Reimagining the Medical Office Building
Recent shifts in culture, labor, workflow, and design are challenging many of the long-held roles and criteria that dictate how healthcare facilities are developed, designed, and managed. One of the most prevalent trends taking shape as a result of these changes to the nation’s care delivery model is thoughtful reevaluation of the design of medical office buildings (MOBs) and other outpatient facilities.
Not long ago—before these sweeping changes began taking place—most MOBs were designed as multitenant facilities organized to house numerous independent physicians or medical practice groups. Typically, that meant floor plans calling for long public hallways linking numerous separate suites, each with its own entrance, reception area, waiting room, exam rooms, restrooms, physicians and business offices, records storage, staff break room, imaging center, and lab.
However, the transformation of the healthcare industry is forcing providers, designers, and developers to reconsider this sort of isolation and duplication.
In a marked change from just a few years ago, hospitals and health systems now employ more than half of all physicians—and the proportion continues to grow. The impact of this trend alone on MOB design has been remarkable.
This new reality demands that providers, architects, and developers look at MOB design in a new way. Rather than multitenant MOBs, what’s needed are multispecialty MOBs designed to better support physician integration and collaboration, while boosting productivity and efficiency.
Instead of collections of independent doctors’ offices, each with their own infrastructure, future MOBs must be designed to house complementary practices, co-located services, shared support staff, and centralized common areas.
This new breed of multispecialty MOBs will require floor plans that include fewer public hallways—or perhaps no public hallways at all. Main entrances will open into larger, shared reception areas and waiting rooms for all patients, serving as central gateways to all doctors within the facility. Waiting areas will be focal points, and will be designed to provide a soothing, aesthetically pleasing experience while they handle the functions of registration and administration.
Not all spaces can be shared, due to local regulations, American Institute of Architects (AIA) guidelines, or both. However, assuming co-location of the types of medicine being practiced is permitted, many types of shared spaces can be created.
Exam rooms will be organized into groups of standardized pods that can adapt to the ebb and flow of patient demand for particular specialties at any given time. Restrooms, storage, imaging centers, and labs will be shared. Offices for physicians practicing different but complementary specialties will be grouped, facilitating easier interaction and consultation. Break rooms and conference rooms will also be shared, offering additional opportunities for both planned and serendipitous interaction.
Business offices will be centralized—perhaps even eliminated altogether, if those functions are absorbed by employer-hospitals. Even some medical personnel and support staff will be shared, cross-trained, and cross-utilized. MOBs will increasingly incorporate shared conference centers and auditoriums, in both common areas and suites, for staff training and patient education.
In addition to streamlining workflows, the more integrated design of multispecialty MOBs will reduce facilities costs as duplicated spaces and services are eliminated. For example, in the case of an 85,000-square-foot MOB with budgeted construction costs of $175 per square foot, a savings in construction costs of nearly $750,000 could result from the reduction of total square footage by just 5%.
Although there would be a proportionately smaller reduction in construction costs for a smaller building, a reduction in square footage would still deliver significant long-term savings in the form of reduced rents and operating expenses.
Interestingly, multispecialty MOB design is not a new idea. Many large clinics and academic medical centers—with the need and authority to require collaboration between physicians and staff—have favored this design model for decades. What’s changed is that more and more mainstream hospitals and health systems now have the leverage required to compel the implementation of this model because they employ more of their own physicians.
They also have greater urgency to do so to reduce costs and increase quality while better integrating all stakeholders involved in patient care.
As a result, with much of future reimbursement now hinging on quantifiable measures of patient outcomes, these multispecialty MOBs also must be designed based on proven models of successful care. The intensive, collaborative design process that in the past has been limited largely to inpatient facilities will be more frequently applied to MOBs and other outpatient facilities, including the incorporation of evidence-based design principles to promote a healing environment.
Individual floors or even entire MOBs will be designed and organized around practices and services that are naturally complementary. There will be MOBs that are wholly dedicated to specific demographics of the population—for example, female baby boomers—offering weight loss, anti-aging, OB-GYN, mammography, and plastic surgery services in a seamless, collaborative setting.
Other possibilities include MOBs dedicated to orthopedics, sports medicine, and rehabilitative and physical therapy; pediatric and young family specialties; or to elder care. This “one-stop shop” is efficient, attractive, convenient, and economical all at once, cutting down commute times for both the consumer and the staff.
Other key design elements
Additional design considerations that must be weighed for future MOB development include:
Technology. This new era of collaborative care, patient-centered medical homes, and ACOs is only practical thanks to electronic medical records (EMR), tablet computing, wireless networks, and other recent technological advances. Multispecialty MOBs must therefore be designed with careful consideration toward optimizing technology for physicians, support staff, patients, and their families.
Entire facilities will be designed with Wi-Fi capabilities and space-saving, temporary “touchdown” (shared) computer workstations. Materials will be selected, and windows and walls placed in ways that enhance connectivity instead of impede it.
Modularity and mobility. Under this new model, the components of the facility will be interchangeable and cross-utilized. For example, exam rooms will not be dedicated to just one use or function; they will be multiuse and multispecialty. To that end, more furnishings and equipment on wheels are used within buildings to facilitate and encourage easy movement.
Lean and green. Woven throughout the multispecialty MOB design process will be “Lean and green” principles—Lean architecture and design that minimizes the amount of materials, time, and effort used while still delivering the desired outcome.
Wherever possible, green materials and practices will be employed to minimize energy use and reduce a facility’s carbon footprint.
It’s all about the benefits
First and foremost, collaborative care and multispecialty MOB design is all about the benefits to the patient. But, done right, it can also benefit the patient’s family, physicians, staff, and the hospital or health system as a whole. Families will appreciate a simplified building layout and coordinated patient experience.
ians and staff will enjoy working in a more efficient, collaborative environment. Hospitals and health systems will benefit from reduced construction and operating costs, and greater employee productivity. Modern multispecialty MOBs may also be used as employee recruitment and retention tools, as well as a way to reinforce brands and differentiate facilities from competition.
The more recent stock of physicians are more inclined to be hospital employees with shared spaces and staff, avoiding the risk and headaches of running their own businesses while enjoying more balance in their lives. Organizational cultures must change and adapt to the new trends in healthcare, and a well-designed multispecialty MOB can create a built environment that facilitates that cultural shift.
Cinda Z. Terry, RID, is Healthcare Project Manager—National Planning & Development with Duke Realty. For more information, please visit www.dukerealty.com. Brenda Bush-Moline, AIA, LEED AP, EDAC, is an Associate Principal at VOA Associates Inc. For more information, please visit www.voa.com.