The Incredible Shrinking Waiting Room

The Incredible Shrinking Waiting Room

Lauritzen Outpatient Center by HOK.
Courtesy HOK

Lauritzen Outpatient Center
University of Nebraska Medical Center, Omaha, NE
Architects: HOK

Patients have described Nebraska Medical Center as a maze, which can make navigating the campus a challenge. The University of Nebraska melds with Clarkson and University Hospitals, coming together at a point just west of downtown Omaha.

Soon patients making the trip for same-day operations and services will be able to streamline that journey, once the four-story Lauritzen Outpatient Center is complete in August 2016.

“The goal is to create a one-stop shop for outpatient services, focused on outpatient surgery procedures,” Rosanna Morris, the hospital’s chief operating officer, told Livewell Nebraska. At 165,000 square feet, the building is anchored by 12 outpatient surgical suites. It also includes flexible clinic space with universal exam room layouts. Radiology and pharmacy services will be provided, as well as occupational and physical therapy. Clinical spaces will comprise almost 200,000 square feet, with structured parking tucked beneath the building.

The latest addition to Omaha’s sprawling medical campus, now under construction, is a facility dedicated to outpatient services. Architects at HOK and RDG worked to streamline wayfinding in the four-story building, adding separate elevator bays for patients entering and exiting.
 

“One of the key challenges of the project is the patient experience,” said HOK’s senior medical planner, Kerry Cheung. The building’s massing is organized around a central volume that houses three separate elevator bays and puts forth a glassy, south-facing public front. Cheung said the layout allows patients to intuitively find their way from the main elevator core to wherever they’re going.

The southern elevators serve patients entering the building and traveling to care facilities, while another bay serves back-of-house activities and staff transport. A third elevator core offers patients leaving after surgery and check-ups to bypass the waiting rooms and other areas they might have to backtrack through in other hospitals.

 

“There’s a really important concept of the design where we separate the traffic flows so patients don’t see carts going down the hallway,” said Cheung, “And so there’s a much more private and dignified exit.”

To further aid wayfinding and the patient experience, designers worked with the client to consolidate clinic space, from orthopedics to physical therapy, alongside medical imaging. Unlike in older healthcare facilities, where getting an x-ray often requires an odyssey to another part of the building or even another address, Lauritzen doctors will be able to easily refer patients down the hall.

“One of the key reasons for us being able to do that is that everyone came together and decided that’s the best way to serve the patient,” said Cheung.

That new building will also allow the hospital to consolidate outpatient surgery rooms from University Tower and repurpose that space.

HOK is collaborating with RDG on the project, and MCL is the contractor. Construction on the new facility began this fall.

Chris Bentley


Perkins Eastman transformed Albert Ledner’s quirky O’Toole building into a bright and efficient emergency department.
Chris Cooper
 

Lenox Hill Healthplex
New York, New York
Architects: Perkins Eastman

The sudden closure of St. Vincent’s hospital in Greenwich Village left lower Manhattan with a serious shortage of emergency room capacity. At the same time the Albert C. Ledner-designed O’Toole building, located in a New York City landmark district, stood empty; its quirky forms and layout (thankfully) resistant to easy condominium conversion. Following a national trend toward smaller, faster outpatient care centers, North Shore-LIJ purchased the building to create Manhattan’s first stand-alone emergency department, which opened late this summer.

The idea behind these stand-alone emergency centers is to improve care and lessen wait times by concentrating services for the vast majority of emergency room visits, including an X-ray, CT, and MRI imaging center, ultrasounds, and ambulatory surgery, all of which are for outpatient treatments. Patients requiring long-term care are transferred to a traditional hospital (EMTs make a determination in the ambulance about which facility is best suited to the patient’s needs, or the patient can request a specific hospital). “It’s a faster way to deliver care,” said Frank Gunther, a principal at Perkins Eastman, the firm that lead the adaptive reuse project.

 
 

The architects worked with the Landmarks Preservation Commission and New York’s State Historic Preservation Office to update the building’s distinctive top-heavy exterior. They removed white tiles that had been added to the exterior and tested the concrete underneath to determine the exact shade of white stain Ledner had used. They created a new glass entry pavilion with a cantilevered glass canopy that extends out to the sidewalk, which opens up the otherwise opaque building to the street. Once inside, visitors encounter unusually small waiting areas, which flank the entrance—the proof of the in-and-out, patient-centered approach. Twenty-six exam rooms are arranged around the perimeter with access to natural light through the translucent glass block walls. In the center, a “results waiting area” with semi-private cubicles is bounded by two nurses stations, putting patients and care-givers in immediate proximity. The interiors are bright and uncluttered, cheerful yet serene.

 

Responding to community demographics and needs, the facility also has a dedicated unit for treating victims of sexual assault and a decontamination unit for disaster preparedness, which are segregated from the walk-in areas. Staff offices and an ambulance reception area are located in the basement. The upper floors are being developed into medical offices.

The new facility serves a crucial role in the lower Manhattan community, and the efficient design helps make a trip to the emergency room both a shorter and more pleasant healing experience.

