Cover Focus | Mar 2017

Best-laid Plans

Insights into office design for function and comfort.

A medical practice must have certain functional components, as well as some specific inclusions for regulatory reasons. What are some of the challenging considerations this presents for an architect? If a physician or group is looking to renovate or build, how can they be sure their architects get these requirements right?

You will hear us say this a lot, to the point of belaboring it, but we say it because we truly believe in our process. Whenever we start a project, we are trying to establish an open discourse with our client. This allows everyone to talk openly and freely about the requirements, challenges, operational logistics, things that work at their current spaces, things that don’t work at all. Once we establish a set of criteria as a group, only then can we start the design process. It is true that an architect is only as good as their client. If we can’t establish a level of trust in each other, you will have a very difficult time designing a space together. There are always challenges in every project. We were involved from the very beginning with the Medical Dermatology Associates (MDA). We went with them to every potential space in the city to make sure it was a good fit for them and all of their programmatic needs. We were heavily involved, not only for our own general curiosity, but to make sure what we are designing for our clients is exactly what they expect. We involved ourselves in every process and decision made. This insures we have all the information we need to create a space everyone will be happy with. Our biggest advice would be to do your research and make sure that the architect you select is a good fit for you personally and one who has a real curiosity into your processes and needs.  Empathy is a great quality to look for in an architect. You will be spending more time together than you probably would like throughout the process, and having a rapport with them will aid the communication.

 

Given that there are some restrictions and specific requirements in a medical practice, how can architects and designers keep things fresh? Can you share some of the general "hot trends" in design that you were able to include in this latest medical office design?

To be honest, we don’t do very much medical design. I think the fact that MDA’s space turned out so well shows how well we communicate with our clients to give them a space that meets and exceeds their expectations. We are architects. To pretend we know all the caveats of the daily operations and logistics of a medical office would be dishonest.  What we do very well though is listen to our clients. We ask a lot of questions and pay attention to everything they have to say. For instance, the more they talked about their daily operations, we started to understand that they spend a large percentage of their time in the corridors and these spaces were vital to the operation of their office. They weren’t just circulation raceways to get patients from point A to point B. They were spaces where doctors and nurses conversed, passed information, filled paperwork out, etc. By adding built-in workstations, magnetic panels, widening the corridor, adding natural light to the corridor and creating an unconventional lighting scheme, we transformed a utilitarian space into one that is a dynamic extension of their daily operations. We also try to not pay attention to trends. That we hadn’t done many medical spaces made us, in our minds, even more apt to succeed in designing a fresh environment.  What we do know very well is how people use and perceive space.  Medical offices are often incredibly impersonal. They lack specificity and warmth, and they aren’t designed with visitors in mind. Only when it comes time to put out magazines is the visitor experience considered. With MDA, we evaluated the spaces where the visitors spend their time and the exact points where visitors truly become patients. Only once into the exam room is a visitor a patient, and right up until that point, it’s critical for visitors to be treated well spatially. Materials and textures should be deployed in a way that welcomes and intrigues visitors so that they can engage with the space in a more comfortable and clear way.

How important is comfort in the design? Can you share some thoughts in this regard?

Comfort is always important. If it’s not, you have a bad architect. Image isn’t as interesting. But comfort is also subjective. Specifically in a medical suite, we want a visitor, who presumably is coming to be treated in some way, to feel emotionally very comfortable prior to their treatment. We worked with MDA to create environments that were clearly designed for the patients’ well-being. This to us is comfort. We always want patients to have intellectual and emotional responses to spaces, whether they are aware of them or not. For example, the use of natural materials and natural light is paramount to our work. Natural light and materials connects inhabitants to a world larger than just the room they are in. This works on an intellectual level as well. At MDA, we talked a lot about layers. The layers of the space and the layers of material that are evident in the space and suite are all intellectually connected back to the layers of the skin and body. Again, a visitor doesn’t have to banged over the head with these ideas to connect to them subconsciously. 

 

In an ideal world, what do you see as the process of designing a space to be like? Are there some things physicians/practices should keep in mind in terms of when and how to make changes (is it ever too late? Do costs climb at certain points, etc.)?

Ideally it works as we have described above. There is a great deal of thinking and planning that goes into the process to establish criteria before any aesthetic ideas are ever considered or discussed. Then ideas and plans should be evaluated based on the criteria that have been established. There is a lot of back and forth and refining that should take place. We always ask our clients to ‘inhabit’ the designs we are working on. Architects do this naturally and by training, but it’s harder for a client. We ask our clients to ‘live’ in the designs. Walk through them. Spend a work day or two in them. This is a great tactic, because as we walk through scenarios with our clients, designs change and get better. But it’s never too late to make a change. It just becomes a question of money. Once something is in place, changing it costs more money than it did to install it the first time. It’s the nature of construction. This happens to us, too. We often see things that we didn’t fully anticipate, and sometimes changes need to be made. We are deeply engaged from the very beginning to the very end, however, and this helps. An architect should want to be as involved through construction as they are in the design process because in construction is where it all happens. That’s is, I think, were we excel. We put in the extra time to make it right, and it is reflected in the final product AND the continuing relationships we hold with our past and present clients.

What about equipment currently used or that may be added in the future? Do you design around current technology (EHRs, computers, ipads, etc.) and how do you allow for flexibility? What about lasers and other devices that might have specific voltage or energy requirements?

We always design to meet and exceed our clients’ needs by designing open frameworks as much as complete spaces. Any space should be able to adapt to changing technologies. If it can’t it was likely too fixed to begin with. If a client wants to change a chair design, the space should be able to accommodate that, and the same is true for any technology. If we have learned anything over the last decade in design, it’s that technology changes and spaces can’t be too over-determined or fixed or they will become obsolete very quickly. Luckily, most technology is in the process of getting smaller, so finding more space for things isn’t as big an issue. But it is the little things that count. For example, we always shy away from building LCD monitors into niches in walls. It’s nice for them to be ‘flush’ with the wall, yes, but what happens when they change? If they don’t still fit into the space allocated for them then the design looks incorrect and we never want for that to be the way something is perceived.

What's your favorite feature of the new practice for MDA of Chicago?

Our favorite feature in the space is the overall conceptual idea — the flow of the space. We spent a lot of time designing the spatial layout to insure the floor plan operated smoothly over and over – almost like a machine. Staff needs to be in specific places at specific times, and in order from them to produce efficiently, the space needs to be open enough to create that dialogue, but also protected enough to ensure the safety and security of their patients. At the end of the day, anyone can pick out the coolest wall paneling or the next best energy efficient light fixture, but if the experience of the space doesn’t resonate to something bigger than a fancy material palette, then you as an architect did not successfully do your job. We design spaces with the principle idea that if you took away all the materials and were left with a white box does the space still hold up and work well?  That said, the reception room sure is a great balance of warmth and light!

 

Edward Blumer is a Project Architect at Woodhouse Tinucci Architects (www.woodtinarch.com) in Chicago. You can reach him at e.blumer@woodtinarch.com.