye throughout the CVS Health store and approaching the MinuteClinic such as sugary cereal presented on the way to the MinuteClinic waiting area and the gum displayed in front of the pharmacy. Other images show items that would catch a child’s eye while waiting to be seen in the clinic such as coloring books and stuffed animals. The photos also show some examples of what a child might focus on while being treated such as a syringe if receiving a flu vaccination or a nurse practitioner holding an otoscope prior to the exam. The sequence diagram varies from the other patients because the child doesn’t directly interact with things such as signing into the kiosk, so instead of this they would be looking at toys waiting for the time to pass. Also, if a child is given a flu vaccination, the parent may buy the child candy as a reward, which would most likely be the main event the child focuses on.

272

retail medical clinics

Receive Bandage

Receive Vaccine

Wait for Adults

6 7

5

3:00 pm

Pharmacy

4

3

2 1

School

Wait on Exam Bed

Look at Toys Skip Into CVS

Unbuckle

4:00 pm

Clinic Visit Run around CVS Health

Clean Clinic

8

CAREGIVER

9

Pick Out Candy 10 Eat Candy

PATIENT

11

Buckle Up

Soccer Practice

273

users / patient experience

WHAT DOES SUZY SEE?

274

1/11

2

4

5

retail medical clinics

3

275

users / patient experience

WHAT DOES SUZY SEE?

276

6

7

9

10

retail medical clinics

8

277

users / patient experience

SUZY’S TOUCHPOINTS The circulation of the patient also greatly varies based on who the patient is. In Suzy’s case, she would have a much different experience than her parent, for example. Whereas an adult would have a more straightforward visit, children are typically more active and have more energy. Because of this, their circulation pattern would be characterized by nontypical movements such as indirect paths and loops around the store. The red line represents the circulation path she would take and the green dots represent the various experiences Suzy has. The main points in Suzy’s experience would be unbuckling her seatbelt and hopping out of her parents’ vehicle, and unsystematically making her way to the entrance of CVS Health, perhaps by skipping or hopping to make her experience more exciting. She would then probably get distracted by toys, candy, and other items so would most likely stray from the direct path to the MinuteClinic. While waiting for her parent to sign into the kiosk and then waiting for her actual appointment, she would most likely be looking around at the toys that are placed directly in front of her chair and in front of the MinuteClinic. In the clinic itself, she would most likely move around from the chair, to the bed, and browse the fascinating tools and supplies that are located in the clinic. After she receives her vaccination, her parent would allow her to browse the shelves and run around a bit before she gets to pick out candy and while waiting for her parent to pay, she would begin eating her candy.

278

retail medical clinics

279

users / patient experience

JOE HAS A FEVER When a person is ill, it is difficult for them to function normally. Even a relatively simple task like driving to a MinuteClinic to be examined can seem extremely daunting. The design of MinuteClinics really needs to incorporate the perspective of a sick patient because they are the patients that need the most care and assistance as soon as possible.

When patients aren’t feeling well, their vision may be skewed and things may appear fuzzy or dizzy, making it hard to concentrate on their surroundings.

When an ill person visits a MinuteClinic, their main goals include being seen as quickly as possible/not having to wait long, having a quick and efficient examination, and obtaining a prescription. We can understand what ill people feel because most people have been sick or not feeling well multiple times in their lives. These perspectives show how distorted or disoriented views can look to people who are all ill. Some images show how hard it is to focus when trying to locate the actual clinic when you are ill. The other images show what types of things a sick person may be focusing on while in the waiting area, such as how much their wait time is on the kiosk and focusing on the door to the clinic, waiting for it to open so they can be so they can be seen. Other images show what it might be like for a sick person while in the clinic. Typical ill people who have a job may be coming from work to be diagnosed and then proceed home to get rest after seeing the nurse practitioner and receiving a prescription to help fight their sickness.

280

retail medical clinics

Caregiver enters Info into Computer

Patient Exam

Caregiver Writes Prescription

6

12:30 pm

Pharmacy

4

3

2 1

Work

7

5

Clinic Visit Sit & Wait for Appointment

Sign into Kiosk Walk Into CVS

Get Off Bus

1:30 pm Lunch

8

Go to Pharmacy Wait for 9 Prescription

CAREGIVER

10

Receive 11 Prescription Get on Bus

PATIENT Go Home to Rest

281

users / patient experience

WHAT DOES JOE SEE?

282

1/11

2

4

5

retail medical clinics

3

283

users / patient experience

WHAT DOES JOE SEE?

284

6

7

9

10

retail medical clinics

8

285

users / patient experience

JOE’S TOUCHPOINTS Because Joe is an ill adult, his experience will vary greatly than Suzy’s experience. Joe is a middle aged man who went to work despite not feeling well. When his persistent sore throat did not go away, he decided it was in his best interest to visit the MinuteClinic during his lunch break to try and get diagnosed. Joe lives in a more urban environment and has access to public transportation so he would most likely take the bus and have to walk from the bus stop to the actual CVS Health.

Because he is sick, his experience would most likely lay directly with the MinuteClinic and the pharmacy. He would most likely not stop and browse the store while waiting for the MinuteClinic appointment. Also, because he is sick, he would most likely not want to be around other people which makes the typical MinuteClinic waiting area problematic.

After the diagnosis and possible prescription write up from the nurse practitioner, Joe would head straight to the pharmacy to get his prescription filled as quickly as possible. He will end up just waiting for the prescription to be filled so he doesn’t have to come back later and can rest. Unfortunately, prescriptions typically take a minimum of 15 minutes to be filled and he has to have a consultation and then interact with the pharmacist a second time to actually receive his prescription.

After getting the prescription filled, he can pay for the prescription at the pharmacy and continue walking out of the store to head to the bus stop and wait for his bus ride home so he can rest.

286

retail medical clinics

287

users / patient experience

PHYLLIS NEEDS A PRESCRIPTION The elderly play a very important role when it comes to the MinuteClinic. Because of the increasing elderly population in the United States it is becoming more pertinent that the MinuteClinic cater it’s branding and strategies towards the elderly. Many elderly people have ailments in many different forms, however one ailment that most elderly people have in common is loss of eye sight.

Loss of hearing also plays an important part when dealing with the elderly. These two factors play an important role when designing MinuteClinics. Because of their loss of eye sight and hearing, elderly people may have a hard time finding the MinuteClinic or knowing what to do once they get there.

The following images represent the experiences leading up to, during, and after the MinuteClinic.

Because of their location and signage, it may be hard for the elderly to find the clinic.

However, difference in floor pattern may help lead the way for the elderly. The other images show some difficulties that the elderly may have in the waiting room. Most signage and instructions are extremely small and can make it hard for the elderly to read. Other images show how the elderly may perceive the nurse practitioner. Because of their impaired hearing, elderly people may think that the caregiver is treating them like a child when really they’re just trying to help them comprehend.

Because the elderly have back problems and trouble walking, floor patterns and visuals are inherently important for the elderly to get around.

288

retail medical clinics

Blood Pressure Exam Give Caregiver Caregiver Renews Information Prescription 6

5:00 pm

7

5

Assist Customers 3

1

Grocery Shop

Clinic Visit

4

Sit & Wait for Appointment

Caregiver helps with Kiosk 2 Limp Into CVS Get Dropped off at Curb

Paperwork

8

Go to Pharmacy

6:00 pm CAREGIVER

9

Sit & Wait for Prescription 10 Receive 11 Prescription Get Picked Up at Curb

PATIENT Prepare Dinner

289

users / patient experience

WHAT DOES PHYLLIS SEE?

