Trending: The Expansion of Ambulatory Care

After two years of declining construction starts, health care development is on the rise. Health care networks are expanding their footprint to respond to the needs of an aging population, increases in chronic diseases, increases in the frequency of patient visits and health care reform. To meet these challenges, all signs are pointing towards the expansion of ambulatory care centers that are equipped to improve patients’ access to health services, reduce the cost of care and deliver seamless and integrated health care all under one roof in an outpatient setting.

A Model for the Future
Health care facility designs are evolving to support the changing landscape and are increasingly resulting in the repurposing of existing facilities. Environetics, an architecture, interior design and engineering firm founded in New York, experienced this investment in the repurposing of existing facilities firsthand through a recent project with one of Southern New Jersey’s leading health care providers, Lourdes Health System.

In March 2013, Environetics completed a $14 million, 55,000-square-foot ambulatory care center in the heart of Lourdes’ service area in Cherry Hill, N.J. The facility is an adaptive reuse of a vacant supermarket. LourdesCare was designed with the knowledge that to stay ahead of the accountable care paradigm, health care organizations must improve access and promote greater seamlessness in the continuum of care — one-stop shopping.

The facility is home to Lourdes Cardiology Services and other nationally recognized physician specialists, including cardiac surgeons, orthopedic surgeons, physical medicine rehabilitation specialists, podiatrists, rheumatologists, sports medicine specialists and vascular surgeons. Other services include cardiac testing, cardiac rehabilitation, heart failure care, lab services, physical therapy, wellness services and general diagnostic imaging.

Designing a Facility to Meet Tomorrow’s Challenges
Lourdes Health System wanted a facility that could evolve with the changes in health care delivery and be able to facilitate the management of patients’ wellness at all stages of life. Every design detail is meant to support Lourdes Health System’s goals.

In selecting the existing property to repurpose, the vacant supermarket was an ideal choice. For many of the same reasons that the space is suitable for a supermarket, it lends itself well to health care — expansive structural bays, high floor-to-structure clearances and ample parking. It also allows for flexibility and, given the nature of change in the health care industry, flexibility is critical. The new facility is designed to allow for growth and contraction of departments over time via interchangeability of rooms, standardized planning modules and unifying circulation systems.

The project’s architects strived to design a space that was easily understood by first-time visitors to the facility. This was accomplished by orienting all of the major waiting rooms along a single concourse that faces the street and main entry drive. Each practice is identified with a diagonal marker wall (or marquee wall) along the curve to further enhance wayfinding. Additionally, all check-in and checkout spaces are purposely treated the same so patients can quickly become orientated to the process when they arrive.

One of the major reasons for selecting the property was that the building is located at a high-visibility intersection. This very attribute, however, presented a challenge to the design team because the building sits at a lower elevation than the roads, so passersby look down at the building. The Environetics team embraced this as a design opportunity and created a gently arching fin wall that brought attention to the main entry and became a brand identity element for Lourdes Health System while screening the mechanical units on the roof.

The expansive glass storefront allows drivers and pedestrians on Brace Road to window-shop for health care services. Just through the front doors, the fin wall from the exterior leads the visitor into the main entry and transitions to a gently curving soffit that defines the circulation and the waiting spaces. The concourse is designed to be full of light, with continuous glazing and a simulated wood canopy that creates cover outside while continuing to the inside, helping to create a visual transition from outside to in.

Inside, the interior design team aimed to enhance the feeling of warmth and hospitality with natural materials and lively lighting design. Finishes conform to a strategy of on-stage and off-stage areas, resulting in a disciplined allocation of cost. Areas frequented by patients promote a sense of comfort and hospitality, while staff work areas and other off-stage support spaces are more utilitarian.

This project is exemplary of a growing trend in health care financing. The LourdesCare project was financed and led by Rosewood Real Estate Enterprises and completed with a design-build approach with services from Environetics, consulting architects Alberto & Associates and contractors The Norwood Company. The design/build model allowed for an efficient and effective cost-management process that involved daily collaboration between all parties over the course of a remarkable 11 months from the start of planning through the completion of construction.

Fletcher H. MacNeill, AIA, NCARB, LEED AP is the principal in the health care practice at Environetics, founded in New York.