VA Outpatient Clinic Project

VETERANS AFFAIRS MULTI-SPECIALTY OUTPATIENT CLINIC Interior Design V | Special Focus Populations Alyssa Faustina | Kellen Roth | Nicole Galuschik

PROJECT INTRODUCTION The U.S. Department of Veterans Affairs is one area of the ever growing healthcare industry that serves and cares for the military veterans in the United States.

Maintaining 1,700 hospitals, clinics, community living centers, domiciliaries, readjustment counseling centers, and other facilities; the VA is the nation’s largest integrated healthcare system. The VA facilities face many challenges when providing services to the growing veterans population. These challenges include the implementation of technology innovations, providing healthcare and other benefits in a timely manner, as well as providing adequate care for the evolving veteran population regarding mental health and lack of housing.

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TABLE OF CONTENTS

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PRE-DESIGN General Research | Precedent Studies | Concept

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GENERAL RESEARCH

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Northeast Ohio Facilities General Information -

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Ohio o Number of veterans: 913,296 VA expenditures in Ohio: $4.5 billion ○ Compensation and pensions: $1.3 billion ○ Readjustment benefits: $101 million ○ Medical and construction programs: $1.9 billion ○ Insurance and indemnities: $47 million Number of veterans receiving disability compensation or pension payments: 108,079 Number of Ohio veterans using GI Bill education benefits: 13,314 Number of home loans in Ohio backed by VA guarantees: 8,248 Value of Ohio home loans guaranteed by VA: $1.3 billion o Number of VA life insurance policies held by Ohio residents: 46,305 Value of VA life insurance policies held by Ohio residents: $524 million Number of Ohio participants in VA vocational rehabilitation: 2,055 Number of veterans buried in Ohio’s VA national cemeteries: 2,840 Number of headstones and markers provided for graves of Ohio veterans and survivors: 14,467

VA Medical Centers:5 locations Outpatient Clinics: 3 locations Community based Outpatient Clinic: 30 locations Vet Centers: 8 locations VISN: 1 location Ohio Veterans Homes: 3 locations

Georgetown Home 168 Beds

Sandusky Home 427 Beds

Sandusky Domiciliary 293 Beds

1,064 sheltered and unsheltered homeless veterans in Ohio

Current Laws and Services Comparison of different Veterans population and their support programs -

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Services veterans need: secure housing, nutritional meals, basic physical health care, substance abuse care and aftercare, mental health counseling, personal development and empowerment, job assessment, training and placement assistance Most effective programs: community based, nonprofit, “veterans helping veterans” groups; these programs feature transitional housing with the camaraderie living structure, substance-free environments with fellow veterans Only the United States & Canada have life insurance programs for disabled veterans The united states is the only country that provides survivor education benefits More types of disabilities are compensated for the United States compared to other countries The huge veteran population and the small size of the VA contributes to the problems among veterans and providing benefits effectively and in a timely manner, even though the United States has one of the best all encompassing plans Almost half of the veterans who return report difficulties and receive inadequate care from the VA Restricting access to lethal weapons prevents suicides, but the Department of Defence (DOD) prohibits restricting the access to own weapons In 2010, half of the 300 military suicides were by those deployed in Afghanistan and Iraq, which an estimate of 22 veterans commit suicide every day The inability of the VA and the DOD to “electronically talk to each other” remains one of the biggest obstacles to getting quality care

Canada

Australia

United Kingdom

United States

Total Population

33,500,000

21,200,000

61,100,000

307,200,000

Number of Clients Served

220,000

415,000

900,000

23,800,000

Number of Annual Releases

4,000

5,000

24,000

200,000

Budget (2009-2010)

$3.4 billion

$11.3 billion

$19.4 billion

$100.14 billion

Number of Staff

3,700

2,100

2,100

278,500

Programs Supporting Transition

New Veterans Charter Disability Awards Rehabilitation Financial Benefits Health Benefits Job Placement

Military and Compensation Act Rehabilitation Permanent Impairment Incapacity Payments Special Rate Disability Pension Career Transition Assistance Scheme

Armed Forces Compensation Scheme Lump-Sum Payment Guaranteed Income Payment Career Transition Partnership

VA Disability Compensation VA Disability Pension VA Health Care System Independent Living Program Vocational Rehabilitation and Employment Program Post 9/11 GI Bill

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Healthcare Technology With ever-advancing technology in the healthcare industry, planning for future technology has become a key consideration when designing modern healthcare facilities. Because of this, it is crucial to be familiar with the broad range technologies that are required in today’s healthcare settings and ways to successfully implement them.