290

1/11

2

4

5

retail medical clinics

3

291

users / patient experience

WHAT DOES PHYLLIS SEE?

292

6

7

9

10

retail medical clinics

8

293

users / patient experience

PHYLLIS’S TOUCHPOINTS Because of many ailments that the elderly face, it is not surprising that a standard visit to the MinuteClinic may be much more difficult than a typical person. Because Phyllis has back problems and eye problems, it is difficult for her to see and walk.

Because of this she can’t drive, so she would most likely be taken to CVS Health by a family member or friend during a series of errands like grocery shopping. When entering CVS Health, because of her lack of eye sight, it may be difficult for Phyllis to find the MinuteClinic. Because of this, she may be more likely to not take a direct path to the clinic and instead wander between various aisles to reach her destination. As one of the images shows, the kiosk may be difficult for Phyllis to use both because of her lack of eyesight and perhaps because of her lack of knowledge about technology.

Therefore, getting a CVS Health caregiver to help her would be necessary for her to sign in. When in the clinic, she would be renewing a prescription for high blood pressure, so a standard exam and blood pressure screening would be necessary for the nurse practitioner to right her a prescription.

Afterwards, she would go to the pharmacy to fill her prescription and would have to wait approximately 15 minutes for her prescription to be filled. During this time, she may browse the other aisles and wait in the pharmacy waiting chairs because of her back problems. Afterwards, she could pick up her prescription and pay directly at the pharmacy before getting picked up at the curb.

294

retail medical clinics

295

PROGRAM BOUNDARIES boundary types + elements 298 precedent studies 310 metrics 364

297

BOUNDARY TYPES + ELEMENTS Before embarking on a study of program boundaries it is important to define what we are looking at. While most people can qualitatively agree on where boundaries are and whether they are sharp or blurred, we wanted to quantify this distinction.

By defining boundary design elements and then categorizing boundaries by the number of elements present, we were able to compare them more objectively and discern patterns that were not initially apparent.

298

299

program boundaries / boundary types + elements

BOUNDARY TYPES Sharp Boundary: 7 or more boundary elements Moderate Boundary: 5 to 6 boundary elements

BOUNDARY ELEMENTS surface shift lighting change scalar shift ceiling shift

Soft Boundary: 3 to 4 boundary elements Blurred Boundary: 2 or fewer boundary elements

defined portal physical barrier visual barrier elevation change impermanent assembly

300

retail medical clinics

Surface Shift A surface shift is defined as a change in material or treatment within a coplanar surface.

Examples would include floors switching from wood to carpet as shown below, or a change in wall paper as seen at right. Changes in paint color or tile patterns also fall into this category.

Notation for this boundary element consists of a line marking the shift accompanied by arrows indicating the different surfaces to either side of the divide.

301

program boundaries / boundary types + elements

Lighting Change We define a lighting change as a an instance when the lighting fixtures, or overall lighting strategy changes between spaces, thereby contributing to the perceived boundary. This can also include a shift from day lit to artificial lighting techniques.

The notation for this element involves circles highlighting the lighting sources used, connected into a series, which gives a directional component to the transition across program thresholds.

302

retail medical clinics

Scalar Shift A scalar shift is understood as a change in the scale of space. To a certain extent this element aligns with the feeling of enclosure, as smaller spaces tend to feel more enclosed.

Besides changes in room size, it can also include transitions from outdoors to indoors, or shift in the width of aisles in a retail store.

Scalar shifts are notated with boxes representing the relative scales of space along the boundary that are connected to emphasize the contraction or expansion of the spatial scale.

303

program boundaries / boundary types + elements

Ceiling Shift Ceiling shifts refer to changes in ceiling height.

Typically this includes a drop or rise in the entire ceiling, but it also encompasses architectural details such as molding or dropped beams that visually separate equal height spaces.

Ceiling shifts are marked with curved arrows that are directed from high to low across a program boundary.

304

retail medical clinics

Defined Portal Defined portals are openings across boundaries that provide a dedicated pathway between spaces. Boundaries with defined portals can not be physically crossed except through the portal. Doorways in walls are a classic example, but portals also include openings without doors, as shown below.

Defined portals are noted with a simple outline marking the extent of the opening.

305

program boundaries / boundary types + elements

Physical Barrier A physical barrier requires physical interaction in order to cross the boundary it delineates. This can include closed doors, railings, or continuous counters or shelving often seen in retail environments.

Physical barriers will be marked with X’s approximating the faces of the barrier as demonstrated in these two examples.

306

retail medical clinics

Visual Barrier A visual barrier interrupts sightlines between spaces, thereby contributing to a perceived program boundary. This includes objects that extend above eye level, such as high shelves or more structural elements like walls, columns or even escalators (shown below). Elements like frosted glass or mullions that obscure sightlines will also fall into this category.

Visual barriers will be marked by a color overlay as shown in the examples on this page.

307

program boundaries / boundary types + elements

Elevation Change Elevation change occurs at a shift in floor level.

This boundary element is often accompanied by ramps or stairs designed to facilitate travel between spaces at different elevations. It can also be more subtle and continuous such as the boundary between a road and a sidewalk.

Elevation changes will be notated with a stepped line connecting the two levels.

308

retail medical clinics

Impermanent Assembly Impermanent assemblies are boundary elements that are nonstructural, and therefore removable. Items such as furniture, shelving, counters, and railings that are arranged so as to divide space will fall into this category.

The notation for impermanent assemblies is a simplified outline of the main surfaces, demonstrated in these two examples.

309

PRECEDENT STUDIES Retail medical clinics combine multiple programs by definition, and the degree to which these programs should be separate is up for debate. In order to better understand the range of threshold conditions, we compared several specific precedents that unite different programs: CVS Health, Barnes & Noble, Nordstrom, and South Station. Cataloguing the boundary sharpness and design components allowed us to uncover patterns in the way boundaries are defined, and deduce which techniques are most suitable in a retail medical clinic environment.

310

311

program boundaries / precedent studies

CVS HEALTH WELLESLEY 1. EXTERIOR APPROACH | Soft Boundary 2. EXTERIOR ENTRANCE | Sharp Boundary 3. MINUTECLINIC I Moderate Boundary 4. PHARMACY I Moderate Boundary

312

retail medical clinics

4.

3.

2.

1.

313

program boundaries / precedent studies

1. EXTERIOR APPROACH | Soft Boundary boundary elements a. surface shift: exterior ground materials shift from asphalt to concrete. b. physical barrier: a railing along the perimeter of the parking lot. c. visual barrier: trees, landscaping, and railing act as visual barrier.

314

retail medical clinics

a. c.

b.

315

program boundaries / precedent studies

EXTERIOR ENTRANCE | Sharp Boundary boundary elements a. surface shift: material changes from concrete to carpeted flooring. b. lighting change: changes from daylight to recessed lighting followed by track lighting in the interior store. c. scalar shift: shift from open exterior space to a constrained entry vestibule, followed by the open store interior.

316

d. ceiling shift: lowered ceiling in vestibule changes to raised ceiling on store interior. e. defined portal: there is one set of doors for foot customers to enter. f. physical barrier: doors limit physical movement. g. visual barrier: windows and shelving limit view into store interior.

retail medical clinics

d.

g. d.

b.

g.

e.

c.

f. a.

