The evolution of healthcare delivery has put providers on a pathway searching for the right mix of services, facility types, and building layouts that maximize care delivery, improve the patient experience, and drive the best returns.

In fall 2011, Scott & White Healthcare decided to construct a medical office building (MOB) adjacent to a new 143-bed hospital it was building. The goal was to reduce travel time and distance for some of its specialists and make care more convenient for patients. But the system also wanted to create efficiencies at the four-story, 119,000-square-foot MOB, called Scott & White Clinic Rock Prairie, too.

“We wanted to have a facility on the same campus so that physicians needing quick access to our patients in our hospital could get over there quickly while minimizing interruption to our clinic patients,” says Linda Clark, vice president of clinic operations for Baylor Scott & White Health, College Station region (College Station, Texas). (Scott & White Healthcare merged with Baylor Health Care System in 2013 to become Baylor Scott & White Health.)


Aligning services

Many of the specialists were operating out of the existing Scott & White Clinic University Drive, so the first step was deciding what services needed to be near the hospital as part of the new Rock Prairie MOB. “Trust me, everyone wanted to move over there,” Clark says.

Two guidelines drove the decision process: First, specialties that needed quick access to the hospital or spent a lot of the time there were given priority. Next, those services that don’t necessarily spend a lot of time in the hospital but that work closely or provide a complementary service to the specialties that were moving over were considered.

General primary care and services that didn’t require a lot of hospital access, such as ophthalmology and dermatology, remained at the University Drive clinic, which was updated after the new MOB opened in 2013.

“We wanted to get some synergies out of the services we provide to our patients,” Clark says.

For example, Clark says the staff allergist doesn’t see many patients in the hospital but he does share patients with cardiology and pulmonology. In the new Rock Prairie clinic, all three of those specialties are co-located on the fourth floor, where they can share equipment and treatment rooms.

On the second floor, pediatrics, OB/GYN, and women’s imaging are located together, recognizing that women receiving prenatal care would already be familiar with the space when they brought their kids in for pediatric care.

The third floor houses those services related to muscular and skeletal care, including neurology, endocrinology, orthopedics, and physical therapy. “We have a whole theme in how these specialties were laid out,” Clark says.


Flexible design features

With its new departmental synergies in place, Scott & White then turned its attention to creating a layout that could flex and grow as its services evolve and healthcare demands change.

For example, Clark says instead of allowing each specialty to create its own exam room layout, she created a general design with the same number of upper cabinets and types of drawers. The only variance was the placement of the exam table based on the way the doors were installed.

“The departments adapt quickly to whether the rooms are right-handed or left-handed, as long as the general layout of the space is the same,” she says.

In addition, if one service outgrows its space, a nearby department can be relocated to create room for the expanded program and staff will already be familiar with the room setting.

“I want to be able to move people into that space fairly quickly with a minimum amount of renovations and a minimum amount of disruptions to the services that we’re providing,” she says.

Some clinic spaces are also designed to flex on a daily basis. For example, the operator decided that some gastrointestinal (GI) procedures would be done at the hospital instead of the outpatient clinic when GI moved to the second floor of the new MOB. That change meant usage of a GI treatment room would drop to roughly 20 percent.

However, Clark anticipated that OB/GYN services, which are located next to GI, would continue to grow and expand. So rather than have a 200-square-foot GI room sitting empty, the treatment room between the two is designated as shared space—a solution that reduced duplicate services, resulted in a larger treatment room for OB/GYN, and brought operational savings to the clinic.

The design team also turned to its in-house Lean expert to work with the staff to reduce wasted space and extra steps, while further improving the flexibility of the medical clinic. Clark says that many of her older existing facilities have large waiting areas for each specialty service, which amounts to a lot of space that can go unused.

The new Rock Prairie clinic is designed so that each floor has one shared waiting area with a central check-in area to reduce redundant services and save square footage. Check-out functions are done in the exam rooms away from the exit doors to further reduce bottlenecks at the entry and exit points of the clinic floors.

“As opposed to a typical medical office building, which is a lobby, hallway, and separate doctor’s offices, this entire building works as one,” says Richard Couturier, vice president, healthcare development for the South/West regions at Duke Realty (Indianapolis), the developer on the project. “It doesn’t have that feeling of a typical physician office building.”

Through these flexible and Lean design features, Scott & White was able to reduce the overall floor plan of the MOB by about 7,500 square feet while also adding some new services, including endocrinology, pulmonology, a sleep lab, and neurosurgery. A planned radiation oncology unit is set to open on the first floor within the next year.


All part of the plan

After two years in the space, Clark says the clinic is functioning as expected, but there are some departments that are nearing capacity within their existing spaces. At that point, she knows she’s going to need to make a change—whether it’s flexing into a nearby department, building out some of the medical center’s shelled space, or relocating a service to another location.

“Our plan all along when we built both the clinic and the hospital was keeping in mind future growth and how we would do that on this campus whether it’s attached to this building or a second MOB very near to the building,” she says.

Anne DiNardo is senior editor of Healthcare Design. She can be reached at