A Safety Net of Healthcare
The history of Adelante Healthcare Mesa, a 42,500-square-foot, nonprofit, Federally Qualified Health Center in Mesa, Ariz., is steeped in a commitment to provide access to healthcare services for the under- and uninsured of Maricopa County. Adelante, which means “forward or progressive” in Spanish, began as Clinica Adelante, a mobile organization of volunteer healthcare professionals who served the needs of poor migrant farm workers in the area. Today, the group’s physical locations have become a model for welcoming, respectful, and comprehensive primary care. Providing collaborative care, or a “one-stop shop” experience, for patients is an important factor in Adelante’s vision.
Adelante Healthcare Mesa CEO Avein Saaty-Tafoya identifies evidence-based design (EBD) as one of the tools used to shape the center. Using EBD research focused on community health and safety net clinic design, Jain Malkin Inc. (San Diego) was brought in to develop spaces that would help relieve stress and meet the needs of patients, staff, and families in the diverse community. “We asked ourselves: How do we develop a design that speaks to people from many different cultures, that makes them feel welcome, and makes them look forward to coming back for a visit?” says Jain Malkin, president and CEO of the former Jain Malkin Inc.
Malkin turned to the surrounding environment for inspiration. “We looked at the geology of the desert canyons that have been carved by rain water and rivers over long periods of time, and decided to bring in that design concept of water, waves, and currents,” she says. The concept was expressed on the façade of the greeter desk in the lobby and on all receptionist desks throughout the center. Curved banners hanging from the ceiling and seating arranged in a serpentine shape also carried through the thought of waves and calm in the space.
The sage green, terra cotta, orange, and tan colors in the facility were drawn from the surrounding desert to give each department a unique palette that would lend identity and pride of place for staff. The generous use of wood enhances the warmth of the colors, while carpeting and acoustic ceiling tile contribute to reduced noise levels.
Malkin estimates that natural light fills 95% of the spaces in the facility. Featuring floor-to-ceiling walls, the two-story lobby allows daylight to flood in and spill into the interior spaces. Lighting in the facility is 95% LED, which allowed the design team to improve energy efficiency and to be creative with its use of strategically placed soffits that add a soft glow and enhance wayfinding. This attention to interior lighting details has been submitted for LEED Platinum certification for Commercial Interiors. If achieved, Adelante Healthcare Mesa would be the first community health center in the nation with this designation.
The building’s main lobby splits the functions and flows of the clinic in half, with the programs for women and children on one side and adult internal medicine on the other. All departments were designed with two waiting areas—an area for sick patients and another for patients who are visiting for a routine checkup. “It was very important to the CEO that the seating not be ganged seating or look like a bus station,” Malkin says.
Involving family members in the care process has been shown to improve patient outcomes, and at Adelante Healthcare Mesa, this was achieved through “talking rooms.” These rooms, most of which are connected to exam rooms, encourage a free flow of discussion between the care provider and the patient, as well as family members. Comfortably appointed with a table and chairs as well as a reclining chair, the rooms offer an informal atmosphere devoid of medical equipment, which can sometimes be intimidating. They also free up exam rooms for cleaning and timely setup.
The exam rooms also support the concept of engaging patients at all levels. Mobile tables and laptops allow physicians to position him or herself anywhere in the room that will make a patient more comfortable. A large, touch-screen monitor mounted on the wall in each exam room provides positive distraction, displaying nature scenes or educational information about a particular illness. As a Center for Health Design Pebble Project facility, Adelante will be conducting a research study to analyze what types of viewing selections patients make when they’re able to choose their own programming.
A staff circulation core runs off each clinic’s reception area, connecting the clinics to one another to provide maximum flexibility for expansion or contraction in staff size and exam rooms, depending on patient volume.
The many services and wellness programs offered at Adelante Healthcare Mesa, as well as the free use of certain areas for the public, are another part of the vision to engage the community.
“We didn’t want to be a doctor’s office; we wanted to be a place of healing and a place of hope. We have a mantra about being hosts to our guests, and we have a culture that is all about hospitality and customer service, bringing the patient experience to the forefront,” Saaty-Tafoya says.