317

program boundaries / precedent studies

3. MINUTECLINIC I Moderate Boundary boundary elements a. surface shift: floor material shifts from carpet to dark wood. b. lighting change: lighting changes from track lighting in the main store to fluorescent lighting in the clinic. c. scalar shift: shift from the larger open layout of the main store interior to a more enclosed area.

318

d. ceiling shift: ceiling lowers to delineate clinic waiting area. e. visual barrier: frosted glass limits sightlines into clinic waiting area. f. impermanent assembly: shelving help direct sightlines and foot traffic.

retail medical clinics

b.

e. d.

f. c.

e.

e.

e.

a.

319

program boundaries / precedent studies

d.

e. g. f.

a.

320

retail medical clinics

b.

4. PHARMACY I Moderate Boundary boundary elements

g.

f. c.

a. surface shift: floor material shifts from carpet to light wood. b. lighting change: lighting changes from track lighting in main store interior to panel florescent lighting. c. scalar shift: shift from the larger open layout of the main store interior to a more enclosed area. d. ceiling shift: lowered ceiling announces pharmacy area. e. visual barrier: high shelving limits sightlines. f. impermanent assembly: high and low shelving used to direct foot traffic. g. physical barrier: counters limit movement.

321

program boundaries / precedent studies

BARNES & NOBLE 1. EXTERIOR APPROACH | Soft Boundary 2. EXTERIOR ENTRANCE | Sharp Boundary 3. CAFE | Moderate Boundary 4. JR SECTION | Moderate Boundary 5. MUSIC | Sharp Boundary 6. CHECKOUT | Moderate Boundary

322

retail medical clinics

4.

5.

3.

2.

1.

6.

323

program boundaries / precedent studies

1. EXTERIOR APPROACH | Soft Boundary boundary elements a. impermanent assembly: parked cars channel the path of approach. b. elevation change: a raised sidewalk surrounds the front of the building, adding a step up from the lower parking lot surface. c. surface shift: exterior materials shift between landscaped beds, asphalt and concrete.

324

retail medical clinics

b.

c.

a.

325

program boundaries / precedent studies

2. EXTERIOR ENTRANCE | Sharp Boundary boundary elements

326

d. scalar shift: shift from open exterior space to a constrained entry vestibule, followed by the open store interior.

a. ceiling shift: ceiling lowers from the outside to under the awning and again under the entry vestibule before rising again on the store interior.

e. visual barrier: despite the presence of windows within the entry vestibule, dense mullions and walls obscure the view between spaces.

b. physical barrier: doors and windows limit physical movement.

f. lighting change: lighting shifts from natural to recessed to a fluorescent lighting.

c. defined portal: the entry vestibule contains two sets of doorways.

g. surface shift: floors change from concrete to carpet to tile.

retail medical clinics

e.

f.

b./c.

d.

g.

327

program boundaries / precedent studies

3. CAFE | Moderate Boundary boundary elements a. surface shift: walls shift color and floors change from carpet to tile. b. ceiling shift: ceiling bump down designates cafe bar area. c. physical barrier: a metal fence surrounds the cafe seating area, guiding foot traffic through the area.

328

d. impermanent assembly: the metal fence, shelving and tables surrounding the cafe seating area are removable items positioned to help create a program boundary. e. lighting change: lighting shifts from fluorescent fixtures to recessed and spot lighting.

retail medical clinics

b.

e.

c./d.

c./d.

b. d. d.

c./d. d.

329

program boundaries / precedent studies

a.

b.

c.

d.

330

retail medical clinics

d.

4. JR SECTION | Moderate Boundary a. ceiling shift: ceiling bump down outlines JR Section. b. lighting change: a band of recessed lighting encircles the area, and the section interior is more brightly lit than the rest of the store. c. impermanent assembly: removable shelves. d. surface shift: color shift in walls and floors.

e.

e. defined portal: playful columns and pediment define the portal.

331

program boundaries / precedent studies

5. MUSIC | Sharp Boundary boundary elements a. visual barrier: the high shelves and frosted glass block views to the rest of the store.

e. impermanent assembly: the shelving and theft detector are removable elements.

b. physical barrier: the music department is surrounded by high shelves and access is restricted through a security check point.

f. scalar shift: shift from the larger open layout of the main store interior to a more enclosed area.

c. lighting change: a band of recessed lighting encircles the area and directed sconces highlight key displays.

332

d. defined portal: foot traffic is permitted at only one location between the shelves.

g. ceiling shift: ceiling bump down outlines the music section.

retail medical clinics

c. a./b.

d.

g.

a./e. f.

333

program boundaries / precedent studies

6. CHECKOUT | Moderate Boundary boundary elements a. ceiling shift: ceiling height is lower over the checkout compared to the rest of the store. b. surface shift: the floor shifts from carpet to tile. c. lighting change: lighting shifts from fluorescent lighting only to a combination of pendant and natural lighting. d. physical barrier: the checkout counter provides 334

a physical barrier between customer and employee. e. impermanent assembly: the checkout counter is a removable assembly.

retail medical clinics

c.

d./e.

335

program boundaries / precedent studies

NORDSTROM 1. EXTERIOR APPROACH | Soft Boundary 2. EXTERIOR ENTRANCE | Sharp Boundary 3. MALL ENTRANCE | Moderate Boundary 4. CAFE | Moderate Boundary 5. CENTRAL ATRIUM | Moderate Boundary 6. TRENDY RETAIL | Soft Boundary 7. UPSCALE RETAIL | Blurred Boundary

336

retail medical clinics

4.

3.

5.

6.

7.

337

program boundaries / precedent studies

1. EXTERIOR APPROACH | Soft Boundary boundary elements a. elevation change: a raised sidewalk surrounds the front of the building, adding a step up from the lower parking lot surface. b. impermanent assembly: parked cars channel the path of approach as do a row of pillars lined up in front of the main entrance. c. surface shift: exterior materials shift between landscaped beds, asphalt painted to mark pedes338

trian and traffic right-of-way, the concrete sidewalk and pillars.

retail medical clinics

b. a.

c.

339

program boundaries / precedent studies

2. EXTERIOR ENTRANCE | Sharp Boundary boundary elements a. scalar shift: shift from open exterior space to a constrained entry vestibule, followed by the open store interior.

e. lighting change: lighting shifts from natural to recessed to a combination of fluorescent and track lighting.

b. defined portal: doorway.

f. ceiling shift: ceiling height is lower in the entry vestibule compared to the store interior.

c. physical barrier: doors and windows limit physical movement.

g. surface shift: walls shift color and floors change from concrete to carpet to tile.

d. visual barrier: the double glass entry and thick 340

mullions combine to obscure views in and out of the store.

retail medical clinics

e.

f.

d.

g.

b./c.

341

program boundaries / precedent studies

3. MALL ENTRANCE | Moderate Boundary boundary elements a. defined portal: the extended portal acts almost like a hallway connecting the store to the mall. b. surface shift: walls change colors and floors change tile type. c. scalar shift: the extended portal compresses the scale of the space compared to the relatively open mall and store. d. lighting change: lighting shifts from a combina342

tion of fluorescent and track lighting to recessed to skylit. e. ceiling change: ceiling height is lower in the entry hallway compared to the store and mall interiors.

retail medical clinics

a.

b.

d. e.