Technology Integration Strategies: ●

Technologies to consider: ●

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Information Technology ○ The technological infrastructure used to manage healthcare related data ■ Examples: teledata, audiovisual Medical Technology ○ Medical technology and equipment used for patient care ■ Examples: virtual medicine, surgical tools, vital monitoring equipment, examination tables Patient Technology ○ Technology utilized by patients to enhance their experience ■ Examples: bedside terminals, mobile applications, kiosks Visitor Technology ○ Technology utilized by visitors of healthcare facilities ■ Examples: outlets, furniture, kiosks ○

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Long-Term Flexibility ○ Since modern technology evolves so rapidly, it is difficult to estimate when future technologies will come and what their requirements will consist of. ○ Because of this, the design of modern healthcare facilities must be as flexible as possible to ensure future technologies will be compatible.

■ Flexibility can be achieved by maximizing open space and making spaces as modular as possible ■ Designers should also look to minimize the amount of built-in equipment where possible ■ Another strategy is to design each space so that it has the potential to accommodate multiple functions Public Spaces and Waiting Areas ○ Public areas should provide accommodations which allow for easy use of technology by staff patients, and visitors ■ Due to the frequent use of consumer electronics in today’s society, it should be assumed a majority of visitors will frequently be using technology such as a laptop or smartphone within the facility. Because of this it is important to plan for ample outlets within waiting areas as well as other public spaces.

Wayfinding ○ Technological advancements have made it possible for designers to simplify wayfinding like never before ■ Kiosks are being implemented throughout healthcare facilities as a way of helping patients and guests find areas they are looking for. They do this by displaying a digital map of the facility. Kiosks also offer many other features such as allowing patients and guests to easily schedule appointments.

Biophilic Design -

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Created by a man named Edward O Wilson -indulged in the knowledge behind the relationship between human life and its broad affiliation with the natural world - 1984 Biophilia Wilson said that biophilia is the “innate tendency to focus on life and life-like processes”.

There are reasons behind the affiliation between humans and life like processes as stated by Wilson; they are inherent or biologically based, part of evolution, a way to achieve inner happiness and are part of the diversity of life Recent studies have shown that “bland and claustrophobic” spaces tend to negatively influence patients and by simply changing patient’s views in their room can produce positive feedback in relation to recovery time Hospitals that have taken this design plunge have overall have saved $93 million annually nationwide in patients rooms where they have a view of nature yielding to a speedy recovery time Terrapin Bright Green LLC states there are three thoughts when designers begin creating an interior with biophilia in mind: “nature in the space, natural analogues and the nature of the space”

biophilia (noun)

an innate love for the

natural world, supposed to be felt universally by humankind

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Homeless Veterans -

In January 2014, almost 50,000 veterans were homeless (8.6%) of total homeless population Veterans with low socioeconomic status, mental health disorder and/or history of substance abuse are at an increased risk of homelessness Recent veterans are more commonly female, if they experience sexual trauma while serving are more likely to become homeless They experience shortage of affordable housing, living wage jobs, access to healthcare, combined with symptoms of PTSD, substance abuse and mental illness Veterans who served in the late Vietnam and post-Vietnam era are at greatest risk of homelessness Only 8% are claimed, but there are actually 17% homeless population are veterans Female veterans are 2-3 times more likely to become homeless than any other group in the US adult population Veterans spend an average of 6 years homeless, compared to non veterans who spend 4 years The average wait time to get a disability claim processed is 8 months, with full disability payment is $2,769/month There are an estimated 500,000 veterans homeless at some point during the year, the VA only reaches 20% of those in need Homeless veterans are younger on average than total veteran population Top priority - a safe, secure, clean housing that offers a supportive environment free of drugs and alcohol Many vets have skills learned through the military that are not applicable for occupations in civilian life Returning veterans are twice as likely to become chronically homeless

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Programs - VA’s Health Care for Homeless Veterans Program (HVHC) operates 133 sites, with case management for homeless veterans with mental health problems that serves 40,000 veterans annually - Compensated Work-Therapy (CWT) operates 66 homes with 520 beds in transitional residences, 2/3 of those beds are for homeless veterans, 14,000 veterans participate in CWT programs annually - HUD-VA Supported Housing (VASH) is a joint program with the Department of Housing and Urban Development (HUD), which works to provide permanent housing and treatment to homeless mentally ill veterans and those suffering from substance abuse

