With the Affordable Care Act in place and an economy on the rise, retail and healthcare are an inseparable pair. Healthcare organizations are ramping up to improve patient experience and population health—not only by embracing preventive care and cost-conscious measures, but also by creating retail-like healthcare environments. Today’s providers are migrating deeper than ever into communities, luring consumers with convenient care in a smaller, less-expensive outpatient footprint.

“I think the biggest hospitals in the country are eventually going to figure out that acute care hospitals are going to get smaller and receive fewer investments from here on out, and what’s going to get increasingly invested in are these retail places,” says geomedical consultant Bill Davenhall, formerly of Esri (Redlands, Calif.), a geographic information systems software provider.

In turn, retailers in the drug store, grocery store, and general merchandise markets are capitalizing on an opportunity to provide healthcare services in the same space their customers buy health-related products. Whether they’re aggressively pursuing these opportunities on their own or—more and more—partnering with healthcare systems, the result is a growing mix of healthcare and retail strategies in site selection, design elements, and more.

Add to this a trend toward more merchants setting up branded shops within healthcare campuses and healthcare spaces moving into former stores, and the lines between retail and healthcare become even blurrier.


Selecting sites, street by street
As both physicians and retailers race to deliver more community-oriented healthcare, they’re increasingly relying on big data. According to Este Geraghty, chief medical officer at Esri, that means examining insurance coverage, age, race, predominant languages, and disease prevalence, as well as less expected factors such as income level, educational attainment, and home ownership rates, in order to select sites and specialties offered.

Craig Beam, managing director of healthcare services for commercial real estate firm CBRE (Newport Beach, Calif.), says this process has helped healthcare providers leverage retailers’ site-selection savvy: “A more thoughtful approach is starting to emerge that looks at demographics, payer mix, traffic patterns, and medical use rates. While these can define areas, there’s still the need to consider visibility, access, parking, and the more traditional retail qualifications for a site,” he says, noting that healthcare providers are now taking over mid-sized spaces vacated in recent years by retailers like Blockbuster, Circuit City, and RadioShack.

Beam uses proprietary analytics software to help health systems select new locations; he can pinpoint a given diagnostic code “down to the street corner.” Then, for example, he might advise a primary care provider in a saturated market to buy up existing practices rather than launch new sites. And healthcare providers that give the community what it needs (ideally, in an attractive setting) are also those most likely to score highly on satisfaction surveys. Thus, designers who can provide the tools to research patients’ behavior, desires, and unmet needs will be more competitive in tomorrow’s healthcare design market.

Yet healthcare systems aren’t currently moving into community-based models purely for profit. “It’s mostly market share,” Beam says. “Most are looking at it as less about the financial viability of a space and more about retaining market presence, which is a nice way of saying most of them lose money.” The real money to be made is in long-term brand recognition and referrals from branded clinics to other providers in the system for pricier diagnostic and testing services or ongoing care.


Familiarity builds comfort—and clientele
Still, simply sending a patient to the hospital for a scan isn’t enough. Consumers want easy-to-navigate, convenient care sites. And with growing demand for preventive care that strives to keep the chronically ill from requiring hospitalization in the first place, providers are finding creative ways to improve access.

Avein Saaty-Tafoya, president and CEO of Adelante Healthcare (Phoenix), is an early adopter of a pro-design and retail-centric approach to healthcare. Three-quarters of patients served by this Maricopa County-wide network of community health centers have incomes that fall below 200 percent of the federal poverty level; the centers are federally funded and provide safety-net services including primary care, mental health services, and nutrition counseling. Despite those inherent challenges, Saaty-Tafoya has managed to raise patient satisfaction scores over the past few years.

Like the big data gurus, she borrowed from retail: “We learned that the status quo was not our goal. In retail and hospitality environments, the management and staff are dogged in their pursuit of exceeding every customer’s needs and retaining them along with having them recommend to friends and family. Anything less than that is considered a missed opportunity. The culture of healthcare has had a ‘good enough’ approach and, unfortunately, in the not-for-profit sector, our culture is often overwhelmed and under-resourced, so the idea of exceeding expectations for all patients seemed to be a luxury.”

