2021 Merit Award: Pieces of All

Warren Clinic is a clinic prototype developed for Saint Francis Health System For use across various locations in the Tulsa, Oklahoma area. The solution can be adapted into different configurations based on the specific needs of the site, taking advantage of on-stage/off-stage organization, daylighting and generous views. Furthermore, the design augments the health system’s existing brand pink to create a branded glass wall on the exterior of the building to create an iconic architectural element. The Merit Award winning project was submitted to Design Showcase by CallisonRTKL. Here, the project led by Yoriko Francisco, Director, and Dana Brandel, Associate Director, both from CallisonRTKL (Dallas), share some thoughts on some of the design solutions the jury celebrated.

healthcare design: The client has commissioned you to create a clinical model that is adaptable to different locations. How did you define this specific approach as a solution?

Yuriko Francisco: We tested and developed a modular approach that can compress, expand, and transform according to each location and demand, always maintaining important common elements such as workflow, protocols, access to offerings, daylight and branding, among others. Our multidisciplinary in-house team included architects, interior designers and branding professionals, and working towards common goals has proven to be key in achieving project goals. Key stakeholders, including administrators, department managers and providers/physicians, were also involved before and during the design. By combining a compact and flexible footprint with boundless views of the outside, the unit is all about integrating efficiency and cheerfulness, which is not always the case in similar buildings. The needs of caregivers and patients are addressed without compromising performance or environmental quality.

Tell us about the ways your team had to anticipate the different implementations of the module and how it was designed to be flexible.

Francisco: During the programming phase, we analyzed the test-room-to-physician ratios to determine the ideal future condition. A Day in the Life exercises were used to model typical clinician flows and how support and other staff members affect the overall experience. Along with the patient journey, a model was developed to replicate ideal clinical scenarios and to determine the number of examination rooms required and the location of critical support areas.

Through our extensive research, our team has determined that the concept of a modular room around four physicians and 12 examination rooms works best operationally. When several capsules are attached together, some secondary support spaces, such as supplies storage and staff lounges, can be shared. Connecting modular capsules is what allows each particular clinic site to programmatically flex to suit the needs of each community it serves.

Our jurors praised the generous access to daylight delivered. How did the design process help you achieve this?

Francisco: During a rigorous vision session involving leadership and end users, such as administrators, department managers, clinicians and clinicians, our team applied our understanding of the positive outcomes of integrating natural light into healthcare spaces and leveraged the benefits of our unique modular design approach to land on the “Light from Above” design theme. This design approach combines the evidence-based benefits of daylighting with the spiritual context that St. Francis Health System and Warren Clinic seek to emulate in all of their facilities. Our primary goal in designing the project has always been to create an exceptional experience for patients, families and staff. We truly feel that infusing natural light throughout the venue has been key in enhancing the wellbeing of all visitors and crafting a positive experience.

Operationally, the modules are very efficient. How did you handle the flow of both the patient journey and clinical functions?

Dana Brandl: [The client] He wanted a new clinical model that would improve patient outcomes and improve staff performance. To achieve this, our team approached the patient experience by incorporating the following key principles:

• Separate flows of staff and visitors – Separation of flows is the core of the clinic model. Warren Clinics transforms the traditional clinic from the inside out, creating an on-stage/off-theater approach. Through this, patients can access examination rooms through circulation that is separate from the staff, providing patients with a quieter and more private experience.
• Small / scattered waiting areas – upon entry, visitors are escorted or directed to dedicated decentralized waiting areas. These waiting areas are located outside each examination room, giving patients direct access to the examination room. The flow of patients is greatly improved by this approach, besides eliminating unnecessary interaction between patients.
• Separate Staff Work Area – Staff work and circulation areas are separate from patient and visitor circulation throughout the clinic environment. This maximizes privacy/confidentiality and reduces distractions, allowing each provider to maximize time in the examination room and focus on patient care.

The results of these key operational elements are improved staff efficiency, allowing more patients to be seen on a given day, and a collaborative environment for staff that improves patient care. From the patients’ point of view, they enter a place with few waiting times. If they happen to wait, it will be in a designated area, next to their exam room, with a view outside.

The brand stars in this project, especially the signature pink wall on the outside. How did you come to this bold choice?

brandlFrancis Health System’s legacy is embodied on Yale Avenue’s main campus, often called “the pink hospital on the hill” by Tulsa locals. This iconic pink color from Saint Francis inspired us to develop a branded glass wall concept infused with varying pink tones as a front element in the prototype design. Our proposed bold, bright and unique “Saint Francis” design will serve as a visual symbol of the brand and an element that people can identify and interact with as they approach the site. As a glowing beacon at night, the wall will also enhance the clinic’s connection to the community it serves.

The prototype was delivered several times around Tulsa. How did it evolve with constant iterations?

brandl: Our team realized that each new site would be unique and would require a custom solution while still being committed to prototype design and standards. We understand that no design is a “one size fits all” solution. As we continue to implement modular prototype design in new sites, we are constantly developing and modifying certain aspects to meet not only the standards of each site but the needs of each specific community.

After living in first-generation clinics for about a year, the owner invited our team to conduct a post-occupancy assessment to determine any lessons learned that could be incorporated into future locations. We developed a list of mostly small design tweaks, but perhaps the most significant changes were related to patient intake. First generation clinics included a front desk/reception, but volunteers were not always available to the staff of that station. A vacant desk and frosted glass between the reception desk and adjacent registration booths made it difficult for patient service representatives to receive incoming patients. In subsequent clinics, the front desk was cleared along with the frost on the glass to allow the patient service representative to make eye contact with and welcome patients coming in. Also, after the first generation clinics became operational, and the examination room throughput turned out to be operating as planned, we eliminated the redundant waiting area from the prototype.

Jennifer Kovacs Silves is the editor-in-chief of Healthcare Design. It can be accessed at [email protected].


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