Little Apple Pediatric Clinic (Spring 2017)

Little Apple Pediatric Clinic

Site Analysis Key Neighborhood Characterisitcs

Manhattan Catholic School Sunflower CASA Woodrow Wilson Elementary Our Site: Pediatric Clinic Manhattan Education Center Bus Stop: At Juliette and Laramie Manhattan Public Library Strasser Village Apartments

N

Site Analysis

Demographics: • Kansas State Univeristy academic body • Highschool students • Middle school students • Elementary education students • Families • Working Class • United States Army Community of Fort Riley County

N

Residential Zone

Pubilc Zone

Mental Health in Kansas Behavioral Health Barometer Kansas, 2014; Kansas Action for Children

Mental Health Treatment/ Counseling Among Adults Mental Health Treatment/ Counseling Among Adults Aged 18 or Older with Any Mental Illness in Kansas Mental Health Treatment/ Counseling Among Adults Aged 18 or Older with Any Mental Illness in Kansas

Aged 18 or Older with Any Mental Illness in Kansas

48.3% 48.3%

51.7% 51.7%

Recieved Mental Health Recieved Mental Health Treatment/ Counseling Treatment/ Counseling Did not recieve Mental Health Did not recieve Mental Health Treatment/ Counseling Treatment/ Counseling

Number per 1,000 children under 18 hospitalized for Number per 1,000 children under 18 hospitalized for mental health Number per 1,000 children under 18 hospitalized mental health

for mental health

5.01 / 1000 5.01 / 1000 0.46 0.46

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health, 2010 - 2014 Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health, 2010 - 2014

Source: Kansas Action for Children,, Riley County Health Department, Trend 2011-2015 Source: Kansas Action for Children,, Riley County Health Department, Trend 2011-2015

Obesity in Kansas The State of Obesity in Kansas

2-4

12.8%

10-17

14.2%

18-25

22.1%

Age 26-44

36.9%

45-64

38.9%

65+

30.5%

Age

0

5

10

15

20

25

30

35

Percent of 100 Percent ofout out 100

Percent of Obese Residents in Kansas

Source: Trust for America’s Health and Robert Wood Johnson Foundation. The State of Obesity 2016 (PDF). Washington, D.C. 2016

40

Physical Activity in Kansas Kansas: State Nutrition, Physical Activity, and Obesity Profile

Adult’s Physical Activity Statistics Shown 7 days prior to survey achieved 300 min. moderate intensity a week

did not achieve any physical activity in the past month

Children’s Physical Activity Statistics Shown 7 days prior to survey achieved recommended 60 min. of exercise per day

attended P.E. sessions at school

did not participate in any physical activity

watched TV for 3 + hours

How do I achieve an optimal environment?

Concept

The idea of cell biomimicry enhances function and efficiency of pediatric services to promote the development of the Manhattan, Kansas community.

Cell as it Relates to a Single Room

1. Cell is the most fundamental and basic unit of nature 2. Contains organelles such as nucleus, mitochondria, and lysosomes 3. All organelles are part of a cell for efficient and functional operation 4. Starts the process of growth and development

1. Exam Room is one basic unit of the Pediatric Clinic 2. Contains furnishings such as height adjustable exam table, side chairs, doctor’s seat with writing table, ADA sink and cabinetry 3. All furnishings are part of the exam room for efficient and functional operation 4. Adjacent rooms represent the process of growth and development

Cell Mitosis as it relates to the Pediatric Clinic

Control Room

Laboratory

Sub-waiting

Nursing Room

Nursing Room

Business Manager Office Business Office

Exam 4

Lab Restroom

Blood Draw Room

Exam 5

Radiology

Exam 6

Breakroom

Doctor’s Office

Business Staff Collaboration

Well Waiting Doctor’s Office

Conference Room

Reception Mechanical Room Staff Restroom Data Closet

Work Room

Check-In

Staff Collaboration Check-Out

Main Entrance

Group Consulting

Doctor’s Office

Nurse Station

Group Consulting Vision and Hearing

Sick Waiting

Exam 1 Waiting Restroom

1. Cell mitosis is the multiplication of cells 2. Cells communicate with each other to perform specific tasks 3. All cells equipped with tools to perform functional and efficient in unison