No more. Like retailers, today’s successful healthcare providers pivot quickly, taking into account consumers’ changing needs. In Adelante’s case, that means electronic portals from which patients schedule appointments, simplified and transparent sliding-scale fee schedules, and even some more basic comforts designed to bring the community in, such as air-conditioned play spaces at its Mesa, Ariz., facility that open during heat advisory days.

To assuage patient anxiety, departmental front desks were opened up; waiting areas were scaled down to create conversational spaces with private nooks; and elevated exam room tables and instrumentation were reduced in favor of lower, round tables that stimulate doctor-patient communication. Skylights, transoms, and plentiful windows—even a motion-activated “virtual pond” water feature—are examples of how the provider has worked to “maximize the ‘feel-good’ spaces throughout our health centers,” Saaty-Tafoya says. “These are places where all of us would rather be.”

And such efforts to create a culture all pay off in supporting the brand. “From a branding perspective, you can’t take everything in retail and apply it to healthcare, but a lot of things make sense,” says Daniel Montaño, creative director of the brand experience studio at Little, an architecture and design firm based in Charlotte, N.C. “You go to the grocery store or Starbucks a lot more in your healthy years than you go to a healthcare provider,” he says. In other words, tomorrow’s healthcare consumers are being indoctrinated with retail branding today.

But branding is no longer attached to individual physicians; it’s more likely to be found for sites under a specific ownership umbrella. “With baby boomers coming of age, there’s going to be an influx of patients where everyone has insurance or supposedly will. The need for primary care will drastically increase, but it’s not the doctors who’ll see most of the patients. It’s physician assistants and nurse practitioners. You might see your physician once a year, so that brand recognition is more important,” says Keith Fleming, di
rector of healthcare planning at Little.

Making those connections is key, because once patients develop a sense of trust with a brand, a provider could have a customer for a lifetime—one who’s as willing to pass up a drugstore clinic to stay in her healthcare system as she is to drive a bit farther to shop at a favorite grocery store.


All-in-one convenience
Near Columbus, Ohio, CannonDesign helped the OhioHealth system borrow another retail concept for its Pickerington Medical Campus, which opened in June. The facility offers something like a medical office building, diagnostics site, and emergency department all in one, a move inspired by one-stop superstores that allow tired shoppers to decrease time spent on the run. It’s a concept that’s catching on quickly as harried adults race between work and personal responsibilities, with scant energy left over for their own health.

In Minneapolis, Christine Hester Devens, associate principal and interior project designer at AECOM, (Minneapolis) was among those tapped to design the Park Nicollet Women’s Center. Although this one-stop health shop is feminine in name, kids and partners are considered part of the user base, too. So when AECOM designers created experience maps by posing as potential patients, they imagined both expectant moms with kids and family in tow, as well as older women taking advantage of urogynecological services, for example.

That meant planning a building that would support different types of care—and different types of patients. A primary welcome lounge was designed for families, with iPads, modular seating, and café tables, while sub-waiting areas are quieter and promote relaxation. Thematic art for various spaces depicts a diversity of life stages and states of health, and a community room offers multifunctional space to accommodate everything from birthing classes to menopause groups, with built-in sofas that offer both seating and storage as well as an adjacent storage room for tables and chairs to allow flexibility.

CannonDesign completed another all-in-one concept in St. Louis, with BJC HealthCare’s first outpatient facility for St. Louis Children’s Hospital and the Washington University Medical Center, where the client’s goal was to prevent chronically ill parents and their caregivers from having to trek long distances from home and then hike through an unwieldy, unfamiliar medical campus. Jocelyn Stroupe, director of healthcare interiors for CannonDesign (Chicago), says the owner requested “a retail approach to design and putting it where the community need is.” The facility offers a café and Safety Shop for car seats and other kid-related equipment, as well as a pharmacy. It’s a nod to another expectation consumers learned in retail: clustering of similar services, which speeds shoppers along their errand runs.