DEMOGRAPHICS

56% African American or Hispanic 67% suffer from substance abuse

91% male

54% mental or physical disability

98% single

76% live in city

Veterans with PTSD -

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Veterans returning from recent conflicts in Afghanistan and Iraq often have severe disabilities, including traumatic brain injuries (TBIs) and Post Traumatic Stress Disorder (PTSD) Working with combat veterans soon after their war experience can prevent the development of a disastrous life course Mental health providers can reduce family problems by helping veterans and their families anticipate and prepare for family challenges PTSD interferes with social functioning, they withdrawal from others and prevents the development of new social relationships Veterans should connect with other veterans to develop social networks, as well as support systems - what they value most Steady employment can help long term functioning by reducing financial stress, provide meaningful activity and self-esteem, as well as providing opportunities for friendship and companionship Patient perspective: fear of returning to the war zone, concerns about having been evacuated and what this means, worries about reactions of unit, fear of career ramifications, concern about reactions of family, concerns about returning to active duty Returning veterans experience intrusive thoughts, and images, anxiety and panic in response to trauma cues, and feelings of guilt or intense anger are likely to feel relatively powerless Exposure therapy is one of the best supported treatments for PTSD which helps correct faulty perceptions of danger, improve perceived self-control or memories and accompanying negative emotions, and strengthen adaptive coping responses under conditions of distress One in five troops returning home from Iraq and Afghanistan suffers from PTSD

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PRECEDENT STUDIES

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Project Description Case Study - Humber River Hospital Innovative | Forward-thinking Due to an outdated facility and a need for modern medical technology, The Humber River Hospital recently made the decision to invest in a brand new building. The hospital Contracted HDR Architecture to design the new facility and construction began in 2011. Construction for the new facility was completed in late 2015.

The new Humber River Hospital has been hailed as North America’s first fully digital hospital. According to HDR, the facility uses “the most current technologies possible to enhance all aspects of quality patient care delivery, improving efficiency, accuracy, reliability and safety.� Technological innovations incorporated into the design include smart bed technology, robotic technology for certain surgical procedures, automated laboratory processing, automated guided vehicles that deliver medical supplies, and bedside computer screens that allow patients to control their environments. Additionally, interactive maps that use pictures instead of words provide patients with easy wayfinding.

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Architect: HDR | Location: Toronto, Ontario, Canada | Total SF: 1,700,000

Case Study - Humber River Hospital

Design Features

Architect: HDR | Location: Toronto, Ontario, Canada | Total SF: 1,700,000

Technology | Biophilia | Innovation

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More than 40 kiosks have been placed throughout the facility.

These kiosks allow patients and family members easily schedule appointments. Additionally, they display maps of the building to assist with wayfinding.

The facility utilizes 10 automated guided vehicles (AGVs) that deliver materials, clean linens, and food throughout the building.

HDR was able to incorporate biophilia into the design of the facility. One way they were able to do this was through a large custom art piece displayed on the north and south facades of the building. The piece which is entitled “Aspen Grove� was inspired by local wildlife and conveys natural patterns through abstract forms.

Integrated bedside terminals in patient rooms give patients access to many functions such as ordering meals, calling nurses, or adjusting lighting levels.

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Project Description Wellbeing | Patient Centered | Recovery

With Biophilia becoming an important factor in design and directly linking quick recovery and nature, it is of no doubt healthcare facilities are digging deeper into this theory.

Specifically, Massachusetts General Hospital in Boston MA has undergone transformations to their Lunder Building pertaining to biophiliac design. The decision to include these biophilic elements is tightly coordinated with the institutions’ broader mission of delivering safe and efficient medical care, maintaining patient comfort, and ensuring staff satisfaction. This building includes multiple instances where nature can be seen through the hanging vines in the atrium, or the view of the bamboo garden.

By creating natural inspired environments for the patients and staff. Mass General Hospital has seen improvements in their staff and patients from this change. The main goal of such change was to show the adoption of biophilic design can be widespread to many different buildings. All individuals were very receptive to the change and continue to promote the wellbeing of the patients and staff.

