As the operating costs of medical office buildings (MOBs) continue to rise, creating an efficient MOB can help control expenses, as well as make life easier for patients and physicians.

When planning an MOB for optimal efficiency and function, the first step is to establish a building program to fit a site. Master planning should consider such factors as access and parking, building location and orientation, possible future expansion and, if applicable, a direct connection to the hospital.

Step two is creating a program that will fit the needs of the users, with systems and materials that strike a reasonable balance between first cost and life-cycle cost.
Reception desk, MOB—Columbus Community Hospital, Columbus, Nebraska

To review these steps in more detail:

Site Plan

To maximize efficiency, if the MOB site is adjacent to a hospital, it is best to attach it to the hospital with a connecting link. For patient parking, the building should be oriented to provide adequate parking convenient to its entrance for efficient movement to and from the building. Pedestrians should not be expected to endure long walks or, on a tight site, negotiate a confusing landscape. An attractive option is to situate a parking structure so that patients can enter and exit the MOB directly.

As for parking space, the number of individual spaces should not fall below five per 1,000 gross square feet (or one per 200 square feet). Some zoning ordinances, particularly in smaller communities, will allow for lighter parking, but this usually means too few parking spots even for patients and their family members, not to mention physicians and staff members who will occupy the building.

Both the parking layout and the building site plan should take into consideration the inevitability of future expansion. Horizontal expansion is usually the most cost-effective and efficient for healthcare projects and MOBs because it is less interruptive to daily activities of the operation.

Building Requirements

Because an MOB is a business occupancy, it should not be designed as an institutional occupancy as hospitals are, even when the building is connected to a hospital. The requirements of institutional occupancy would add construction costs, making the building rent-prohibitive. MOBs should be designed allowing a building efficiency, based on usable floor area versus total rentable floor area (which includes space for major vertical penetrations, is generally fixed for the life of the building, and is rarely affected by changes in corridor size or configuration) of 83 to 86% efficient rental area.

For further efficiency, as mentioned earlier, building systems and materials should be chosen carefully to strike the appropriate balance between first cost and life-cycle cost. All material, mechanical, plumbing, and electrical system selections need to be made based on an estimation of how long they will be in use and the necessary maintenance in the interim. For the building exterior, the most efficient selections, needing far less maintenance than others, are masonry, stone, and metal panels, all of which are relatively long lasting and aesthetically appealing.

In planning bay sizes, the building design should allow for flexibility. Bay sizes can be determined based on the probable size of the suites in the building. The building owner should be able to offer a range that can accommodate practices with two to five physicians. A smaller physician suite could be placed on a shallow bay side of the public corridor, with the larger suite being more appropriate on the deeper bay side.
Atrium lobby with waiting area—Faith Regional Health Services, Norfolk, Nebraska

Exam room—Methodist Physicians Clinic, Omaha

Suite Design Considerations

Once the overall plan and orientation of the building have been finalized, interviews can be conducted with each physician practice that is planning to occupy the new facility. A detailed space- utilization program will help define the size, number, and nature of all rooms planned for each suite. Care should be taken not only to include clinical spaces, but also to identify adequate space for storage, computers, medical waste disposal, and an employee break area, as well as a public waiting area, medical records area, and business offices. This approach can only be followed, however, when specific occupants have been identified. When the medical practices to be accommodated have not as yet been determined, the building initially must be designed with open shell areas, postponing suite design for a later date.

Some general guidelines should be followed in designing suites. For example, in designing examination rooms, all spaces should be the same size with similar orientation, to avoid having some rooms that are less favored by physicians, staff members, and others. Staff can function more smoothly and find supplies more easily in exam rooms that are all arranged in the same pattern. Certain practices (e.g., OB/GYN) must also be given special attention in how the door opening of the exam room is arranged.

Each suite should be planned to provide a secondary entrance point dedicated for use by physicians and staff. Patients using specialized practices, such as plastic or cosmetic surgery, also will benefit from the availability of a private entrance/exit, both for the suite and the building. This must be addressed not only in the suite floor plan but also in the site plan, so that pickup and parking for these suites can be facilitated.

For efficiency in suite circulation patterns, internal corridors should be planned wide enough to accommodate the high levels of activity that frequently occur around nurses' stations and other congregation points. Admitting and discharge desks should be separate from each other or placed in different locations. For discharge, in particular, privacy screens can be helpful for patients discussing financial situations.
Hallway—Methodist Physicians Clinic, Omaha

Registration and waiting area—Methodist Physicians Clinic, Omaha

A wide range of finishes is available for use in healthcare settings. Design teams should choose flooring and wallcovering products that are proven suitable for clinical usage. Specific selections depend on the type of practice and the amount of durability and maintenance required—e.g., sheet vinyl or rubber flooring for the exam rooms, vinyl tile for the corridors, and carpet for the offices.

The steps discussed above are aimed at creating the highest possible efficiency for the design, construction, and operation of an MOB, and they can pave the way toward curbing the costs of its operation and enhancing revenues. HD

Kamran Elahi, NCARB, is Vice-President and Project Manager for HDR, an architectural engineering firm based in Omaha, Nebraska

Sidebar

The Special Challenges of MOBs

by Pete Harrington

Unfortunately, some contractors conceptualize medical office buildings (MOBs) as nothing more than “regular” office space with cleaner, brighter interiors, more sewer capacity, and maybe additional water lines for sinks. In truth, MOBs have numerous characteristics unique to their specialized uses, and constructing them requires considerable planning and expertise.

Traffic flow, equipment access, and space utilization all must be taken into account when planning and building MOBs. Even the most basic of these facilities can, for example, feature examination rooms or lab areas and house various types of medical and scientific equipment. HVAC requirements are, therefore, more stringent than those for regular office settings. Moreover, in many areas of the country, more and more direct-care-oriented MOBs are offering outpatient care, including ambulatory surgery services. Offices may be part of the construction, but those are sometimes located on higher floors above the outpatient/ambulatory care areas.

The types of equipment to be used when the buildings are functional must also be considered during the construction phase. For example, magnetic resonance imaging (MRI) equipment doesn't simply fit through a standard door, so movable walls may be needed for practical access. Elevators that can accommodate patient gurneys, fire protection measures that don't use sprinkler heads in surgical or research areas, and even special security controls to limit access are all factors to be considered in constructing such buildings.

Specialized help with this sort of construction is strongly advised. Just as a patient with a foot problem wouldn't seek help from a hand surgeon, or a lab tech wouldn't use pliers to pick up a microscopic sample, medical practitioners and researchers seeking construction guidance will best be served by specialists who can guide them through the process as painlessly as possible.

Pete Harrington is Senior Vice-President, National Development/Construction, Duke Realty Corporation, Indianapolis. For further information, phone (317) 808-6187, e-mailpete.harrington@dukerealty.com, or visit http://www.dukerealty.com.