Healthcare Design - January 2015 - 61

Kris DecKer/Firewater PhotograPhy (Village Family meDicine); John Bartelstone PhotograPhy (BrooKlyn inFusion center)

ment rooms having three monitors: one behind the
patient's head for the dental assistant, one straight
ahead in front of the patient or placed directly
overhead, and a third where the dentist can view it.
Many dental instruments and tools have digital output that can be viewed on the monitor. These are
very sophisticated systems with good connectivity.
For designers and architects, what's the significance of the shift toward more community
clinics?
The ACA has allocated significant funds for expansion of community clinics, which means that design
professionals need to know how to design these
facilities, which have more comprehensive services
and are more multidisciplinary in nature. The goal
is to do as much as possible at each visit, including
vaccinations, gender-appropriate screenings, mental health assessments, dental care-for adults and
children. With a population of patients who may
be hard to reach by phone or email, or who may
not show up for future appointments for a variety
of reasons, this care model has a proactive focus,
characterized by collaborative team care that leads
to more informed decision-making.
In addition to understanding how these clinics
are typically organized in terms of space planning, one must be familiar with their funding and
regulations as well as the unique combination of
psychosocial issues that inform the design. Some
community health centers are considered Federally
Qualified Health Centers (FQHC), a designation
that brings with it additional funding for serving
specific groups of underserved populations, such
as seasonal agricultural workers, residents of public
housing, or the homeless. There's a high priority to
educate all patients about cessation of smoking,
good nutrition, and making lifestyle changes that
will result in better health. These programs may
result in space allocation for a café or juice bar,
a farmers' market where patients can buy fruits
and vegetables, or offices for clinical navigators
to connect patients to programs available in the
community.
Within the examination area of the clinic, there
may be a combination of large exam rooms (accommodating several providers) and talking rooms
without exam tables. Although the latter may not
functionally need a sink, in some jurisdictions the
room must have a sink in order to bill for the consultation-which is an example of knowing which
regulatory agencies have jurisdiction (and there
may be several). Many of these clinics have patientcentered medical home status, which may be
designated by a number of accreditation agencies,

each with a set of standards and specific criteria.
Depending upon geographic location, clinics
typically serve immigrant populations, many of
whom may not yet speak English, have a fear of
"modern" medicine, and may have little education. This brings with it many psychosocial challenges for clinical staff who have to understand
the nuances of each of these cultures-and
some of these may have implications for space
planning.
In your preface, you say, "The field has now
reached maturity. No longer concerned with
discovering the basic rules and principles,
healthcare design specialists can devote
themselves to innovation and refining what
has been learned." What do you see as the
most pressing needs in terms of innovation
in our industry?
Many designers who work in medical office design follow the same cookbook recipe that's been
around for many years, because they may have
been engaged by the building developer, whose
goal is to get the tenant in quickly and at the lowest cost. Space planners are often paid minimal

Top: the exam room at
Village Family medicine in
spartanburg, s.c., designed
by mcmillan Pazdan smith
architecture, represents
"a new type of exam room
used for assessment and
consultation," malkin says. "it
is devoid of an exam table. it's
based on the acknowledgement
that the majority of patients
visiting a family practice
physician do not have to
disrobe." Above: "this private
chemotherapy infusion space
has every evidence-based
design feature," malkin says of
the memorial sloan-Kettering
Brooklyn infusion center,
designed by ZgF architects.
"From the chair, patients can
use the computer monitor
to order lunch, skype with
friends, or summon a nurse's
help at any time."

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Healthcare Design - January 2015

Table of Contents for the Digital Edition of Healthcare Design - January 2015