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Massachusetts General Hospital Architect: NBBJ | Location: Boston, Massachusetts | Total SF: 535,000

Case Study - Miami Valley Hospital

Project Description

Architect: NBBJ | Location: Dayton, Ohio, USA | Total SF: 480,000

Flexibility | Efficiency | Prefabrication In 2008, the Miami Valley Hospital located in Dayton, Ohio contracted NBBJ to design a brand new cardiovascular patient care tower on their campus. The project which was completed in 2010 had an important impact on construction technology as it was the first major healthcare project in the U.S. to use prefabricated components.

In total, about 35% of the project consisted of components that were assembled off-site and then shipped in and installed. The incorporation of prefabrication techniques had a great impact on the overall efficiency of the construction process. As a direct result of prefabrication, the quality of construction was improved, there were zero worker injuries, and the construction schedule was decreased by two months.

Additionally, the patient rooms have been designed to be acuity-adaptable meaning their dimensions and support a multitude of activities and functions. Because of this adaptability, the facility has a great deal of flexibility when it comes to incorporating new technology in the future.

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Case Study - Miami Valley Hospital

Design Features

Architect: NBBJ | Location: Dayton, Ohio, USA | Total SF: 480,000

Flexibility | Efficiency | Prefabrication

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Rather than traditional construction, the design team opted to prefabricate individual components within the patient rooms to maximize efficiency and reduce costs.

The design team designed the restroom and the headwall unit within the patient room to be two separate prefabricated components.

The unique prefabricated design allowed the components to be easily shipped to the project site.

Case Study - Miami Valley Hospital

Design Features

Architect: NBBJ | Location: Dayton, Ohio, USA | Total SF: 480,000

Flexibility | Comfort | Visibility

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Traditional patient room layouts pose the issue of poor sightlines and reduced visibility.

The uniquely angular design of the new facility’s patient rooms allows for much better sightlines and visibility which provides patients with a better overall experience.

16-foot-wide hallways which incorporate corporate-inspired workstations provide caregivers plenty of workspace as well as ample room for storing supplies. Where the three hallways converge, there is a central nurses’ station which acts as an information hub and wayfinding device.

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Boarding House

Project Description

Architect: Andyrahman Architects | Location: Surabaya, Indonesia | 2016

Nature Focused | Biophilia | Bioclimatic

The boarding house located in Indonesia has taken on the contemporary issues that have been circling the architecture community and design and building around the issues..

Biophilic and bioclimatic design deal with the design of the space and how it relates to nature. Bioclimatic architecture is taking a structure and designing it based on the local climate and in turn making the space environmentally friendly.

The design of the boarding house includes large perforated walls that allow the space to breathe. The light and air from the open roof optimizes the feel of the space. “By combining bioclimatic and biophilic ideas, and with additional principle on low budget and maintenance, the house becomes a climate conscious and humane architecture, which is based on the existence and survival of human life on increasingly crowded and congested earth without abandoning the side of humanity, which becomes a big architecture agenda in the second decade of 21st century.�- Arch Daily

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Sarah’s Hope

Project Description

Architect: Murphy & Dittenhafer Architects | Location: Baltimore, Maryland | 2013

Community Focused | On-site Services

Sarah’s Hope is an emergency housing facility for families experiencing immediate and short term housing crises. The project was to renovate and expand the shelter for $8.5 million.

This expansion was able to double the number of clients served, creating suites that slept two or three people with a shared bathroom per suite. The suites allowed space to accommodate families to stay together.

The expansion of Sarah’s Hope not only provided temporary housing, but also provides on-site services including: intensive case management, life skills training, employment readiness classes, parenting classes, health screenings, public school enrollment, daycare services and other child and youth activities.

By providing these services on-site, Sarah’s Hope is able to stabilize families quicker so they can maintain long term self-sufficiency and permanent housing.

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Louis Stokes Cleveland VA Medical Center

Project Description

Architect: Perspectus Architecture | Location: Cleveland, Ohio | 2015

Innovation | Patient Centered | Research Based

The Louis Stokes Cleveland VA Medical Center is part of the VISN 10 which is made up of ten medical centers and 58 community based outpatient clinics. The Wade Park Campus is located downtown Cleveland, classified as a Clinical Referral Level 1a, which is the most complex VAH facility. Wade Park is ranked the third most complex VHA facility in the country.

The Wade Park Campus is a teaching hospital, which provides patients with a range of care services including inpatient care with 673 beds, a full service emergency department, as well as 122 beds for homeless veterans.

