From Office to Ambulatory Care
Speed to market. Reduced capital expenditures. Improved access to care. Enhancing the patient experience. These four driving forces are causing healthcare providers to re-evaluate how their strategic direction—including real estate strategies—can impact the bottom line, patient satisfaction, and overall care delivery.
Now more than ever, providers need modern facilities that can improve the efficiency of the care-delivery process. At the same time, the current soft commercial real estate market is allowing them to explore alternatives to traditional facility renovation or ground-up medical center construction.
One option that is gaining favor nationwide is the repurposing of existing building stock—often vacant office buildings or shuttered big-box retail spaces—to accommodate outpatient medical functions. This approach is attractive in that it can be significantly faster and less expensive than a build-to-suit solution.
Outpatient centers can usually be classified as a “B” occupancy or office building usage, requiring fewer regulatory approvals and smaller space requirements as compared to a traditional hospital. However, the challenge of adaptive reuse in healthcare is successfully inserting function into building form to create a building that supports operational efficiency while providing a welcoming and healing experience for patients.
The right solution at the right time
For Kaiser Permanente of the Mid-Atlantic States, the recent economic downturn coincided with a building expansion program, focused on delivering several new multispecialty outpatient facilities. In the Washington, D.C., metropolitan region, the market for developer-driven office space has been traditionally robust, catering to the workplace needs of the federal government.
However, no different than other major cities, the D.C. office market was also hit by the recession, leaving an inventory of empty speculative office buildings in its wake. Kaiser Permanente was able to evaluate its options.
A confluence of attractively priced real estate, membership growth, and lease expirations at other facilities in the vicinity led to the solution of converting existing office buildings to house medical functions. AECOM was retained to provide design services for two of those multispecialty facilities, including one in Gaithersburg, Maryland, which transformed an existing, vacant six-story, 200,000-square-foot office building into a state-of-the-art ambulatory care center.
This particular site had several advantages. Conveniently located off Interstate 270 in a quiet, green setting, it is easily accessible to patients. This relatively tall building has great visibility and provides an excellent means to promote the Kaiser Permanente brand of integrated healthcare delivery to the community.
The building floorplate was also flexible enough to allow the team to meet the project’s goals: maximizing space utilization for healthcare delivery while reinforcing Kaiser Permanente’s commitment to the total health of its members at every touch point.
More than just an outpatient clinic, the Gaithersburg Medical Center houses a wide array of primary and specialty medical care services, including 24-hour urgent care center, 23-hour-stay clinical observation unit, ambulatory surgery, infusion center, 24/7 pharmacy, laboratory, and sophisticated radiology center—all located under one roof. Completed in March 2012, the facility is now Kaiser Permanente’s largest in Maryland.
“Mid-Atlantic Permanente Medical Group physicians helped design these buildings to ensure they house all the technology and equipment our physicians need to quickly and easily provide total care, at any time of the day or night,” says Bernadette Loftus, MD, The Permanente Medical Group associate executive director for the Mid-Atlantic States. “A broad array of Permanente specialists, primary care providers, along with lab, pharmacy, and imaging—and the supporting equipment—are all co-located in a single building, which is a boon for the healthcare quality and convenience we can provide.”
Addressing technical challenges
While the adaptation of an existing building afforded Kaiser Permanente the opportunity to deliver this project more quickly than ground-up construction, the team needed to overcome a number of technical challenges associated with designing an ambulatory care function within a building that was originally designed for corporate office occupancy.
These included the size and location of building core functions (elevator types, central location, and public restrooms), the dimensions of the structural grid, structural floor loading, introduction of medical gases, and exterior window conditions. Fortunately, existing surface parking and site conditions met the requirements for a healthcare facility.
The team was able to identify, design, and implement necessary improvements, including:
- A new elevator, able to accommodate stretchers, threaded through all six floors of the existing building;
- A completely new emergency power system;
- The additional life safety features associated with ambulatory care;
- The addition of new air-handling systems for ambulatory surgery;
- The addition of canopies at patient access points; and
- An expanded loading dock.
Modifying the template
Kaiser Permanente is well-known for its design standards and room templates that help the organization provide efficiency and consistency in the delivery of healthcare services.
For the Gaithersburg Medical Center, in order to be successful with the application of room templates, the client and design team realized that 100% compliance with the Kaiser Permanente templates was not feasible; therefore, being flexible with the kit-of-parts would be the key to success. The Gaithersburg Medical Center fundamentally adheres to the standard Kaiser Permanente room templates for MOB facilities, with customization that took into account the unique circumstances of this project.
The multidisciplinary design team worked in collaboration with the individual clinical users as well as Kaiser Permanente’s National Facilities Planning group. The team looked for appropriate functions where such exceptions to template design would not only mitigate any negative impact to operations, but even enhance the healthcare delivery environment.
For example, the existing building at the Gaithersburg location includes a curved exterior frontage, which proved challenging to accommodate standard exam room template modules. In response, the design team placed more flexible “open” functions, such as infusion therapy and rehabilitation services, along the curved area, thus minimizing impact on template deviations while enhancing views and the overall environment for these spaces designed for longer patient visits.
Optimizing the healing environment
The design supports Kaiser Permanente’s integrated healthcare delivery model and commitment to preventive care, empowering members to maximize their total health. The design team needed to develop interior design enhancements that transformed a corporate facility into a truly healing environment.
This was delivered in a manner that respected the building’s existing LEED silver certification by limiting removal of finishes, while adding simple features to the existing palette and ultimately developing interior spaces that promote the Kaiser Permanente Total Health Environment program.
All design decisions—fr
om how members enter the building, to circulation and wayfinding, to the color palette—focused on enhancing the member experience. The final results provide a calming and sophisticated healthcare setting that is scalable to a large and diverse range of patients. T
his project also provides a great opportunity to promote Kaiser Permanente’s “Thrive” program to support and physically manifest the total health and wellness themes of the organization’s signature brand. Features include on-site exercise and walking paths, and a weekly farmers market stand on site. Not only intended to promote wellness, these strategies also provided Kaiser Permanente opportunities to connect and integrate with the community.
Fast track to success
Nobody said it would be easy to deliver a 200,000-square-foot healthcare facility in fewer than 30 months from programming to full facility activation, but the project team embraced this challenge from the start. Through close collaboration between the client, program manager, and design and construction team members, the project was delivered so Kaiser Permanente could open the doors to its first patients three months ahead of the original schedule.
The team was even able to accommodate design changes necessitated by emerging medical technologies without missing a beat. For example, facility design revisions during construction were able to readily accommodate changes to state-of-the-art electronic patient flow tracking systems and diagnostic imaging systems without impacting the ultimate delivery date.
The Gaithersburg Medical Center sets forth a new building model, created in response to the needs of the community. It delivers a powerful and attractive message: high sustainable value is all around us.
According to Robert Pearl, MD, executive director and CEO, The Permanente Medical Group, and president and CEO, Mid-Atlantic Permanente Medical Group, “This new facility embodies Kaiser Permanente’s commitment to providing exceptional quality in the most effective and convenient way possible. Combined with our comprehensive electronic medical record and the Internet-based tools that patients can use to schedule an appointment, review their laboratory results, and send a secure email to their physicians, this next generation facility will provide a level of unmatched access and convenience for patients and their families.”
The Gaithersburg Medical Center sets an example that adaptive reuse can be a successful option for healthcare, and can be deployed at different scales and settings in order to make high-quality care more convenient and accessible to the community. HCD
Gregory Chang, AIA, LEED AP, is Managing Director, Healthcare, at AECOM. He can be reached at firstname.lastname@example.org.