343

program boundaries / precedent studies

4. CAFE ENTRANCE | Moderate Boundary boundary elements a. visual barrier: sightlines into the cafe are limited by wall dividing the spaces. b. defined portal: the access point to the cafe is an opening within a larger wall. c. scalar shift: the spatial experience moves from the open plan retail to a more enclosed and cosy space.

344

d. ceiling shift: the height of the ceiling lowers within the cafe, compared to the store. e. lighting change: lighting shifts from a combination of fluorescent and track lighting to recessed, pendant, and table lamps combined with natural light. f. surface shift: walls and floors change color and texture.

retail medical clinics

d. e. a.

b. f.

c.

345

program boundaries / precedent studies

5. CENTRAL ATRIUM | Moderate Boundary boundary elements a. ceiling shift: there is a slight drop in the ceiling surrounding the atrium, and within it the ceiling rises the to the full height of the multi-tiered store. b. visual barrier: escalators and columns obstruct sightlines across the atrium. c. impermanent assembly: clustered seating centered around the atrium provides a break spot for tired customers.

346

d. elevation change: since the atrium acts as a circulation core, escalators bridge multiple levels. e. surface shift: there is a different tile treatment around the border of the central circulation core. f. lighting change: the lighting shifts from purely artificial to sky lit.

retail medical clinics

b.

a.

d.

e. c.

b. f. a.

c.

347

program boundaries / precedent studies

a. b.

348

retail medical clinics

c.

6. TRENDY RETAIL | Soft Boundary a. lighting change: shifts from a combination of fluorescent and track lighting to recessed and pendant lighting. d.

b. visual barrier: bulky display and column obscure views. c. ceiling shift: the ceiling bumps down along the boundary, with a drop ceiling outside the boundary and an exposed ceiling inside. d. surface shift: walls and floors shift color and texture.

349

program boundaries / precedent studies

7. UPSCALE RETAIL | Blurred Boundary boundary elements a. surface shift: floors shift color and material from high gloss tile to marble tile. b. lighting change: shifts from a combination of fluorescent and track lighting to recessed lighting in the ceiling and shelving.

350

retail medical clinics

c.

a. b.

d.

351

program boundaries / precedent studies

SOUTH STATION 1. EXTERIOR APPROACH | Soft Boundary 2. EXTERIOR ENTRANCE | Sharp Boundary 3. GREAT ROOM I Moderate Boundary 4. CAFETERIA I Moderate Boundary 5. RETAIL STANDS I Soft Boundary

352

retail medical clinics

4.

5.

3.

2.

1.

353

program boundaries / precedent studies

1. EXTERIOR APPROACH | Soft Boundary boundary elements a. surface shift: ground material changes from ashphalt to concrete that has a funnel shape b. elevation change: a raised sidewalk surrounds the building, adding a step up from the street. c. visual barrier: pavillions to subway limit complete view of South Station

354

retail medical clinics

c.

b.

a.

355

program boundaries / precedent studies

2. EXTERIOR ENTRANCE | Sharp Boundary boundary elements a. surface shift: material shift from concrtete to carpet and tiles b. lighting change: lighting shifts from natural to recessed to a combination of fluorescent and track lighting. c. scalar shift: shift from open exterior space to a constrained entry vestibule.

356

d. ceiling shift: ceiling is lower in entry hallway compared to station interior. e. defined portal: large punctures contain windows and door in fill. f. physical barrier: door limit movement. g. elevation change: a ramp leads visitor up and into entry hallway.

retail medical clinics

b.

f. c.

a.

357

program boundaries / precedent studies

b.

d.

e.

e.

a.

c.

358

retail medical clinics

3. GREAT ROOM I Moderate Boundary boundary elements a. surface shift: floor material is consistant but floor pattern changes. b. lighting change: lighting changes from recessed lighting in entry hallway to natural light in the great room. c. scalar shift: shift from constrained enrty hallway to open space of great room. d. ceiling shift: ceiling is higher than enrty hallway, and lower than main space of great room. e. defined portal: large punctures allow for free movement between entry and great room.

359

program boundaries /precedent studies

4. CAFETERIA I Moderate Boundary boundary elements

d. ceiling shift: ceiling is lower than in the great room.

a. surface shift: floor material changes from large smooth tiles to small tiles.

e. defined portal: the access points to the cafeteria are large openings within a larger wall.

b. lighting change: shift track lighting to recessed and pendant lighting.

f. physical barrier: counters within cafeteria space help define foot traffic.

c. scalar shift: the spatial experience moves from the open plan of the great room to a more enclosed and intimate space.

360

retail medical clinics

b.

d.

e.

e.

f.

c. a.

361

program boundaries / precedent studies

5. RETAIL STANDS I Soft Boundary boundary elements a. lighting change: shifts to a combination of natural, track and pendent lighting. b. physical barrier: partial walls limit movement c. visual barrier: sightlines into tavern space are limited by the placement of high and short walls.

362

retail medical clinics

a. a.

c. b.

b.

c.

363

METRICS After tallying up the findings for each store, it appears certain retail markets favor softer boundaries than other. Retail that is shelf dependant, often makes use of shelves as a boundary element, but this can lead to sharper boundaries and more abrupt transitions. Higher end stores like Nordstorm, seem to favor a more open plan that avoids physical obstructions, relying instead on lighting, material and ceiling heights to differentiate zones.

364

program boundaries / metrics

BOUNDARY TYPES BOUNDARY ELEMENTS

366

STORE CVS

BARNES & NOBLE

NORDSTROM

SOUTH STATION

BOUNDARY TYPES 100%

0%

BOUNDARY ELEMENTS

SURFACE SHIFT

100%

83%

100%

LIGHTING CHANGE

100%

100%

33%

SCALAR SHIFT

100%

63%

0%

0%

CEILING SHIFT

100%

82%

17%

0%

DEFINED PORTAL

100%

55%

0%

0%

PHYSICAL BARRIER

100%

36%

33%

0%

VISUAL BARRIER

75%

36%

66%

0%

ELEVATION CHANGE

25%

9%

50%

0%

IMPERMANENT ASSEMBLY

25%

45%

33%

0%

367

BUSINESS DEPLOYMENT alternative retail rexperiences components of CVS health types of CVS health examples of prototypes layout analysis

370 378 382 390 398

369

ALTERNATIVE RETAIL EXPERIENCES Analyzing innovative aspects of retail and customer experience through three examples that showcase alternative approaches to retail. The methods vary from using technology; creating a cultural following for the brand; to the organization logic and brand representation in the store.

370

business deployment / alternative retail experiences

TESCO Hompelus Store The aisle precedes the store. TESCO in Seoul, South Korea opened virtual stores in subway stations. Wall billboards that resemble store shelves with QR codes for each item allow the customer to scan the items, which are added to an online cart and then shipped to the shopper’s address in the same day.

372

Retail Experience: Using technology to upgrade the customer’s experience.

Value: Saves the customer’s time and suits their busy lifestyle; saves space; new experiences using new technology innovations; additional advertisement and product sales for the store.

retail medical clinics

373

business deployment / alternative retail experiences

374

Lululemon Fitness Store

Retail Experience:

Lululemon sells yoga and fitness products priced and targeted towards a higher-class demographic.

The culture of the brand is associated with the alternative health lifestyles and body and mind wellness. The ads boost mantras of positivity and Zen symbols.