Veterans in Northeast Ohio

344,941

Admissions

11,219

Outpatient Encounters

1,763,962

Women Veterans Served

7,209

OIF/OEF Veterans Served

12,518

Medical Care Employees

4,663 *numbers based annually

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Programs of Excellence: ● Serious Mental Illness ● Substance Abuse Disorders ● Healthcare for the Homeless ● Domiciliary Care for Homeless Veterans ● Cardiac Surgery ● Spinal Cord Injury ● Geriatrics Evaluation and Management ● Telemedicine

References General Research

Precedent Studies

Department of Veterans Affairs State Summary

http://www.hdrinc.com/portfolio/humber-river-hospital http://www.healthcaredesignmagazine.com/article/ Getting-smart-technology

http://dvs.ohio.gov/VETERANS_HOMES

http://www.endhomelessness.org/library/entry/fact-sheet-veteran-homelessness http://www.veterans.gc.ca/eng/about-us/reports/departmental-audit-evaluation/2009-12-nvc/4-4 https://www.theguardian.com/world/2013/mar/26/us-veterans-inadequate-care-war http://www.partners.org/Innovation-And-Leadership/Technology/Virtual-Medicine.aspx http://searchhealthit.techtarget.com/definition/Health-IT-information-technology http://www.healthcaredesignmagazine.com/article/Modular-Construction-Delivers-Flexibility-Healthcare http://www.healthcaredesignmagazine.com/article/getting-smart-technology http://www.facilitiesnet.com/healthcarefacilities/article/Hospital-Construction-Should-A im-For-Flexibility-From-Start--13456?source=next http://www.partners.org/Innovation-And-Leadership/Technology/Virtual-Medicine.aspx http://searchhealthit.techtarget.com/definition/Health-IT-information-technology http://www.healthcaredesignmagazine.com/article/Modular-Construction-Delivers-Flexibility-Healthcare http://www.healthcaredesignmagazine.com/article/getting-smart-technology http://www.facilitiesnet.com/healthcarefacilities/article/Hospital-Construction-Should-A im-For-Flexibility-From-Start--13456?source=next http://www.healthcaredesignmagazine.com/sites/healthcaredesignmagazine.com/files/whitepapers/Lamin-Art _Whitepaper042913.pdf Kellert, S. R., & Wilson, E. O. (1993). The Biophilia hypothesis. Retrieved January 27, 2016.

http://www.hdrinc.com/portfolio/humber-river-hospital http://www.healthcaredesignmagazine.com/article/ Getting-smart-technology https://continuingeducation.bnpmedia.com/coursePrint.php?L=5&C=917 http://www.nbbj.com/work/miami-valley-hospital -heart-and-orthopedic-center/ http://www.nbbj.com/work/miami-valley-hospital -heart-and-orthopedic-center/ http://www.archdaily.com/784043/bioclimatic-and-biophilic-boarding-house-andyrahman-architect http://www.episcopalhousing.org/projects/past-projects/transitional-permanent-and-special-needs-housing/sa rahs-hope/ http://www.cleveland.va.gov/about/index.asp http://www.cleveland.va.gov/locations/directions.asp

http://www.endhomelessness.org/library/entry/fact-sheet-veteran-homelessness http://www.endhomelessness.org/pages/veterans_overview http://www.military.com/benefits/veteran-benefits/homeless-veterans-programs.html http://www.greendoors.org/facts/veteran-homelessness.php http://nchv.org/index.php/news/media/background_and_statistics/ http://www.endhomelessness.org/pages/veterans_overview http://www.ptsd.va.gov/professional/treatment/vets/treatment-iraq-vets.asp https://www.theguardian.com/world/2013/mar/26/us-veterans-inadequate-care-war

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CONCEPT

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Inspiration

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Revive > Strengthen, Activate, Galvanize

A feeling, a hope or desire for a second chance. Nature, people and other living organisms go through a revival everyday, but in some cases, this restoration of life is more complicated and poses the question; to continue, or not? If given the opportunity to have a second chance, why not go forward? Nothing will ever come back the same exact way, shape or form, it comes back with a story. These pieces and parts join together creating a solid foundation; a place of belonging. Like metal, oxidation takes place when a chemical reaction occurs on a metal's surface. The oxidation produces rust which strengthens and makes the surface more desirable. The rust shows the age and life the metal has endured. Revival; defined as the restoration of life, regaining consciousness, and giving a new strength and energy to something.