Physician Dictation

Exam Restroom

Exam 2

Exam 3

Janitor’s Closet

Expansion (Undeveloped)

Storage, Recycling, and Future Expansion (Undeveloped)

1. Adjacencies are the “mitosis” of rooms 2. Rooms adjacent to each other enhance communication between staff and patients, and operation of pediatric tasks 3. All rooms equipped with tools and furnishings to perform functionally and efficient in unison

N

Organism as it relates to the Master Plan Nutrition Center

Physical Therapy and Exercise

Mental Health Clinic

N

1. Organism is the whole entity fully developed from cells 2. Cells that make up the organism work in unison to function to its full potential

1. Master plan is the whole entity fully developed from the Pediatric Clinic, Mental Health Clinic, Nutrition Center, and Physical Therapy and Exercise 2. Four services within the master plan work in unison to help the development of Riley County

Master Plan Secondary Entry Occpanc: Business Occupancy: Business Preface Cell: The clinic includes three com• The mostthat benefit plimentary services the development of mental, fundamental physical, unit and emotional of naturehealth of the Riley Country residences of all types. A Physical Therapy Package of provides and Exercise service Services: residents in need of access to • Encompass equipment and assistance in a physicalfundamentals health routine. Secondly, there is a current need of health for better awareness of obtaining a healthy diet, so a nutrition • Mental and cooking center is incorporated.• Emotional Lastly, a high rate of mental• Physical illness exists within the community, so a Mental Health clinc is provided.

Square Feet: 3,000 FT.

MASTER PLAN Occupancy: Business Square Feet: 3,400 FT.

N

Occpancy: Business Square Feet: 3,000 FT.

HEALTHCARE CLINIC Occupancy: Business Total Square Feet: 21,600 Pediatric Center

Occpancy: Business Sqaure Feet: 12,200 FT.

Physical Therapy and Exercise Nutrition Center Mental Health Clinic

Main Entry

Clinic Floor Plan Models Traditional Model Check-In

Support

On-Stage Off-Stage Model

Staff Work

Consult

Exam

Exam Waiting

Waiting

Check-In

Exam

Consult

Support

Staff Work

Consult

Support

Staff Work

Offices

Exam

Opportunities:

Opportunities:

• patient familiarity with this model • exam rooms in close proximity

• efficient travel between exam and staff space • greater staff communication • increases privacy of staff

Limitations • separation of staff • staff spaces more open to public

Limitations • separation of exam rooms, increase wayfinding

On-Stage Off-Stage Model On-Stage Off-Stage Model

Control Room

Laboratory

Radiology/ Lab

Wait Consult

Waiting

Check-In

Exam

Support

Staff Work

Nursing Room

Offices

Nursing Room

Well Waiting

Consult

Lab Restroom

Sub-waiting

Business Manager Office Business Office

Exam 6

Exam

Business Staff Collaboration

Breakroom

Doctor’s Office

Doctor’s Office

Reception Work Room

Check-In

Waiting Main Entrance

Staff Work

Staff Collaboration

Check-Out

Group Consulting

Group Consulting Vision and Hearing

Consult Waiting Restroom

Exam Restroom

Physician Dictation

Exam Exam 1

Exam 2

Office Doctor’s Office

Nurse Station

Sick Waiting

Reduces used space by 50%

Exam 5

Radiology

Check-In

Exam

Achieves 15% increase in operational efficiencies

Exam 4

Blood Draw Room

Exam 3

Conference Room

Staff Work Mechanical Room Staff Restroom Data Closet

Janitor’s Closet

Expansion (Undeveloped)

Storage, Recycling, and Future Expansion (Undeveloped)

(Pacific Medical Building)

