Dr. Edward Levitan, founder of Visions HealthCare, a private health and wellness center, spent nearly two years searching for an ideal spot to relocate the practice. Proximity between the new facility and an existing one in Wellesley, Mass., was key to allowing practitioners and staff to move freely between the two while capturing an expanded patient base. And Levitan found that opportunity in a location in Dedham, Mass., at the site of a shuttered restaurant.

The goals of the project, along with some unusual characteristics of the site and building, created a number of construction challenges for the project team. Zoning restrictions, sustainability requirements, and one giant billboard were all part of the mix as the architects, contractors, and designers figured out the best approach for this unique renovation. 

The building itself
Visions’ goal for this building was not only to transform an existing eyesore but also to create a flagship for the brand. It hired Smook Architecture & Urban Design Inc. (Boston) to serve as the master planner and architect for the project. The company’s business plan includes the construction of 50 such facilities throughout New England and a 200-acre sustainable campus where doctors, students, and patients can share ideas on an approach to care that focuses on patients’ physical, biochemical, emotional, energetic, and spiritual needs to determine and treat the root cause of disease.

Originally a small wood-framed structure, the 80-year-old building on the site Visions ultimately selected had been expanded over the years to become a 7,000-square-foot restaurant.  Its location offered proximity to a major arterial road, hospitals, and other amenities.

Due to zoning restrictions, demolishing the building and constructing anew would have resulted in a smaller building positioned in a less favorable manner, with less parking than Visions was seeking. And so adapted reuse with full renovation was chosen. An interesting catch: The existing building included ea large billboard affixed to an elevator tower, overlooking a major interstate that loops around Boston. This billboard is viewed by hundreds of thousands of commuters every day and provided an excellent opportunity for Visions signage; due to changes in zoning ordinances, it couldn’t be replaced if demolished. Renovation plans called for a 4,000-square-foot expansion to the one-story building with a partial second floor to allow for a full second floor. The overall design approach facilitates easy navigation of the Visions model by placing primary care on the ground floor and wellness (including acupuncture, energy and spiritual, nutrition, and chiropractic services) on the second. These spaces were simply and cleanly designed on the interior with cost and efficiency in mind. The exterior was clad in a fiber cement board panel system. The entry of the building, which faces a major state road, is punctuated by a double height glass-enclosed, lobby. The lobby was bracketed by an L-shaped masonry wall that extends from inside to out, tying the building to the landscape.

The existing building had limited floor-to-floor heights within the two-story portions of the building and conventional framing, with numerous engineered lumber girders and beams. Because of those factors, the installation of systems such as heating, ventilation and air conditioning ducts, fire sprinklers, and lighting—as  well as data and security systems--all required careful juggling.

Although the permitting process called for the existing building to remain, the design team suspected that once demolition and construction began, the structure would need substantial augmentation or replacement in order to conform to current design loading and building codes. This suspicion proved accurate, and the only portion of the building that remained untouched was the existing elevator core with its accompanying billboard.

Although the building is somewhat irregular in shape, the interior layout is actually quite repetitive, with exam rooms and offices all being constructed on a uniform module. It quickly became apparent that utilizing panelized wood construction (with floor, walls, and roof systems constructed off-site and shipped via flatbed) would offer the most economical and expeditious means to construct the building within a tight eight-month timeframe.

Sustainability and green design
It was imperative that this facility be a healthy and safe haven for Visions patients, many of whom suffer from severe sensitivity to allergens, pollutants, and other toxins found in the built environment. As such, interior materials and finishes were selected to minimize any volatile organic compounds or off-gassing, both of which are health hazards, while furthering the sustainable mission of the company. All paints and adhesives used within the building were specified to meet or exceed the Green Seal GS-11 requirements. Woods used within the building include a Forest Stewardship Council-certified flooring that’s a urea formaldehyde-free bamboo product.

The building was also designed to maximize sunlight and fresh air. Operable windows were chosen in lieu of fixed windows within the offices. Adjustable window treatments were specified to control sunlight and solar gain. LED lighting was used both for energy efficiency and low heat emission. LED lighting presents many advantages over incandescent light sources, including lower energy consumption, longer lifetime, improved physical robustness, smaller size, and faster switching. Initial costs are offset by lower maintenance costs.

Choice of exterior building materials was also greatly driven by Visions’ sustainability mission. Local building materials were used to minimize carbon emissions by eliminating excessive transportation to the site. The primary cladding of the façade is fiber cement board panels. A white membrane roof was chosen to reduce the heat island effect; the material has a high reflectance coefficient, which greatly reduces the overall heating and cooling load requirements for the building.

A building stone was used at the entry lobby as a feature wall carried from outside to inside. The locally manufactured product contains up to 25 percent post-industrial recycled content, created in a non-toxic manufacturing environment resulting in no environmental pollutants or off-gassing. A locally quarried natural stone was used on the lobby floor.

Lessons learned
Oftentimes a building site is not particularly appropriate for its use. In this case, multiple attempts at a restaurant offering didn’t work out, presenting the opportunity to see if the site would be a better fit for a healthcare function. With big-box retailers shutting their doors and leaving plenty of former commercial spaces vacant, adaptive reuse of an existing building is a green strategy worth pursuing. Creative thinking can reposition these structures into healthcares uses, a need that continues to grow in the U.S. thanks to an aging baby boomer population and industry shift to outpatient care. Owners, developers, contractors, and designers should keep their eyes open for such opportunities.

Clay Benjamin Smook, AIA, LEED BD+C, is founding principal of Smook Architecture & Urban Design Inc. (Boston). He can be reached at clay@smookarchitecture.com.