Stores offer more than just products; they offer a lifestyle. They offer weekly yoga classes in stores.

They promote other fitness classes and instructors and maintain a blog and newsletter.

Creating a cultural following for the store and brand. Association or “Brand Tribe”.

Value: Enforcing the brand’s moral values; promoting the use of the products; creating social circles through the store’s activities.

retail medical clinics

375

business deployment / alternative retail experiences

376

Farmacia Santa Cruz

Retail Experience:

ntelligent, clear, and visible store layout added to painstaking organization of the store’s products, make the customer’s independence possible.

The Store is divided into areas; each area has products categorized. Each area has its individual organization method and is assembled differently.

Finding products is easy since they are labeled by their letters similar to the elements table !

A visible aesthetic for the store, while allowing customer to “flow” with ease through the layout.

Value: Clear minimal display; promoting the use of the products; enforcing the brand; layout follows logic instead of marketing scheme.

retail medical clinics

377

COMPONENTS OF CVS HEALTH Any CVS Health store is composed of the collection of components or parts. The building or layout is the “kit� that contains the parts in an assembly and configuration relative to the individual store. This chapter takes a look at the parts and their particular aspects in an effort to understand the logic of their assembly and organization.

378

business deployment / alternative retail experiences

PHARMACY

PERMANENT SHELVES

MinuteClinic

4-5 Shelves

Header Graphic 13.5”

20’

59.75”

51’

10’

24’ 13

”W

380

5”

7.2

Dimensional Property

Fixed

Fixed

Fixed

Frequency

Always

Always

Sometimes

retail medical clinics

FREEZERS

PHOTO KIOSK

TEMPORARY SHELVES

SELF CHECKOUT

21”

78.63”

Display

54.25”

60”

50.9”

78 .1

3” ”

.88

29

20

.8”

26”

48

”

13

.9

”

.7”

30

Fixed

Always

Fixed

Fixed

Fixed

Sometimes

Sometimes

Sometimes

381

TYPES OF CVS HEALTH CVS Health stores exist in multiple sizes and have a range of offered services at each location. The differing services provided, the diversity in layout, and the total square footage of a store are due to multiple factors. This chapter is an analytical look at these three factors: Customizing; Scale; and Cluster. Each of these factors, examined in subchapters, influences the store layout and business deployment.

382

business deployment / alternative retail experiences

CUSTOMIZATION In this section, the analytical look is at the categories of store buildings. And the type of services provided typically in each type. This would help understand how the previously discussed store components could be aligned with the limits of the architecture. The overwhelming emphasis in stores being for the two main primary services of the CVS Health chain: the pharmacy; and the front store (retail aisles).

We can identify three types of CVS Health stores: 1) The Purpose Built CVS Health: these are locations that were built from the ground specifically for the CVS Health corporation. They offer the highest number of the services that CVS Health could provide. They also have customized layout and store technology and fixtures. Theses are the lowest level of customizing between these three.

2) Fitted in Existing Building CVS Health: stores that are typically in dense or urban locations.

They occupy a floor or part of a multi-use building.

They can have some customizing privileges, but still could lack in that regard if the layout of the existing space is the minimum.

3) Acquired Existing Chain: These stores are the result of CVS Health purchasing an existing small, independent chain or individual store.

Like the fitted stores they are modeled after the available square footage and the logistics of the location. Some instances of acquired stores they remain in their Existing conditions under the original name, such as Longs Drugs and Navarro Pharmacy.

384

retail medical clinics

PRIMARY Pharmacy

SECONDARY Retial

SUPPORT MinuteclinicSelf checkout- Photo

4-5 Shelves 21”

20’ Header Graphic 13.5”

59.75” 60”

78.63”

10’ 13

”W

51’

”

7.25

20

.8”

24’ 78 .1

3” ”

.88

29

4-5 Shelves

Header Graphic 13.5” 21”

59.75”

60”

50.9” 13

”W

”

7.25

78.63”

51’

20

.8”

24’

48

.9

” .7”

30

78 .1

3” .8 29

8”

4-5 Shelves

Header Graphic 13.5”

59.75”

78.63”

13

”W

51’

”

7.25

78 .1

24’

3” ”

.88

29

385

business deployment / alternative retail experiences

SCALE TYPICAL

SMALLEST

386

Total SF: 5,814 Pharmacy SF: 998 Retail SF: 4,170

Total SF: 10,000 Pharmacy SF: Retail SF:

Services: Pharmacy+ Retail

Services: Pharmacy+ Retail + MinuteClinic

retail medical clinics

LARGEST

Total SF: 17,849 Pharmacy SF: 1,307 Retail SF: 13,523 Services: Pharmacy+ Retail+ Self checkout+ ADA Pharmacy consultation + Photo counter.

387

business deployment / alternative retail experiences

CLUSTER The CVS Health corporation uses a system to categorize stores based on multiple factors including: the site context, urban setting, population density, demographic, medians of income, competitive market, and transportation.

These factors help indicate and influence decisions of store scale, customizing, products carried, and services offered.

URBAN OFFICE

URBAN RESIDENTIAL

SUBURBAN CORE

SUBURBAN PLUS

RURAL PHARMACY

388

retail medical clinics

DENSITY

TRADE RADIUS

COMPETITIVE INTENSITY

INCOME AFFLUENCE

HIGH

0.25 MILES

LOW

HIGH

HIGH

0.25 MILES

LOW

HIGH

LOW

3 MILES

MEDIUM

MEDIUM

LOW

10 MILES

MEDIUM

MEDIUM

LOW

15 MILES

HIGH

LOW

389

EXAMPLES OF PROTOTYPES The combined factors from the previous chapter are the indicators influencing the resulting stores. Each CVS Health store has an arrangement of these factors that is specific to its own. Understanding that helps in understanding the limits and opportunities available in improving stores.

390

business deployment / alternative retail experiences

Prototype A Purpose Built

MOST

TYPICAL

CUSTOMIZING

SCALE

CLUSTER TYPES

392

Suburban Core - Suburban Plus- Rural Pharmacy

LEAST

retail medical clinics

393

business deployment / alternative retail experiences

Prototype B Fitted

MOST

TYPICAL

CUSTOMIZING

SCALE

CLUSTER TYPES

394

Urban Office- Urban Residential

LEAST

retail medical clinics

395

business deployment / alternative retail experiences

Prototype C Acquired

MOST

TYPICAL

LEAST

CUSTOMIZING

SCALE

CLUSTER TYPES

396

Urban Residential- Urban Office- Suburban core - Suburban Plus

retail medical clinics

397

LAYOUT ANALYSIS As we have come to understand the various factors indicating the scale, layout and services of a store; we noticed repetitive layout schemes and set plan rules. In order to comprehend those and arrive at an alternative to them, this series of analytical layout tests present different schemes that tests ideas deviating from the norm.

398

business deployment / alternative retail experiences

Front Pharmacy Scheme The Pharmacy is front of house while retail is a second layer. This is an inverse of the common store layout. Allows pharmacy to have front window space.

This scheme has potential of being successful in the case the privacy of the pharmacy was solved and reconciled with the entry. There needs to be a solution to the retail organization.

Pros: Maximum visibility for pharmacy and exterior access. Circulation flow and retail is visible and continuous.

Cons: Front large object shadows retail behind it. Lack of privacy near entry.