Little Apple Pediatric On-Stage Off-Stage Model

Floor Plan Control Room

Laboratory

Sub-waiting

Nursing Room

Nursing Room

Business Manager’s Office

Business Office

Lab Restroom

Exam 4

Blood Draw Room

Exam 5

Exam 6

Business Staff Collaboration

Radiology

Breakroom

Doctor’s Office

Well-Waiting Doctor’s Office

Conference Room

Reception Work Room

Check-In

Staff Restroom

Staff Collaboration Check-Out

Doctor’s Office Triage Zone

Janitor’s Closet

Nurses’ Station

Group Group Consulting Consulting

Main Entrance

Vision and Hearing

Physician Dictation Exam 1

Sick Waiting Waiting Restroom

Mechanical Closet Data Closet

Exam Restroom

Exam 2

Exam 3

Storage, Recycling, and Future Expansion (Undeveloped)

Expansion (Undeveloped)

N

Annotated Floor Plan Business Office:

Staff Collaboration (Best Option)

• Private staff collaboration space for business office • Work room provides additional collaboration zone • Medical record files

• High ceiling with skylights to invite daylight (WELL) • Mobile media carts for information sharing • Medical preparation and storage align wall allows for most open space and light • Flexible collaboation zones • Nurse’s Station has stand/sit desks with personal storage

Breakroom: Control Room

Laboratory

Sub-waiting

Lab Restroom

Blood Draw Room

Radiology

Breakroom

• Various seating options for eating, resting, collaboration • Staff lockers • Food Preparation

Conference Room Waiting Area: • Sick and well waiting • Flexible and movebale furniture accomates various activities: work, rest, play • Fish tank in wall • Provides territoriality • Supports multiple postures

Nursing Room

Nursing Room

Business Manager Office Business Office

Exam 4

Exam 5

Exam 6

Doctor’s Office

Business Staff Collaboration

Well Waiting Doctor’s Office

Conference Room

• adjacency to collaboration • various media and tools for information sharing • more private

Reception Mechanical Room Staff Restroom Data Closet

Work Room

Check-In

Staff Collaboration Check-Out

Reception: • Separate Check-in and Check-out spaces • Direct line of site from entrance • Additional wayfinding features

Main Entrance

Group Consulting

Doctor’s Office

Nurse Station

Group Consulting Vision and Hearing

Sick Waiting

Physician Dictation Exam 1

Waiting Restroom

Exam Restroom

Exam 2

Exam 3

Janitor’s Closet

Storage, Recycling, and Future Expansion (Undeveloped)

Expansion (Undeveloped)

Staff Collaboration Options 11’ Freestanding Partition equipped with white boards and computer monitors

Collaborative Lounge adjacent to media wall

Nurse’s Station

Collaborative Table

standing/sitting desk

mobile white board and computer monitor

Media Collaboration information and media sharing

Medical Preparation medical supply storage

Medical Preparation

14’ High Ceiling

medical supply storage

skylight for natural working environment

Media Collaboration

Nurse’s Station

information and media sharing

desk side personal storage standing/sitting desk

Concentration zone private, focused work

Opportunities:

Opportunities:

array of work zones; multiple seating options for posture; nurse’s desk side personal storage; centralized medical supply

large, private collaboration zone; multiple seating options for posture; medical preparation and supply for each wing of exam rooms; mobile media and information sharing

Limitations:

Limitations:

partition obstructs openness and light

medical prep zones obstruct openness and lightt more busy circulation paths

Doctor’s Office Strategies Doctor’s Office Strategy

Exam 6

Doctor’s Office

Opportunities: Retreat zone Private work Phone calls Treatment research Collaboration with nurse

Opportunities: • Retreat zone • Private work Doctor’s Doctor’s Office Office Strategy Phone calls Limitations: Treatment researchLimits collaboration between doctors Opportunities: Retreat zone Collaboration with Utilizes nursemore space Private work • More personal storage Phone calls

Doctor’s Office Strateg Exam 4

Exam 5

Exam 6

Doctor’s Office

Doctor’s Office

Treatment research Collaboration with nurse Limitations:

aboration

Doctor’s • Limits collaboration between doctors Limitations: Office Limits between doctors • collaboration Utilizes more space