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Concept Visuals

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Concept Design Visuals

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Concept Materiality Visuals

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Graphics Study

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Materiality Study

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SCHEMATIC DESIGN Project Intents | Program Requirements | Spatial Program Codes | Block Diagrams | Stacking Diagrams | Space Planning

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When veterans visit the VA outpatient clinic, they should feel comfortable, safe, respected, and proud of where they came from. Through the use of design elements, materials, and programs provided, the patients of this clinic can feel revived with a new sense of life and energy. A focal point as a patient enters will be greeted by a welcoming, open space that houses a sculptural element and memorial that pays homage to veterans, a symbol of strength and importance in today’s society. The use of metals in various forms throughout the clinic will show strength as well as emphasis the various stages of its life cycle. Through abstract forms, nature will be incorporated to create a relaxing environment through patterns, textures and the use of natural daylight. This environment will not only create a space for veterans to feel respected and taken care of, but also a space that is created to emphasise community and their network of support.

SUSTAINABILITY INTENT

DESIGN INTENT

Project Intents

Sustainability and design are two elements that should be interconnected.

Government facilities are pushing for all new constructed buildings to follow the standards of LEED to create sustainable buildings that do not have a negative impact on our environment. This VA outpatient clinic prototype will consider LEED factors including improved indoor air quality, the use of daylight and views, water reduction and green power. When selecting a site for the locations of new VA clinics, all factors should be considered, including access to public transportation, position of the site for the best use of daylight as well as a connection to the natural world.

This prototype will also consider sustainable design through the use of recycled materials, modular design of spaces so they can be easily interchanged when needed, as well as the use of durable materials that will last.

Programmatic Requirements

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Spatial Program

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Adjacency Matrix

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Codes Review Building Codes

ADA Accessibility Codes

Use Group: I2 - Institutional Assumed Construction: Type 1A Building: 3 Stories, Sprinklered Occupant Load: 500

2010 ADA Standards for Accessible Design ICC A117.1-2009 – Accessible And Usable Buildings And Facilities Clear Floor Space ● Must be able to accommodate a single wheelchair of at least 30” by 48” ○ The space can be positioned for a forward or parallel approach to restroom elements ○ A portion of the clear floor space may be located under fixtures, lavatories, or accessories as long as the required knee and toe clearance is provided

General Information: The scope of work is a new construction proposed pro-type structure for a Veterans Affairs Multi-Specialty Outpatient Clinic.

Egress: Maximum Travel Distance: 200' 2 Fire Rated (3 hr) Exit Stairs Provided 4 Exits Provided on the First Level Fire Ratings: 3 hr Exterior Wall Construction 2 hr Floor/Ceiling Assembly 1.5 hr Roof Protection

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Turning Spaces ● may be either a 60” circular space ○ allows a person using a wheelchair to make a 180-degree or 360 degrees turn ● or a T-Shaped turning space within a 60” square minimum with arms and base minimum 36” wide ○ allows for a three-point-turn and may be used to conserve space in some Installations ● A portion of the 60” diameter or T-Shaped turning spaces may be located under fixtures, lavatories, or accessories as long as the required knee and toe clearance is provided.

Codes Review Path of Egress - Level Three Example

ADA Accessibility Graphics for Minimum Standards

Wheelchair Approach to a door

Wheelchair Turning Radius

Indicates Path of Travel ADA Corridor Minimum Requirements Actual Width - 66” Maximum Path of Travel = 200’-0” Actual Path of Travel = 130’-0”

ADA Restroom Requirements - Plan View

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Bubble Diagrams

Floor 1

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Floor 2

Block Diagrams PHYSICAL THERAPY

CAFE

HOMELESS/ SUPPORTIVE HOUSING

MAIN ENTRANCE

PRIMARY CARE

WAITING

INFO/CHECK IN

CLIENT SERVICES

CIRCULATION

SPECIALTY

LACTATION

WAITING

OPEN TO BELOW

PRIMARY CARE

CIRCULATION

RESTROOMS PHARMACY

SENSORY

WAITING

WAITING

WAITING

TELEHEALTH

ADMIN

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Block Diagrams PHYSICAL THERAPY

