As recently as 20 years ago, there was a gold standard for clinic design, focused on caregiver needs rather than patient comfort. Clinics were aesthetically antiseptic places in which white walls, linoleum floors, fluorescent lights, and overactive air conditioners evoked a sense of sterile efficiency.

Yet over the years, the healthcare industry took a closer look at patient comfort to reduce inherent stress associated with clinic visits. A stronger focus on data-driven evidence-based design helped reduce stress and support patient comfort with more homelike features, better lighting, and views of nature.

Concurrently, Lean planning deconstructed the standard clinic module to streamline caregiver workflow, increase efficiency, and improve patient care. The once-standard clinic module featuring three exam rooms per physician soon gave way to open plans in which caregivers share common workspaces and flexible exam rooms.

Modern clinic design is both responding to and leading changes in the healthcare industry. New legislation, changing reimbursement standards, and a greater emphasis on preventive care are inspiring healthcare organizations to realign their care models.

However, what works today in a clinic module may not work tomorrow. To be successful, healthcare organizations must continuously innovate to meet a diverse population and improve care. The new gold standard is based on flexibility and adaptability.

Flexibility versus adaptability
Capital infrastructure represents a major investment for any healthcare organization. To maximize that investment within a changing marketplace, healthcare organizations need to balance flexible space planning with adaptable space planning.

The two are not necessarily interchangeable, and each represents different time frames. Flexible space planning serves short-term needs and organizes services around like experiences and activities, with universal spaces designed to flex according to needs. This may be particularly helpful in multipractice clinic buildings, in which specialties can share laboratory services, waiting areas, exam rooms, or education spaces.

Sioux Center Community Replacement Hospital and Health Center in Sioux Center, Iowa, for instance, integrates four specialty clinics (orthopedics, cardiology, dermatology, and neurology) with a 17-bed inpatient hospital to promote flexible space utilization and workflow efficiency. Common spaces are grouped within a centrally located commons, from which all programming radiates. The laboratory is next to outpatient clinics at one end to streamline patient flow from exam room to lab, while ED, imaging and surgery are adjacent to each other on the opposite end of the plan to accommodate common patient/caregiver flow. Likewise, specialty clinics are adjacent to surgery to address patient/caregiver flow, while the ED and birthing and patient units flex back and forth according to need.

Adaptability, on the other hand, serves long-term programming changes, such as converting a medical office building into an outpatient surgery center or planning for future expansion.

For instance, Essentia Health’s 90,000 square-foot ambulatory care build­ing in Fargo, N.D., is designed to convert to an office building with the vertical addition of two floors, if needs change. The outpatient clinics are stacked to provide opti­mal horizontal adjacencies for providers while diagnostic and treatment spaces are centrally located.

Function and flow
Technology is also fueling the need to balance flexibility and adaptability. For instance, technological advances are making it easier for medical equipment, supplies, and medical ser­vices to flow toward the patients so that they no longer have to move to different points within a clinic.

Additionally, technology is affecting the way spaces are designed to support multiple advanced uses, from telemedicine and private consultations via Skype to group meetings with teleconferencing and educational webinar presentations.

Likewise, with different doctors sharing space within the same clinic, flexible work spaces need to support collaborative care models. Clinics are taking their cues from the corporate world to eliminate private offices for free-address spaces within an open plan. Because these spaces have no permanent walls, the layout can easily adapt to changing programming needs, such as converting a primary care clinic to a specialty clinic if long-term needs arise.

Through this all, Lean planning promotes optimal workflows and operational processes to move systems and people. 

At HealthEast’s Midway Clinic in St. Paul, Minn., Lean planning strategies created separate intake, exam, and checkout rooms to improve effi­ciency throughout the two-story building, which was converted from a former retail space. Patients register in intake rooms on the ground floor and then move to their point of care. Electronic health records expedite the check-in process.

After leaving an exam room, patients stop in one of the private checkout offices where they connect with a specialist who reviews their records. The 15-minute check-in period reduces the time physicians formerly spend fill­ing in missing information and increases doctor-patient care time.

A new kind of clinic
Taking the concept of flexibility and adaptability a step further, many healthcare organizations have an opportunity to imagine a new kind of clinic—a clinic that takes an integrated approach to health and wellness. While most patients will never mistake a clinic for a resort, healthcare facilities nonetheless are projecting a welcoming image with warmer finishes, more intuitive wayfinding, and a stronger connection to natural light and other spa-like features.

This new clinic might be reminiscent of a holistic retreat, in which patients spend a day in a spa-like setting for their annual physical. That day may include separate visits with a primary care physician and necessary specialists for a complete check-up, on-site wellness classes, healthy cooking and nutrition demonstrations, one-on-one wellness coaching, lunch in a chef-inspired cafeteria, or time in a learning center.

Flexible spaces can accommodate different settings as market demands or care models evolve. Common spaces with surrounding ancillary services can be designed to flexibly accommodate different needs and programming throughout the day or year. Open floor plans, modular walls, and system furniture can be reconfigured to accommodate yoga classes one day and cooking demonstrations the next.

For many healthcare organizations, flexibility and adaptability are essential to delivering quality care, responding to today’s needs as well as to lon­g-term changes. We can’t predict what the clinic will look like in five years, but as patients find more choices in their care, the most successful primary care clinics will address the cycles of change. The clinic in five years is a clinic in constant

Christine Guzzo Vickery, CID, EDAC, is vice president and senior interior designer with HGA Architects and Engineers (Minneapolis). She can be reached at