Alan G. Brake


Page’s Austin VA Outpatient Clinic was designed according to the principles of evidence-based design. Natural materials were used throughout the exterior and interior, and daylight and views to the surrounding landscape were provided in all appropriate spaces.
Casey Dunn Photography
 

Austin VA Outpatient Clinic
Austin, Texas
Architects: Page

At 260,000 square feet, the Austin VA Outpatient Clinic is the largest of the U.S. Department of Veterans Affairs’ freestanding outpatient centers. Built to replace a facility that was a quarter of its size, it provides greater capacity to serve the new generation of veterans from the nation’s recent foreign wars. It also consolidates all of the outpatient services that could conceivably be needed—from primary care to minor surgery—under one roof, so local patients do not have to travel to VA installations in other towns.

In addition to being larger than its predecessor, the new clinic is also more comfortable. The VA tasked Texas-based architecture firm Page with incorporating the principals of evidence based design into the facility, namely by giving users daylit environments, natural materials, and direct contact with the natural world. “One of the things that made this project challenging and interesting is that, because of the delivery structure, we had a very limited budget,” said Page design architect Peter Hoffman. “At the same time, the VA demanded that we incorporate the latest evidence based healthcare design concepts into the workspaces for the care givers as well as within the healing environment.”

 
 

Sited in a suburban office park not far from Austin Bergstrom International Airport, the architects looked to nearby McKinney Falls State Park to find inspiration for the building’s formal language and materiality. VA design guidelines called for CMU on the exterior. Page instead recommended using split-face blocks of local limestone in four different colors arranged in a horizontal, strata-like pattern reminiscent of the rock escarpments of the Texas Hill Country. To keep within the budget, the architects only used the stone on the public areas of the exterior—lower on the elevation and around the entrances—while using similarly colored, split-face CMU on the building’s back ends and higher up on the elevation.

 

This sort of playing with the VA design guidelines characterized much of the rest of the project as well. The guidelines suggested terrazzo in the lobby, for example, but Page found that they could save a substantial amount of money by instead specifying a porcelain tile for the lobby, allowing the architects to spend that savings on more natural materials throughout the interior, such as limestone in the elevator lobby, which is interspersed with vertical glass tile sections evocative of waterfalls—a regular theme throughout the project.

Another challenge that Page faced was bringing as much daylight as possible into the building’s deep floor plates. The architects achieved this through two devices. One is a lofty, north facing, glass-encased lobby—hung with a wave-like sculpture by San Francisco artist Daniel Goldstein—that brings sunlight deep into the interior. The other is the placement of large windows at the end of each of the building’s long corridors, which set up views to the landscaped exterior from almost any point within the facility.

Finally, Page incorporated nature into the project by the most direct means possible—by providing outdoor areas where patients can step out of the air conditioning and experience the weather. This being Texas, of course, the architects set up shaded tables and pavilions that offer some mediation of the powerful sun.

Aaron Seward


One Medical’s SoMa office feels more like a tech incubator or residential living room than a doctor’s office.
Dana Hoff
 

One Medical
San Francisco, California
Designers: Urban Chalet

Over the last few years employees at Urban Chalet, a design company based in San Francisco and New York, have taken on more than 25 facilities for One Medical, a company dedicated to making the outpatient experience more humane, not to mention hip. The company’s slogan is “The doctor’s office. Reinvented.”

New offices have opened in San Francisco, New York, Washington D.C., Boston, Chicago, and Los Angeles, all catered to a sensibility that, in the words of Urban Chalet senior design director Michelle Granelli, is “modern, clean, comfortable, and sometimes a little fun and unexpected.”

A great example is their office in San Francisco’s SoMa neighborhood, which at first glance looks like the headquarters of one of the city’s many creative tech offices, not a doctor’s office. And for good reason—the space once belonged to a graphic design firm, and that became an instant inspiration for the plan. “We wanted it to almost feel like the graphic design company moved out and the doctor’s office moved right in,” said Granelli.

 
 

The high-ceilinged space’s rawness and layered textures are especially rare in a medical field obsessed with sterility. Utilities and wood surfaces are exposed, colorful walls are covered with patterns, and a digital wallcovering gives the illusion of raw concrete. “If we had the opportunity to leave something exposed we did,” said Granelli.

Modern furniture contributes to the clean aesthetic, including a modular felt sectional, black form chairs, and geometric copper-clad chairs. Hanging linear lights seem like a closer fit for Square’s or AirBnB’s offices.

The front desk was custom milled and topped by a row of hanging, exposed pendant bulbs. On the wall behind the desk the firm had the “One Medical” logo hand painted in a stencil pattern reflective of the previous company’s aesthetic. Exam rooms are treated with the same finishes, and, since they are located on the window line, receive plenty of natural light.

“Making the space welcoming and comforting hasn’t always been a priority in this field, but that’s changing,” said Granelli.  Each location is unique to its context, so the tech startup look in San Francisco is replaced, for example, by a space more similar to a high-end retail boutique in Beverly Hills. “We try to take into consideration not only the city and neighborhood, but the tenant space itself. That helps us keep the design elevated,” added Granelli.

Sam Lubell

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