Dialysis patients across the country are receiving fast-track, quality care in newly completed healthcare facilities they could almost call home. These facilities house highly accessible, comfortable patient areas that include not only dialysis equipment, but also personal flat-screen TVs, Internet access, indirect lighting, and soothing environments with muted colors.

An outpatient clinic is less expensive to build and operate than a hospital, and it reduces the burden on local hospitals. Patients diagnosed with chronic kidney failure, for example, are no longer forced to seek dialysis treatments in few-and-far-between institutional locations. Today, they can seek treatment in numerous outpatient facilities close to home.

These specialized care centers serve hundreds of thousands of Americans and are part of the increasingly patient-driven healthcare model, providing services to a specific segment of the population. They are filling the gap between the physician's office and the hospital by conveniently and efficiently addressing chronic care issues. According to the National Kidney Foundation, 20 million Americans—1 in 9 U.S. adults—have chronic kidney disease, and another 20 million are at increased risk. The need for specialized dialysis centers to serve these patients continues to grow.

DaVita Dialysis Centers exemplify this trend. A recent collaboration undertaken by Barone Design Group and Houston-based architecture firm Sikes Group to design and construct four new DaVita dialysis centers in San Antonio and Houston represents the design side of this changing face of medicine. Our firm's work included evaluating and implementing solutions that maximize function and patient comfort in dialysis centers that serve between 12 and 24 patients and accommodate medical and business administration staff, as well as a team of healthcare professionals who also provide home-bound care.

New (or substantially renovated) healthcare facilities like the DaVita Dialysis Centers face a challenge, however: expense. New build-out for an outpatient or treatment center averages two to three times the cost of a typical corporate office. Complex plumbing requirements, the focus on sterilization and cleanliness, and the necessity of creating an office within the doctor's office for processing the endless insurance and Medicare paperwork all add to the expense. Specific fire and other safety codes add to the complexity.

The classic “carousel” design is a layout that positions the business operations in the center of the space, as shown on these plans for future DaVita Dialysis Centers.

Additionally, all outpatient treatment facilities must offer maximum accessibility; to accommodate patients with physical limitations. In renovations of older facilities, accessibility adds significantly to the cost. In new build-out, the best strategy is to design for universal access from the start.

The Fast-Track Design Process

Given the complexity of outpatient care environments, new processes and design strategies are employed to meet tight deadlines, manage expense, and create environments that ultimately promote wellness. “To get a project like this completed on a fast-track timeline, the team needs to map its steps and work in advance from the very inception,” says Herschel Sikes, president and founder of Sikes Group. “If you've got an experienced team, final construction documentation can occur post-groundbreaking. The real issue for the design and architecture team is collaboration and timing.”

Sikes points to the following keys for meeting the goals of fast-track projects:

  • The design team. Securing the complete design team from the onset of the project saves time. For a project on deadline, designers should preselect trusted contractors at the beginning.

  • Scheduling. Once the team is aligned, day 1 begins by examining critical deadlines and materials. The project should begin with the identification of all long-lead items that require extended time for shipping. A time line of critical benchmarks should be outlined, some of which should occupy otherwise extended downtimes.

  • Starting early. To get a project rolling quickly, construction often needs to begin with preliminary construction documents, which are then completed during the initial construction phases.

  • Communication. Planning, strategy, and real-time access allow faster completion of projects. Access to a shared intranet enables all team members to update a common grid, allowing project managers to stay up-to-date on all progress or difficulties.

Strategic Design

Quality and functionality cannot be compromised, but efficiency is a must. For example, the classic “carousel” design (figure 1) is a space layout that positions the business operations in the center of the space. Patient rooms and the waiting area represent the next layer, and specialty and long-term supply rooms represent the third layer. The traffic flow of the patients and healthcare providers through all this must be evaluated and controlled to avoid unnecessary disruptions to the completed facility's operations.

The environment must be designed with a variety of necessities and functions in mind, including access to supplies, personal spaces for healthcare providers, receptionists' range of sight, and the capability of handling massive amounts of paperwork and insurance filings (figure 2).

The work desk at this DaVita Dialysis Clinic was designed with a variety of functions in mind.

In a dialysis facility, accommodations for the water supply are critical. Dialysis clinics have huge self-contained filtration systems. Water for cleansing the blood is pumped and looped throughout the entire facility, feeding and exiting individual stations. In general, the design must incorporate extensive incoming water and ongoing drainage. Pipes are hidden in the center of each station and behind walls. Because ongoing maintenance is a must, panels must be easily removable, yet appear as a core element of the design. Architectural features must coordinate with the waterways, as well.

Another differentiator from hospital design is that an outpatient care center is more focused on customer service, not critical care. The objective is to create a streamlined, comfortable environment to serve hundreds or thousands of patients. Outpatient clinics are focused on a single function, as opposed to the vast complexity of hospital services.


The demand is high for retooling and developing environments to care for patients with chronic illnesses, and to handle outpatient needs and specialized medical conditions. Designers and architects must consider all the facets of the space to meet the needs of a new generation of providers and patients. New healthcare facilities are breaking ground every day, and their design is often breaking new ground as designers and architects seek to create new solutions for the next generation of specialized care. HD

Dean Barone, IIDA, IDSA, LEED AP, is President and cofounder of Barone Design Group, an architecture and interiors firm.