Ob

scu

red

Privacy breach

400

retail medical clinics

401

business deployment / alternative retail experiences

Detached Pharmacy Scheme Pharmacy has independent existence that is coexistent with the store simultaneously. Retail takes the majority of the layout.

This scheme is potentially most successful. The exact execution of it and the site are imperative however, as they would determine the success.

Pros: Allows privacy for pharmacy and exterior wall space, and outdoor and indoor access.

Seamless vision line through the store.

Continuous circulation.

Cons: Could result in de-attaching the pharmacy.

Private

402

retail medical clinics

403

business deployment / alternative retail experiences

Central Pharmacy Scheme Pharmacy is the center of the layout, while retail flows around it.

Pros: Circulation could flow around a center.

Cons: A central object blocks vision and obscures and shadows its surroundings.

Lacks privacy for the pharmacy.

d

cure

Obs

Privacy Breach

404

This scheme might be most difficult to improve on.

The break of continuous vision at any point in store makes it difficult to organize retail. It also needs a buffer area for the pharmacy to separate it from retail.

retail medical clinics

405

APPENDIX 2 Exam Room Functionality 408 sustainability Scope of Work + Diagnostics 2 Telemedicine 2 Waiting 2 Privacy 12

407

appendix / sustainability

LEED CERTIFICATIONS CVS/pharmacy has recently opened a new store in West Haven, CT. This store marks their first to achieve Leadership in Energy and Environmental Design (LEED) Platinum certification, which is the most energy efficient CVS store in the United Stiates. The West Haven location is able to achieve 40 percent less energy use and 50 percent less water, through utilizing recylced materials, high-efficienty lighting, HVAC and plumbing systems, day light technology, and solar photovoltaic systems. Additional feautures visible on the outside of the store include an electric car charging station and special landscaping which does not require additional irriguation. CVS hopes to use designs and successes from this location to incorporate into more new store locations and best practices for their stores in the future.

CVS Health now has 8 locations to achieve a LEED certification including CVS/pharmacy retail stores and CVS/pharmacy business offices. Offices that have achieved certificaiton includes the New York Distribution Center, CVS Finance Center, VS Pharmacy Call Center, and CVS Marketing Center.

These certificaitons range includes certified, silver and gold. As a company, they are commited to reducing their impact on the environment which is showing both in their building design and health platforms.

408

retail medical clinics

1000023304, West Haven, CT

CVS 03549 - West Haven CT PLATINUM, AWARDED AUG 2014

LEED BD+C: Retail (v2009) SUSTAINABLE SITES

AWARDED: 21 / 26

MATERIAL & RESOURCES

CONTINUED

SSc1

Site selection

1/1

MRc6

Rapidly renewable materials

0/1

SSc2

Development density and community connectivity

5/5

MRc7

Certified wood

1/1

SSc3

Brownfield redevelopment

1/1

SSc4

Alternative transportation

10 / 10

SSc5.1

Site development - protect or restore habitat

0/1

SSc5.2

Site development - maximize open space

0/1

SSc6.1

Stormwater design - quantity control

1/1

SSc6.2

Stormwater design - quality control

1/1

SSc7.1

Heat island effect - nonroof

1/2

SSc7.2

Heat island effect - roof

1/1

SSc8

Light pollution reduction

0/2

WATER EFFICIENCY

AWARDED: 8 / 10

INDOOR ENVIRONMENTAL QUALITY

AWARDED: 13 / 15

EQc1

Outdoor air delivery monitoring

1/1

EQc2

Increased ventilation

0/1

EQc3.1

Construction IAQ Mgmt plan - during construction

1/1

EQc3.2

Construction IAQ Mgmt plan - before occupancy

1/1

EQc4

Low-emitting materials

5/5

EQc5

Indoor chemical and pollutant source control

0/1

EQc6

Controllability of systems - lighting and thermal comfort

1/1

EQc7.1

Thermal comfort - design

1/1

EQc7.2

Thermal comfort - employee verification

1/1

WEc1

Water efficient landscaping

4/4

EQc8.1

Daylight and views - daylight

1/1

WEc2

Innovative wastewater technologies

0/2

EQc8.2

Daylight and views - views

1/1

WEc3

Water use reduction

4/4 INNOVATION

ENERGY & ATMOSPHERE EAc1 EAc2

Optimize energy performance On-site renewable energy

IDc1

Innovation in design

5/5

14 / 19

IDc2

LEED Accredited Professional

1/1

3/7

EAc3

Enhanced commissioning

2/2

EAc4

Enhanced refrigerant Mgmt

2/2

EAc5

Measurement and verification

1/3

EAc6

Green power

2/2

MATERIAL & RESOURCES MRc1.1 Building reuse - maintain existing walls, floors and roof

AWARDED: 6 / 6

AWARDED: 24 / 35

AWARDED: 7 / 14

REGIONAL PRIORITY

AWARDED: 4 / 4

EAc2

On-site renewable energy

SSc3

Brownfield redevelopment

1/1 1/1

SSc6.1

Stormwater design - quantity control

1/1

SSc7.1

Heat island effect - nonroof

0/1

SSc7.2

Heat island effect - roof

1/1

0/3

MRc1.2 Building reuse - maintain interior nonstructural elements

0/1

MRc2

Construction waste Mgmt

2/2

MRc3

Materials reuse

0/2

MRc4

Recycled content

2/2

MRc5

Regional materials

2/2

TOTAL

40-49 Points CERTIFIED

83 / 110

50-59 Points SILVER

60-79 Points GOLD

80+ Points PLATINUM

409

SOURCES Exam Room Functionality 2 Scope of Work + Diagnostics 2 Telemedicine 2 Waiting 2 Privacy 12

411

sources

Introduction: “Minute Clinic.” Digital Image. Minute Clinic: CVS Minute Clinic Walk-in Clinic. Web. Target Department Store, Digital Image. Warner Robins Georgia, Houston County Georgia. Web.

Chapter 1: “Care Clinics - Walmart.” Walmart. Web “Clinic.” Target Clinic: Health. Web. Crowds of people walking on New York City Street. Digital Image. Gettysimages.com. Web. Graves, Jada A. “Nurse Practitioner.” U.S. News & World Report. Web. Hellman, Nathan. “Physician Assistant.” U.S. News & World Report. Web. “Locations & Visit Times.” Welcome to Walgreens. Web. “Minute Clinic.” Minute Clinic: CVS Minute Clinic Walk-in Clinic. Web. Nurse Practitioner. Digital Image. www.bayareacouincil. com. Web. Pediatric Physician Assistant. Digital Image. Medicalrecruting.com. Web.

412

“Retail Clinic Counts Will Double Between 2012 and 2015 and Save $800 Million Dollars per Year.” Insight Driven Health (2014), Accenture. Web. “Retail Clinics: What’s in Store for Health Care | Center for Advancing Health.” Retail Clinics: What’s in Store for Health Care | Center for Advancing Health. Center for Advancing Health, Web. Rise of the Minute Clinics. Digital Image. Groups.northwestern.edu. Web. Rural Health Family Nurse Practitioner (MSN). Digital Image. Onlinenursingprograms.eku.edu. Web. Stethoscope Doctor. Digital image. Imgkid.com. Web. “The Annals of Family Medicine.” The Annals of Family Medicine. Web.

retail medical clinics

Chapter 2: “Accessible Medical Examination Tables and Chairs.”

