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Doctors Within Borders: The Intersection Between Retail & Healthcare

By Bill Brintnall & Elizabeth Grube

It’s no secret that retail outlets have suffered in recent years. The economic recession hit these commercial properties hard, forcing many to close. At the same time, the healthcare system faces its own set of obstacles as limited access to medical care continues to plague many in the U.S. Is there a viable solution?

One option quickly gaining notoriety takes abandoned retail spaces and converts them into accessible healthcare facilities. Studies show that vacant spaces can attract crime and lead to increased violence in surrounding areas. Repurposing these empty properties to serve the needs of a community will help restore neighborhoods that have felt adverse effects of the economic downturn.

Challenge
With the closing of 399 Borders stores nationwide, this presented a unique opportunity for the MemorialCare Health System. In a design/build partnership, RTKL teamed with Hanna Construction to design and reconstruct a medical clinic within the now defunct Borders retail space. The new clinic integrates healthcare into a community setting and is designed to support the California physician integration model.

MemorialCare turned to RTKL to reprogram the space, converting a traditional retail layout into a fully functional healthcare center. This combination of retail space and healthcare facility design makes the clinic at the cutting edge of patient care. The design not only incorporates elements of both project types, but also provides benefits for each industry. Let’s explore:

Healthcare
Healthcare is changing and outpatient facilities like MemorialCare can allow for:

1. Convenient healthcare: As lifestyles become busier, doctor visits and health monitoring often falls by the wayside. Placing a healthcare facility in a retail outlet within a community makes focusing on health a simple errand.
2. Access to healthcare: These facilities are community-based, rather than suburban-based. Integration into neighborhoods will help provide access to healthcare for lower income communities.
3. Increased revenue for medical systems: In the early 1990s, outpatient care accounted for only 10-15 percent of hospital revenue. Today, that number is closer to 60 percent. This is sure to increase if this type of care becomes even more accessible to patients.
4. Decreased overcrowding in emergency departments: Outpatient facilities like this will reduce overcrowding in traditional hospitals. From 2003 to 2009, the average wait time in U.S. emergency departments increased 25 percent, from 46.5 minutes to 58.1 minutes. These facilities will give patients with less acute illness and injuries another place to go to receive treatment.

Retail
While it may seem an unlikely match at first, the intersection between retail and healthcare is closer than you think. The founding principles are the same: accessibility, affordability and quality. Outpatient facilities can benefit the retail sector by:
1. Bringing shoppers back: Placing these facilities inside malls will drive customers back, increasing the potential for retail sales in other outlets.
2. Encouraging revitalization: Retail functions as the core of many areas. As the focus returns to downtowns, outpatient facilities could help revitalize other abandoned retail spaces in these communities.
3. Creating new destination points: Shopping is no longer enough of a reason to go to shopping centers. Malls must now become community anchors where customers can complete a number of tasks in one visit.
4. Implementing efficient space reprogramming: Space reprogramming is an important factor in the success of these facilities. The design should focus on how people interact with the space to help patients feel like they’re not walking into a medical facility. MemorialCare’s design draws attention from the outside by making use of the retail front with an expansive clinic lobby.

Implementation
The main components of the 30,000-square-foot, two-story building is the urgent care center, imaging area, 19 doctors’ offices and accessibility to mass transit and parking. The new clinic within the retail space “co-locates” workspace for physicians and medical staff. With the box design, the core of activity is around the edges of the space, which will allow for greater circulation and ease of travel back and forth across the clinic. This ultimately cuts down on patient wait times.

The main goal of the design was to prevent the space from feeling clinical. The team fit 19 doctors’ offices, 57 exam rooms and three procedure rooms on two floors. The 20,000-square-foot first floor houses 13 doctors’ offices and 39 exam rooms, while the 10,000-square-foot second floor contains six offices and 18 exam rooms.

The team also embraced the Lean concept by strategically placing the digital radiology and phlebotomy/laboratory areas on the first floor so that patients who already have orders and don’t need to see a physician can just walk right into these spaces. The project’s floorplan also celebrates flexibility. If MemorialCare wants to expand urgent care, they can do so without tearing down walls or doors. Additionally, the urgent care space can be sectioned off from the family medicine area as needed.

As for the interior design, the team focused on color psychology and Evidence-Based Design to implement an orange color story to bring a vibrant energy throughout the space. In MemorialCare’s existing facilities, wayfinding was an issue caused by what can only be described as signage clutter. The team used color at destination points to clearly identify the patient path, thus minimizing signage. Clean lines and crisp colors are carried throughout the entire space. Core materials like the porcelain tile are timeless and will serve to be more sustainable throughout the life of the design. Also, the wall color can easily be updated. Overall, the team carefully chose materials that could execute the design without breaking the bank. For instance, cost-conscious VCT tile was used as flooring in clinic spaces, which comprises most of the space. Wall decorations were kept to a minimum.

In the end, the space reflects a focus on how people will use and interact with the space. Patients, families and staff all use the space in different ways and the project team accommodated for the flexibility to ensure each person has a positive experience.

Results
For such a small clinical space, this project speaks volumes. Like a retail store might develop a new flagship design, MemorialCare wanted a fresh look for its medical centers. The interiors of this new space feel unique.

As the healthcare industry continues to evolve, MemorialCare Healthcare System just may be leading a trend. By taking outpatient care out of hospitals and creating centers within the heart of communities, patients will have greater access to healthcare at a more affordable, premium cost. In essence, patients will make a habit of incorporating preventive healthcare into their daily routines and thus create healthier, more sustainable communities.

Author: Bill Brintnall & Elizabeth Grube
Bill Brintnall, AIA, is a principal in RTKL’s Healthcare Practice Group. Elizabeth Grube, LEED AP, is a designer in RTKL’s Commercial Practice Group.

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Posted October 1, 2013

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