For some, the choice to receive healthcare isn’t always an easy one to make. From juggling work and kids to not having transportation or money to cover the cost, there are a variety of reasons that going to the doctor may end up taking a back seat.

With a mission statement of  “exceptional care, without exception,” Boston Medical Center (BMC) strives to make this process a little bit easier—regardless of one’s social or economic circumstances.

That objective became the hallmark of a recent project to build BMC’s new 245,000-square-foot Shapiro Ambulatory Care Center in Boston’s historic South End neighborhood. The center, which opened in April 2011, is home to a number of outpatient services, including 20 clinics and 250 exam rooms that answer the growing need in the healthcare industry at large to replace the numerous inpatient beds of old with the quicker, more convenient care offerings of today.

“Ambulatory care is a key and increasingly important component of the services BMC provides. This new facility allows us to operate more efficiently and is integral to the medical center’s future,” says Bob Biggio, vice president of facilities and support services at BMC.

BMC, the amalgamation of the former Boston City Hospital and former Boston University Medical Center, serves a highly diverse urban population and provides such initiatives as buses that circulate neighborhoods to take residents to appointments, off-hour clinics so patients don’t have to miss work, and translation services for more than 70 languages. Among the goals for the ambulatory care center was a desire to enhance even further the ease with which community members could seek care.

“As we design buildings for BMC, the paramount concern is that care is convenient, that it’s one-stop shopping, and when patients are able to make the time for care, they get the highest quality of care in the most coordinated fashion possible, because getting them back for another appointment is oftentimes very difficult,” says Rick Kobus, FAIA, FACHA, senior founding principal of Massachusetts-based Tsoi/Kobus & Associates (TK&A), which designed the facility.

Putting the pieces together
TK&A first came on board with BMC to design its Moakley Building, home to the Cancer Care Center, a first dip into enhancing efficiencies at the campus. Next, the firm moved on to do master planning for BMC, and through this process recognized the need for a centrally located ambulatory care center to house the majority of outpatient offerings.

“The design of the facility needed to be patient-centered within a friendly environment. It also needed to be designed to maximize comfort and privacy for all our patients,” Biggio says.

And within the resulting Shapiro Ambulatory Care Center, an efficient platform for the delivery of services was created, starting with same-handed exam rooms throughout and an overall focus on standardization.

“We really tried to maintain that standardization throughout the design process, and it worked well to establish criteria early on for how these spaces are to be finished. We worked with the client and contractor to establish a timely prototype and carried it through from the beginning to end,” says Richard Moon, AIA, associate principal at TK&A and project manager.

In fact, each floor of the nine-story building is based on a modular configuration with four clinical modules on each floor, with the number of modules engaged at any one time dependent upon patient volume.

“The patient corridors run the length of the building, immediately accessible from the waiting area, and we made sure there’s natural light and views at both ends of the corridor, so patients are oriented toward natural light and views of their neighborhood,” Kobus says.

When patients exit public elevators, they have the option of turning either right or left, again with immediate views of the surrounding community to aid in orientation. Dropped ceilings over main intersections in patient areas are highlighted with a wood strip and a change in lighting pattern for wayfinding, in addition to the use of color and floor patterns to provide further directional cues.

Also part of creating the care environment BMC required was an interior design that would not only be attractive to a diverse patient population, but also stand up to the heavy use it will likely face.

Terrazzo flooring was selected for the lobby as well as first- and second-floor public areas. Throughout the rest of the facility, durably finished carpet tiles were used alongside high-quality hardwoods. Countertops in the facility are made of a granite-like resin and aggregate composite material—“which offer a superior, natural look but take the wear and tear,” Kobus says.

The interiors are designed to evoke a Zen-like calm, with an indoor garden of bamboo and river rock that borders the main stairway to the second level; the use of light, neutral tones; and incorporation of sandblasted glass and warm wood accents.

Getting off the ground
While the interiors were focused on the specific needs of patients and staff, the exterior of the building was influenced by an additional group of stakeholders: the neighbors. As part of the South End community, BMC got plenty of attention for its new-build project right from the start. Kobus says there was sensitivity from residents regarding the impact the new addition may have on the environment of the revitalized historic area that’s now home to a vibrant community.

“This building is directly on an axis with Worcester Square in the South End, and there were questions about ‘what are we going to see?’ and ‘what is the building going to look like?’” Kobus says, adding that the concerns were even more heightened by plans for a nine-story building in a generally low-rise side of town.

However, there was also a significant driver for BMC in choosing this location, Moon says. Located on Albany Street, considered a back door to the hospital, there was an opportunity to replace an old maternity building and bring new life to that side of the campus. “It was a great opportunity to revitalize Albany Street in a way that would set the direction for the future,” he says.

To work within the context of the existing buildings on the BMC campus as well as the surrounding neighborhood of predominantly brick row houses, the design team selected a terra cotta cladding for the exterior to complement what was already there while also distinguishing it from its surroundings. Its scale and proportion were also honed to complement neighboring structures.

The terra cotta includes a series of patterns in the tile to create more interest and variation in the façade, which is brought into the building as one of the major feature walls in the lobby and around elevator cores on each floor.

The cladding also allowed the team to use prefabrication to combat another challenge to the urban site—space. There was essentially no laydown area surrounding the site, requiring the team to erect the building up against existing structures on most sides.

“The entire curtain wall was prefabricated and I’d say almost 95% of the exterior was prefabricated,” Moon says. “It provided a very accelerated and efficient construction process in order to build this building within a fairly tight timeframe in a very restricted urban setting.”

Settling in
Since opening to
patients last year, the Shapiro Center has settled into the role it now fills in the South End—inside, offering a calm yet efficient environment for care, and outside, serving as the first major front door for the hospital on Albany Street.

The designers worked to celebrate the relationship BMC has with its neighbors by incorporating a canopy that extends the length of the building and provides accommodations for those using the bus stops outside. “A small, but meaningful gesture for neighbor and patient comfort,” Kobus says. And as for the architecture, Kobus says he’s confident that the right combination of a new take on an old standard was achieved.

“It honors the South End urban design and historic context but in a thoroughly modern way, so there’s no question about the period of time in which the building was designed. It’s not a new building trying to look like an old building,” he says.

For more information on Boston Medical Center, please visit www.bmc.org. Jennifer Kovacs Silvis can be reached at jsilvis@vendomegrp.com.