Welcome to the Americans With Disabilities Act National Network. N.p., n.d. Web. 03 Nov. 2014.

“Infusion Center at St. Thomas More Hospital.” Canon City Infusion Center. N.p., n.d. Web. 24 Sept. 2014.

“Infusion FAQs.” NHIA. N.p., n.d. Web. 24 Sept. 2014.

“Care Plan Platform.” Patient IO. N.p., n.d. Web. 24 Sept.

2014.

“Coram CVS/specialty Infusion Services.” Coram CVS/ specialty Infusion Services. N.p., n.d. Web. 24 Sept. 2014.

Digital image. Internet Medicine Digital Healthcare. N.p., n.d. Web. 01 Nov. 2014.

Digital image. Infusion Center. N.p., n.d. Web. 24 Oct. 2014.

Digital image. Gastroenterology Practice RSS. N.p., n.d.

Web. 01 Nov. 2014.

Digital image. Jefferson City Cancer Treatment | Oncologists in Jefferson City, MO. N.p., n.d. Web. 01 Nov. 2014.

Digital Image. Innovations in Cancer Care. Digital image.

MD News -. N.p., n.d. Web. 01 Nov. 2014.

Malkin, Jain. Medical and Dental Space Planning: A Comprehensive Guide to Design, Equipment, and Clinical Procedures. 3rd ed. New York: J. Wiley, 2002. Print.

Mayer, Christie. “Designing a Divided Exam Room.”

Healthcare Design Blog. Jain Malkin Inc., 24 Apr. 2012.

Web. 25 Nov. 2014.

“Patients | ContinuumRx.” ContinuumRx RSS2. N.p., n.d.

Web. 01 Nov. 2014.

Rheault, Alan. “Design of a Medical Exam Room Can Make a Difference” Physicians News. N.p., 15 Jan. 2014.

Web. 20 Oct. 2014.

“Telemedicine Report to Congress.” EVALUATION. N.p., 31 Jan. 1997. Web. 18 Sept. 2014.

“Doctor’s and Dentist’s Offices.” Melnick Medical Museum. N.p., n.d. Web. 03 Nov. 2014.

“UPMC: #1 Ranked Hospital in Pittsburgh and Pennsylvania.” UPMC: #1 Ranked Hospital in Pittsburgh and Pennsylvania. N.p., 2014. Web. 20 Sept. 2014.

George Pantos. Telehealth and the U.S. College Population(n.d.): n. pag. Feb. 2013. Web. 20 Sept. 2014.

“Where Does It Hurt? Log On. The Doctor Is In.” The New York Times, 8 May 2014. Web. 18 Sept. 2014.

“Health Affairs.” Retail Clinics, Primary Care Physicians, And Emergency Departments: A Comparison Of Patients’ Visits. N.p., 2014. Web. 16 Sept. 2014.

“What Is Telemedicine?” What Is Telemedicine. N.p., 2012.

Web. 02 Nov. 2014.

413

sources

Chapter 3: Airport Lobby. http://dirigo-pro.com/. web Air New Zealand’s Spaceseat. http://www.formworks. co.nz/. web Ambulatory Care Center, King Of Prussia, PA, <http:// www.archilovers.com>

Principles from Evidence-based Design. New York: Routledge, 2015.

Etihad. http://www.asfaar.net/wp-content/uploads/2013/02/Etihad-First-Class1.jpg. web Frankfurt Airport. http://www.airportsinternational.com/. web

American-Sino Hospital. http://architizer.com/. web Automotive waiting area. http://content.angieslist.com/. web

Frank Becker and DEA 653 Planning and Managing the Workplace, The Ecology of Waiting Within an Ambulatory Waiting Room

Barcode Office. http://ad009cdnb.archdaily.net/. web

Frosted Glass. http://3.bp.blogspot.com/. web

Bus Stop. http://www.yanidel.com/. web

Gloria Mark,Daniela Gudith and Ulrich Klocke, The Cost of Interrupted Work: More Speed and Stress

Carpman, Janet Reizenstein, Myron A. Grant, and Deborah A. Simmons. Design That Cares: Planning Health Facilities for Patients and Visitors. Chicago, IL: American Hospital Pub., 1986.

Google Office. http://www.interieurdesigner.be/. web Grand Central Terminal Shoe Shine Stand. http://cdn. acidcow.com/. web

Children’s Hospital of Alabama, <http://www.nora.com> Conference Room. http://i2.wp.com/. web

Grace Hill Neighborhood Health Center. http://hi-enddesign.com/concepts-design/. web

Curitiba Bus Rapid Transit System. http://acdn.architizer. com/. Web

High-Speed Train Business Seating, http://news.hexun. com>

Dental Office / Estudio Arquitectura Hago. http:// ad009cdnb.archdaily.net/. web Apple Store. http://www.wallsforpc.com/. web

L2ds Women’s Medical Clinic and MRI Center. http:// media-cache-ec0.pinimg.com/. web

Devlin, Ann Sloan. Transforming the Doctor’s Office:

414

Maister, D. (1985). The Psychology of Waiting Lines. In J. A. Czepiel, M. R. Solomon & C. F. Surprenant (Eds.),The

retail medical clinics

Service encounter: managing employee/customer interaction in service businesses. Lexington, MA: D. C. Heath and Company, Lexington Books.

Nationwide Children’s Hospital, <http://corykleinphotography.com> Nationwide Children’s Hospital in Columbus, Ohio, <http://online.wsj.com>

Steelcase Health. http://360.steelcase.com/. web Steelcase Waiting Room Furniture. http://www.steelcasehealth.com/. web Stewart-Pollack, Julie, and Rosemary Menconi, Designing for Privacy and Related Needs. New York: Fairchild Publ., 2005.

Tenteki 10 Omotesando. http://socale.jp/. web

New Royal Children’s hospital Melbourne, <http://www. pinterest.com> Obata Clinic. http://architecturephoto.net/jp/oclinic06. jpg. web PCC Austin Family Health Center. http://austintalks.org/. web

The Mother Baby Center. http://acdn.architizer.com/. web Steelcase Health l Hospital Furniture. <http://www. steelcasehealth.com> The Royal Children’s Hospital, <http://www.ewingcole. com> TGV 3G seats, <http://dev.sergeroux.com>

Pediatric Clinic. http://media-cache-ec0.pinimg.com/. web Regent Insurance. http://thedesigntabloid.files.wordpress. com/. Web Sasser, W.E., J. Olsen, and D.D. Wyckoff (1979), Management of Service Operations: Text, Cases and Readings.

New York: Allyn and Bacon.

Schipol Airport. http://www.design.philips.com/

Virgin America LOFT at LAX. https://www.virginamerica. com/. web Walgreens. http://misterburton.com/images/projects/ walgreens.jpg. web

Werribee Mercy Hospital. http://www.blp.com.au/. web 99C. http://containerbox.kr/. web

Shorecare Accident & Medical. http://herbstarchitects. co.nz/. web

415

sources

Chapter 4:

Chapter 5:

CVS. “MinuteClinic®.” Minute Clinic: CVS Minute Clinic Walk-in Clinic. N.p., n.d. Web. 02 Nov. 2014. <http://www. cvs.com/minuteclinic>.

“Add a Drugstore to the Places You Can Get a Strep Test, Physical and Basic Health Care These Days.” LancasterOnline. Web. <http://lancasteronline.com/news/local/ add-a-drugstore-to-the-places-you-can-get-a/article_ e15668d6-cfb5-11e3-a9d5-0017a43b2370.html>.