Opportunities: Retreat zone Private work Phone calls Treatment res Collaboration

Limitations: Limits collaboratio Utilizes more spac

Staff Collaboration

Utilizes more space

Doctor’s Office

Closed Office

Closed Offic

Nurse’s Station

Physician Dictation Physician Dictation

Exam 3

Closed Office

Open Office Exam 1

Exam 2

Exam 3

Open Offic

Open Office

Patient vs. Staff Circulation KEY Patient Circulation Staff Circulation

TRIAGE ZONE

N

Typical Patient Visit Entry to Exam 1 Entry

Exit from Exam 5 Group Consulting 6 Check-Out

2

Check-In

3

Triage Zone Exam Room

4

Nursing Room

Laboratory

Sub-waiting

Nursing Room

Business Manager Office Business Office

Control Room

Exam 4

Lab Restroom

Blood Draw Room

Exam 5

Radiology

Exam 6

Breakroom

Doctor’s Office

Business Staff Collaboration

Well Waiting

2

Doctor’s Office Reception

Staff Collaboration

Check-Out

1

3 Triage Zone

Group Consulting

Mechanical Room Staff Restroom Data Closet

Work Room

6

Check-In

Main Entrance

Conference Room

Group Consulting

5

Vision and Hearing

Sick Waiting

4 Exam 1

Waiting Restroom

Exam Restroom

Doctor’s Office

Nurse Station

Exam 2

Exam 3

Physician Dictation

Janitor’s Closet

Storage, Recycling, and Future Expansion (Undeveloped)

Expansion (Undeveloped)

N

Reception Desk Sliding Countertop; ADA Access, Side Approach

Drawers

Drawers Check-In Recycle

Check-Out ADA Access, Front Approach

• Desk is organically designed to take the form of an cell • Overhanging soundscape acoustic clouds are wayfinding tools • Provokes curiosity of children • Check-out recesses into reception area to eliminate hallway traffic between waiting room and exam rooms

Reception Experience

Elevation A

A

B

Elevation B

Reception Desk Details

Section A

Section B

Section A

Section B

Waiting Room

Buoy Ottoman, Steelcase

Mitra Chair, Steelcase

Paper Table, Steelcase

Campfire Big Lounge, Steelcase

Wayfinding Wayfinding Landmarks EXAM 1

Triage Zone Signage << Exam 1- Exam 3 >> << Exam 4 - Exam 6 >> <<Radiology <<Labratory

Fiber Artwork: Organic Cells

Exam Room Functions Limitations: • Doctor work and treatment zone eliminated • Patient Proximity to Partners- some children may feel uncomfortable

Opportunites: • Connect 3 P’s • Humanize Exeperience • Enhanced Communication • Flexibilty- can be used for consultation Limitations: “Examination Zone” eliminated Patient Proximity to Partners

A

Opportunites: Connect 3 P’s Humanize Exeperience Consultation Enhanced Communication Flexibilty

Connect: Patient Partner Provider

Perspective A

B

Perspective B

Exam Room Functions

• Height adjustable exam table, DRE Med • height ranges from 18” to 31” • allows independent access for children • can be raised to fit the comfortability of doctor • Flat table, pushed against the wall to contain child and maintain safety (Dr. Klinger)

Elevation A

Elevation B

B C

A D

Elevation C

Elevation D

Aesthetic Palette Biophilia- a human’s innate tendency to seek connections with nature • Color pallatte reflects natural pallete of our environment • Analogous color scheme composed of cool greens and blues • Wood and gray tints and tones incorporated to mimic a natural setting • Use of textiles with organic patterns to reflect organic form of cells • Materials with low VOC emissions for WELL Building Standard “Air”

“A Right to Light” Light: Well Building Standard

“Exposure to adequate levels of sunlight is critical for health and well-being, for effects ranging from visual comfort to neurological and phsycological gain” (International WELL Building Standard).

Waiting Room Sunlgiht Access: • Use of casement windows and floor to ceiling glass windows allow light to enter the space • Use of clerestory windows to extend sunlight exposure into more spaces

Staff Collaboration Sunlight Acess: • Roof is equipped with skylights for sunlight exposure • Clerestory windows in exam rooms and floor to ceiling glass in the doctor’s offices extend exposure into space

Triage Zone

Circadian Lighting Features Light: Well Building Standard

USAI: True Zero Connect Armstrong Ceiling Application

Circadian Lighting System Midnight Light: None

Light: Low to None

3:00 A.M.

