Considerations in the Design of Off-Campus Ambulatory Care Centers

Updated on June 2, 2016

Greene 2016_3x3_8250By Tami P. Greene, AIA, NCARB, Associate, Project Manager, IKM Incorporated Architects

The smart phone generation of healthcare consumers likes fast and convenient ‘one stop’ access to care. Hospitals have recognized the trend and have been making the move to locate outpatient services in more-convenient facilities closer to home.

One of the initial decisions that must be made when considering moving outpatient services off the hospital campus is should the freestanding ambulatory care center be housed in new construction or in a retrofit of an existing building?

There is much to consider when evaluating the retrofit of an existing building for your new ambulatory care center. While economics and return on investment play a significant role in this decision, the focus on creating a superior patient experience is becoming increasingly influential in evaluating options. 

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First Impressions via Function

A holistic design that accommodates the patient’s physical and psychological needs contributes to a superior patient experience. If a patient starts their encounter in a run-down strip mall or non-descript office building with confusing or distant parking, has difficulty getting into the building, or finding their way to their appointment, the medical staff is at an immediate disadvantage with an already agitated and dissatisfied patient.

Many suburban office buildings have a series of 3-foot wide, manual doors in the succession of a vestibule. Not only does a patient need to maneuver themselves and potentially a walker or crutches through one heavy man door, but also as they proceed another awaits. For a successful ambulatory care center, patients in wheelchairs, with walkers or crutches will require more than one 3-foot automatic entrance door activated by a paddle on the wall. The appropriate entrance design includes an enclosed vestibule with wide, sliding doors that automatically open by a motion sensor or a large revolving door solution. Either solution requires adjustment to the mechanical systems to keep the environment in the vestibule or entrance lobby at a comfortable temperature as the original design never contemplated the number of door openings experienced in a healthcare occupancy.

Reduce Patient Wait Times with Design

One of the most common complaints is patient wait time. Great advancements provide for efficient patient throughput within the practice site. These new technologies and lean design processes however are for naught if the first experience your patient has is waiting a long time in a crowded elevator lobby. When considering an existing building to retrofit to an ambulatory care center, one must evaluate the elevator count, speed and cab size. For facilities that will have a high patient load for Orthopedic and / or Physical Therapy services on an upper floor, a larger cab size is ideal. This type of attention to vertical circulation is important, as the original building use was not designed for this extensive and consistent flow of persons.

One process technique often employed to create efficiencies is a centrally located registration area near the front door with both staffed check-in stations and electronic kiosks. Does the building you are considering accommodate this type of space? For patients who are smart phone and computer savvy there is likely no hesitation with entering the required information at a kiosk and then sitting to be called for their appointment. For those patients intimidated by the kiosk, staff should be stationed nearby to encourage and assist the use of this technology. The key to central registration is that it is central and occurs once during the patient visit. Requiring multiple registrations during that day’s visits to multiple services in the building is a substantial dissatisfier for all age groups regardless of registration methodology.

Design Aesthetic Interiors to Calm Patients’ Emotions

Though a room’s layout and the three-dimensional space created within is critical to consider, color and texture play a powerful role within a space. Selecting colors and materials of elements found in nature the design invokes a calm feeling for patients during what might be considered a stressful experience. By adding a bold accent color or mosaic tile to one wall, the space will seem more grounded and inviting to patients. The goal is to create a warm and hospitable space, with comfortable furniture, interesting finishes of color, pattern and texture, and warmly lit decorative lighting, so that patients feel at ease with their experience.

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Finally, consider the overall feel of the spaces within the building. Is the floor plate depth narrow enough and exterior glazing large enough to provide adequate natural light in all patient areas? Is the floor-to-floor height such that higher ceilings can be provided in larger spaces like waiting rooms, a therapy gym, or X-ray room? If you are a tenant of a leased building, will you have control of the finishes and signage in public spaces? Or, will your patients struggle to navigate through a low lit, beige lobby with minimal signage?

There is much to consider when evaluating an existing building for your new ambulatory care center. All of which are important issues and potential challenges to overcome so that the most holistic building design can be provided. Keeping the focus on the patient experience is the key to success and high patient satisfaction. This includes providing a clear and convenient circulation path, seamless and friendly registration, efficient patient throughput and aesthetically pleasing environment.

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Tami Greene, AIA, NCARB is a Registered Architect, Associate and Senior Project Manager with IKM Incorporated Architects. Her work focuses on guiding clients through complex healthcare design projects including renovation and new construction for outpatient and ambulatory care facilities and women’s health. She has also completed design projects in the corporate and non-profit sectors.  She is also the chair of IKM’s IDP Program, which focuses on providing opportunities for a well-rounded experience for the firm’s emerging professionals.

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