Stroupe says the facility isn’t borrowing institutional branding but informing it. And it’s an ongoing process. “It’s seen as establishing a new approach to the brand,” she says. “We’re looking at what that means to the main hospital campus and how can that be infused into inpatient care and other elements of that building. We created this new identity for this brand in this outpatient facility, and now it’s informing everything they’re doing moving forward. That’s a common condition we’re seeing as it’s related to aesthetic.”


Adding a retail feel
To attract brand-loyal customers, taking a retail designer’s demographic-, detail-obsessed outlook won’t hurt, either. Convenience is king, topping even personalization in some cases. Medical settings used to rely on coldness and sterility to generate a sense of security (which questionably worked). Now, consumers are overworked and baffled by endless choice. They want familiar providers; consistent experiences; and environments where snacks are welcome, kids can do homework, private conversations aren’t overheard, and seating options accommodate briefcases, backpacks, and coats.

The rest “is pure psychology,” Montaño says. “Don’t slam the desk at the front, but give people a little time when they come in to gather their wits around them to see, ‘I’m here, I see seating over there, now I’m going to go here.’” In other words, don’t make it a mystery and don’t make it difficult. Additionally, it’s about creating a space that feels as energized as those who pass through its doors, whether they’re facing surgery or visiting a family member.

The idea of healthcare as an institution is fading as today’s healthcare consumers demand convenience and care that mimic their experience in grocery stores, clothiers, and coffee shops. Facilities that successfully bridge the gap between healthcare and retail will not only drive a medical care model that responds to how we live, but will create environments that are sources of health and not just places to heal.

Robin Donovan is a freelance writer and editor based in Cincinnati. She can be reached at rkdonovan@gmail.com.


Sidebar: Setting up shop

“Hospitals in dense urban environments are waking up to the idea that ground-floor retail can both be rented and provide a set of goods and service to the city within a city that the hospital actually is,” says Robin Guenther, principal at Perkins+Will (New York).

And if you thought convincing retailers to enter healthcare campuses meant simply getting them over the “ick” factor, think again. Hospitals themselves have become choosier landlords as, for example, they seek quick-service eateries that offer both fast and healthy options.

In turn, retailers are learning just how attractive hospital-based selling spaces can be. With a captive audience of patients and families, as well as 24/7 staffing, a hospital’s foot traffic can turn a small community into a retail-worthy hub. While some health systems prefer to maintain control over retail offerings as additional sources of revenue, others see recognizable retailers positioned on the ground floor as just one more amenity they’re offering to lure healthcare consumers.

Design is typically driven by the retailer with an allotted square footage, though some leases allow for a “more sophisticated approach,” says Jocelyn Stroupe, director of healthcare interiors for CannonDesign. “There’s an interface where the entry occurs, whether on the street or inside the building itself and, in some cases, there are guidelines so that the retailers can finish the entryway, much like in a shopping mall.”

In some cases, incorporating retail means not only design features that mimic a look that appeals to shoppers, rather than patients, but urban planning that supports retail-healthcare adjacencies. For example, in Boston, designers at Perkins+Will tackled the emotional needs of physical rehabilitation patients with the harbor-front Spaulding Rehabilitation Hospital, which is complemented by public-facing spaces, such as a gift shop, do
g-friendly lobby and patio, café, and a community conference center.

And in the same way that the Cleveland Clinic offers out-of-towners an upscale stay with its adjoining InterContinental hotel, health systems need not stick to modest partnerships. In fact, Guenther suggests not only hotel concepts but spa services, too. “Health-supportive upscale retail ideas are becoming more connected in large academic medical centers to service people who are there from a long way away or for a long period of time,” she says, describing average academic medical centers as “islands in neighborhoods where that kind of retail doesn’t exist.”

To help identify the best pairings, consider not only the hospital’s location, but the pent-up demands of its staff. Poll them, Guenther suggests, to see what types of services are most wanted. Would an outdoor eating area, dry cleaner, or small grocery store be most used? Then, take that data to hospital leadership to justify the cost.