9:00 P.M. Light: Medium to Low

Light: None

6:00 P.M.

6:00 A.M.

Light: None

• Humans have biological response to light and dark cycle known as our circadian rhythm • Circadian lighting is aligned with the natural light and dark cycle of the solar day • mimics natural lighting to induce our bodies response to levels of productivity and rest (USAI Lighting)

Light: Medium

9:00 A.M. 3:00 P.M. Light: Medium to High

Light: High

Noon

Acoustic Considerations Comfort: Well Building Standard “Sound Barriers” intent is to reduce sound transmission and acoustic disruptions through sound barriers.” (International WELL Building Standard)

Control Room

Laboratory

Lab Restroom

Sub-waiting

Nursing Room

Nursing Room

Business Manager Office Business Office

Exam 4

Blood Draw Room

Exam 5

Radiology

Exam 6

Breakroom

Doctor’s Office

Business Staff Collaboration

Well Waiting Doctor’s Office

Conference Room

Reception Mechanical Room Staff Restroom Data Closet

Work Room

Check-In

Staff Collaboration Check-Out

Main Entrance

Group Consulting

A

Group Consulting

Doctor’s Office

Nurse Station

Vision and Hearing Sick Waiting Waiting Restroom

Section A

Physician Dictation Exam 1

Exam Restroom

Exam 2

Exam 3

Janitor’s Closet

Storage, Recycling, and Future Expansion (Undeveloped)

Expansion (Undeveloped)

Careful detailing of interior partitions and ceilings improve sound reduction • To reduce acoustic sound from exam room: acoustic batt insulation, acoustic sealant, • Soundscape acoustic clouds applied • Staff collaboration has large open space with high ceiling: acoustic cloud vault system

Appendix

Technical Information

• Exit Distance and Common Path of Travel • Door Acessibility • ADA Door Accessibilty Diagrams • Turning Radii • International Building Code • Minimum Corridor Width • Codes Issues • Restroom Acessibility • Recycle Program • Bibliography

Technical Information

Exit Distance and Common Path of Travel Sprinkled Building: Exit Doors and Exit Access Door Ways must be at least 1/3 the diagonal distance Common Path of Travel Travel Distance (Including Common Path)

Control Room

Laboratory

Diagonal Distance Distance Between Exits Point at which to Make a Decision

Sub-waiting

Lab Restroom

Blood Draw Room

Radiology

Breakroom

Exit Signage

Nursing Room

Nursing Room

Business Manager Office Business Office

Exam 4

Exam 5

Exam 6

Doctor’s Office

Business Staff Collaboration

Well Waiting Doctor’s Office

Conference Room

Reception Mechanical Room Staff Restroom Data Closet

Work Room

Check-In

Staff Collaboration Check-Out

Triage Zone

Main Entrance

Group Consulting

Doctor’s Office

Nurse Station

Group Consulting Vision and Hearing

Sick Waiting

Physician Dictation Exam 1

Waiting Restroom

Exam Restroom

Exam 2

Exam 3

Janitor’s Closet

Storage, Recycling, and Future Expansion (Undeveloped)

Expansion (Undeveloped)

N

Technical Information Door Accessibilty Refer to next slide for diagrams

TRIAGE ZONE

N

Technical Information ADA Door Accessibility Diagrams

Figure 404.2.3 Clear Width of Doorways

Figure 404.2.4.2 Maneuvering Clearances at Doorways without Doors, Sliding Doors, Gates and Folding Doors

Figure 404.2.4.1 Maneuvering Clearances at Manual Swinging Doors and Gates

Technical Information International Building Code Occupany Type: Business 4

Required: 3 Lavatories (Unisex)

2

Required: 2 Exits

4

Required: 31 Water Closets (Unisex)