GK Brand. “GK Tribe Global.” Services. N.p., n.d. Web. 03 Nov. 2014. <http://gkbrand.com/services>.

“SEGD.” Mariam. N.p., n.d. Web. 04 Nov. 2014.

“SEGD.” Clive. N.p., n.d. Web. 04 Nov. 2014.

“Can You Get a Flu Shot and Still Get the Flu Shots Health News.” Can You Get A Flu Shot And Still Get The Flu Shots Health News. N.p., n.d. Web. <http://funny-pictures.picphotos.net/can-you-geta-flu-shot-and-still-get-the-flu-shots-health-news/ i0.wp.com*slinkingtowardretirement.com*wpcontent*uploads*2013*01*flushot-cdbb1370d0f843b99c7582841364d829c386ad91-s6-c10.jpgquestionmarkresize=700,524/>.

“Community.” Calvary. N.p., n.d. Web. <http://www.calvarychapelsouthtampa.com/community/>.

“Concept Gallery.” Display Source Alliance LLC. N.p., n.d.

Web. <http://www.dsadisplay.com/concept-gallery>.

“CVS MinuteClinic: Sick Visit.” Stowed Stuff. N.p., n.d. Web. <http://stowedstuff.com/2012/07/cvs-minuteclinicsick-visit.html>.

“CVS Minute Clinic Opening - Gardner-Webb Photo Services.”GardnerWebb Photo Services CVS Minute Clinic Opening Gallery RSS. N.p., n.d. Web. <http://photos. gardner-webb.edu/2013/April-2013/CVS-Minute-Clinic-Opening/i-Vh2BPHc>.

416

retail medical clinics

“CVS Partners with Dartmouth-Hitchcock for Minute Clinics in N.H.”Concord Monitor. N.p., n.d. Web. <http:// www.concordmonitor.com/community/town-by-town/ concord/9616595-95/cvs-partners-with-dartmouthhitchcock-for-minute-clinics-in-nh>.

“General Medicine Community.” The Path to the Pharmacy Is Paved With....Candy! N.p., n.d. Web. <http://www. wellsphere.com/general-medicine-article/the-path-tothe-pharmacy-is-paved-with-candy/927124>.

“CVS/pharmacies Expand Retail Clinics in Louisiana in Response to Health Care Market Demand.” NOLA. com. N.p., n.d. Web. <http://www.nola.com/health/index. ssf/2013/10/cvspharmacies_expand_retail_cl.html>.

“Honda CR-Z - Back Seat Passenger Impressions - AutoBuzz.my.”AutoBuzz.my. N.p., n.d. Web. <http://autobuzz. my/2012/05/honda-cr-z-back-seat-passenger-impressions/>.

“CVS’ Project Health Kicks Off in 10 Cities Around the Country.” Rolling Out RSS. N.p., n.d. Web. <http://rollingout.com/culture/cvs-free-health-screening-africanamerican-latino-communities/attachment/img_14036/>.

“Inside The Actors Studio Apartment: Shout-Out From the Sick Bay.”Inside The Actors Studio Apartment: ShoutOut From the Sick Bay.N.p., n.d. Web. <http://insidetheactorsstudioapartment.blogspot.com/2012/02/shoutout-from-sick-bay.html>.

“Drugstore Clinics: A Rapidly Growing Option for Sick People.” Detroit Free Press. N.p., n.d. Web. <http://archive.freep.com/article/20130328/BUSINESS06/303280154/Drugstore-clinics-A-rapidly-growing-option-for-sick-people>.

“Journey To Orthodoxy.” Journey To Orthodoxy. N.p., n.d.

Web. <http://journeytoorthodoxy.com/>.

“Franny’s Footsteps.” Frannys Footsteps. N.p., n.d. Web. 03 <http://frannysfootsteps.com/new-friends-and-old-insantiago-and-valparaiso/>.

“Gadget Gallery.” - Amherst Pediatrics. N.p., n.d. Web. <http://amherstpediatrics.net/for-kids/gadget-gallery>.

“Gallery For Cvs Pharmacy Sign.” Gallery For Cvs Pharmacy Sign. N.p., n.d. Web. <http://imgarcade.com/1/ cvs-pharmacy-sign/>.

“Medical Clinics in Retail Settings Are Booming.” USATODAY.COM. N.p., n.d. Web. <http://usatoday30.usatoday. com/news/health/healthcare/health/healthcare/ story/2011-08-28/Medical-clinics-in-retail-settings-arebooming/50168796/1>.

“MinuteClinic Opens at CVS in New Milford - Business - The Litchfield County Times.” Connecticut Weekly Newspaper Covering Local News including Local Sports, Video and Multimedia Coverage, and Classified Advertising. N.p., n.d. Web. <http://www. countytimes.com/articles/2014/01/23/business/ doc52e17122d2564793426692.txt>.

417

sources

Chapter 5 (cont): “Park View CVS Open!” Park View DC. N.p., n.d. Web. <http://parkviewdc.com/2010/07/25/park-view-cvsopen/>.

“Pharmacist At Work.” Fouzi Husainis Blog RSS. N.p., n.d.

Web. <http://www.fouzi.com/photographywpq/pharmacist-at-work>.

“The Official ACM Chicago Program Blog.” : The Magic School Bus: Latino Express Edition. N.p., n.d. Web. <http://acmchicagoprogram.blogspot.com/2014/04/ the-magic-school-bus-latino-express.html>.

“The Fashion World’s Silver Stylistas.” BBC News.

N.p., n.d. Web. <http://www.bbc.com/news/magazine-22013245>.

“UCLA Health System Employee News.” UCLA Health System Employee News. N.p., n.d. Web. <http://townhall. mednet.ucla.edu/hs_news/sep2012/1209p6.html>.

418

Chapter 6: Alengo. Caridac Monitor. Digital image. Istockphoto. N.p., 12 Oct. 2009. Web. 3 Nov. 2014.

Coulam, Des. Paris Flea Market. Digital image. Soundlandscapes’ Blog. N.p., 27 Mar. 2011. Web. 3 Nov. 2014.

Martin, Colin. Photograph 8-14. Digital image. Saitcolonel. wordpress.com. N.p., 24 June 2012. Web. 3 Nov. 2014.

Threshold between Galleries. Digital image. OpenBuildings. N.p., 2010. Web. 3 Nov. 2014.

retail medical clinics

Chapter 7:

Appendix:

Community @ lululemon. Lululemon. Web. Accessed Oct 2014. <http://www.lululemon.com/ community/?mnid=mn;community>

“CVS 03549 - West Haven CT.” U.S. Green Building Council. Web. 02 Nov. 2014. <http://www.usgbc.org>.

Retail Design Institute. Web. Accessed Oct 2014. <http://www.retaildesigninstitute.org/member/1302/ gallery/336>

“CVS/pharmacy Store Applauded for Energy-Efficient Design.” CVS Health. Web. <http://www.cvshealth.com>.

Digital image. Larson Design Group Blog Posts by Serena Wray LEED AP+.Web. 02 Nov. 2014.

Tesco Supermarket in a Subway Station. Designboom.

Jul 06 2011. Web. Accessed Oct 2014. <http://www. designboom.com/technology/tesco-virtual-supermarketin-a-subway-station/>

419