VERTICAL CIRCULATI ON

WAITING

HOMELESS/ SUPPORTIVE HOUSING

OPEN COURTYARD/ ATRIUM

PRIMARY CARE

SENSORY

REST ROOMS

LACTATION

ADMIN

INFO/CHECK IN

INFO/CHECK IN

CHILDREN’S PLAY AREA CAFE

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MAIN ENTRANCE

VERTICAL CIRCULATI ON

OPEN COURTYARD/ ATRIUM BELOW

PHARMACY

TELEHEALTH

CLIENT SERVICES

SPECIALTY

Block Diagrams

PRIMARY CARE

LACTATION

PHARMACY

TELEHEALTH

WAITING REST ROOMS

WAITING ADMIN

VERTICAL CIRCULATION

VERTICAL CIRCULATION

INFO/CHECK IN

OPEN ATRIUM CAFE

MAIN ENTRANCE

SPECIALTY

SENSORY

INFO/CHECK IN

PHYSICAL THERAPY

CLIENT SERVICES

OPEN ATRIUM BELOW

HOMELESS/ SUPPORTIVE HOUSING

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BLOCK DIAGRAMS

CHECK IN

WAITING

SENSORY

TRANSIT TELESTAFF HEALTH ADMIN

CLIENT SERVICES CAFE

VERTICAL CIRCULATION

CHECK IN

48

WAITING

PRIMARY CARE

VERTICAL CIRCULATION

LACTATION PHARMACY CHILDREN’S STAFF LOUNGE PLAY AREA

SPECIALTY

VERTICAL CIRCULATION

PHYSICAL THERAPY

COMMUNITY AREA

Stacking Diagram Floor 3

Floor 2

Floor 1

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Stacking Diagram

SPECIALTY Floor 2

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PRIMARY CARE Floor 1

GREEN SPACE

COMMUNITY CENTER Floor 3

Space Plan - Level 1

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Space Plan - Level 2

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Space Plan - Level 3

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DESIGN DEVELOPMENT Detail Space Development | Final Design Intent | Materiality

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Entrance Wall Concepts

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Building Shell

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Linear Wood Design Elements

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Final Design Intent

When veterans visit the VA outpatient clinic, they should feel comfortable, safe, respected, and proud of where they came from. Through the use of design elements, materials, and programs provided, the patients of this clinic can feel revived with a new sense of life and energy. As a patient enters, they will be inside a space, flooded with natural light. A unique pattern of triangles positioned in a fragmented way which then becomes more solid as they move through the space, further into the community atmosphere of this clinic.

The use of natural elements, such as cork wallcovering and a wood slat ceiling, as well as daylight in the space, will not only bring the idea of nature inside, but it will also help in creating a comfortable space. The wood slat ceiling will also act as an inherent wayfinding tool in combination with the graphics package with allow the clinic to be easily navigated, aiding in the comfortable nature of the space. Along with natural elements, a strong sense of community provided at this clinic will not only give veterans a sense of belonging, it will help revive their overall wellbeing. The cafe and the Hub, which includes a computer lab, gym, group therapy room and lounge, will provide a gathering place for veterans, a place to build a network of support - something that every veteran should have. This environment will not only create a space for veterans to feel respected and taken care of, but also a space that is created to emphasise community and their network of support.

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Materiality

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Materiality

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PROJECT DELIVERABLES Renderings | Presentation Boards | Graphics Package FF&E Specifications | Construction Document Set

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RENDERINGS

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Reception & Waiting Area - Level One

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Front Entrance

Entrance Stairs

Waiting Area

PACT Team Area - Level One

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PACT Team Staff Space

Exam Room

Patient Corridor

Community Area - Level Three

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Lounge Area

Computer Workstations

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PRESENTATION BOARDS

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GRAPHICS PACKAGE

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Patient Corridor Elevation

Exam Room Signage Material: aluminum, cutout, mounted to doors with standoffs

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Primary Care Entrance Elevation Signage Material: frosted glass, etched

Whole Building Floor Signage Material: aluminum, cutout, mounted to ceiling system using cable track above entrance stairs and elevator lobby

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Procedure & Consultation Room Signage Material: aluminum, cutout, mounted to walls with standoffs

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FF&E SPECIFICATIONS

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CONSTRUCTION DOCUMENT SET

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Gantt Chart Key Green - Everyone Gray - Design Phases Blue - Nicole Galuschik Purple - Alyssa Faustina Yellow - Kellan Roth

Appendix Alyssa Faustina Research Bubble diagrams Select Materials FF&E Spec Book Presentation Boards Presentation Powerpoint

Kellan Roth Research Bubble diagrams Building Shell Graphics Renderings Digital Walkthrough

Nicole Galuschik Research Bubble Diagrams Select Materials Program Requirements Build Revit Model Construction Document Set Research Booklet

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