11 Required: 1 Service Sink 3 Required: 1 Water Fountain

TRIAGE ZONE

N

Technical Information Turning Radii

ADA Standards Chapter 304.4 • Turning Radii are 60”

TRIAGE ZONE

N

Technical Information Minimum Corridor Width

Minimum Corridor Width 60” (CH 402) All 60” or more Minimum Corridor Width 44” (CH 402) All 44” or more

Minimum Corridor Width 60” (Ch 402) All 60” or More Minimum Corridor Width 44” (Ch 402) All 44” or More

TRIAGE ZONE

N

Technical Information Restroom Accessibility

18”

56” GRAB BARS 60”

48”

Figure 306.3 Knee Clearance

Figure 604.5.2 Rear Wall Grab at Water Closets

Figure 604.3.1 Size of Clearance at Water Closets

Figure 604.5.1 Side Wall Grab Bar at Water Closets

30”

BABY CHANGING STATION

Reference: Part E ii Toilet Room Accessibility Word Doc Made on Illustrator

Technical Information

Code Issues and Room Annotations 2010 ADA Standards Codes Issues

Figure 404.2.4.1 Maneuvering Clearances at Manual Swining Doors and Gates

What I would do Differently: • Reconfigure the entire business office • Switch Manager’s Office with Business Office • Design a smaller work room or integrate it into the business office as open casework

Control Room

Laboratory

Sub-waiting

Nursing Room

Nursing Room

Business Manager Office Business Office

Exam 4

Lab Restroom

Blood Draw Room

Exam 5

Radiology

Exam 6

Breakroom

Doctor’s Office

Business Staff Collaboration

Well Waiting Doctor’s Office

Conference Room

Reception Mechanical Room Staff Restroom Data Closet

Work Room

Check-In

Staff Collaboration Check-Out

Main Entrance

Group Consulting

Doctor’s Office

Nurse Station

Group Consulting

Triage Zone Vision and Hearing Sick Waiting

Figure 404.2.4.1 Maneuvering Clearances at Manual Swinging Doors and Gates

Physician Dictation Exam 1

Waiting Restroom

Exam Restroom

Exam 2

Exam 3

Janitor’s Closet

Storage, Recycling, and Future Expansion (Undeveloped)

Expansion (Undeveloped)

N

Technical Information Recycle Program

Recycle Program Freestanding Recycling and Trash Bin, Steelcase • Took this idea, and custom made for the waiting area • Also implemented two bins in countertop space in prominent rooms • Exam rooms recycle and waste bins are included in drawers • restricts access from children • used for medicall recycle and waste • Storage and expansion contains stock pile of trash and recyle • Recycle goes to company in Manhatta that sorts recycle waster for the clinic

TRIAGE ZONE

N

Bibliography “Behavioral Health Barometer Kansas, 2014”. SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health. (2010-2014).

Retrieved from: https://www.samhsa.gov/data/sites/default/files/State_BHBarometers_2014_1/BHBarometer-KS.pdf “Circadian Rhythm Lighting”. USAI Lighting. (March 16, 2015). Retrieved from: http://www.usailighting.com/circadian-rhythm-lighting “Kansas: State Nutrition, Physical Activity, and Obesity Profile” Overweight adn Obesity. (September 2012). Retrieved from: https://www.cdc.gov/nccdphp/dnpao/ state-local-programs/profiles/kansas.html “Our Standard”. International WELL Buildling Institute. (2017). Retrieved from: https://standard.wellcertified.com/light/right-light “PMB Utilizes Toyota Lean and Dean on-stage/ off-stage Principles in the design and operation of the new LEED Certified St. Jude Heritage Medical Plaza”.

Pacific Medical Buildings. Retrieved from: http://www.pacificmedicalbuildings.com/wp-content/uploads/2015/09/Heritage-Medical-Plaza-Case-Study-screen. pdf “The State of Obesity in Kansas”. The State of Obesity. (2016). Retrieved from: http://stateofobesity.org/states/ks/ “2016 Kids Count”. Kansas Action for Children. (2016). Retrieved from: http://kac.org/wp-content/uploads/2012/11/2016KansasData.pdf