224 EAST BROAD BRITTNEY WEISS | SENIOR DESIGN THESIS RICHMOND, VA | 2012
“Desparation is the raw material of drastic change.” WILLIAM S. BURROUGHS
20%
of americans suffer from some form of a functional digestive disorder
that’s
63,000,000 equal to the entire population of california, the largest state in america*
40,000,000 are lactose-intolerant
3,000,000
each are estimated to suffer from gastroparesis or barrett’s esophagus
450,000
suffer from crohn’s disease
85%
is the mortality rate of sufferers of barrett’s esophagus once it has become malignant.
1
most die within year. esophageal cancer is #9 in america for men
it is estimated that 1 out of every 133 Americans suffers from celiac disease
that’s
3,000,000 greater than the population of chicago
{
{
people
97%
of those estimated have not been properly diagnosed
Problem Functional digestive disorders account for at least 3,500,000 office visits each year. Many patients walk away from a diagnosis with little information. Short-term medication, experimental procedures, and required diets leave them frustrated, confused, and desparate. Studies show that more people would be prompted to seek help if they were confident their disorders could be corrected. The stress of these emotions can exacerbate malnutrition and other serious complications already present in digestive disorders.
What if there was a space for doctors and patients that was dedicated to better understanding these diseases?
A informative space that helps patients feel connected and important as they’re guided and encouraged to make the drastic life changes required of their illness?
My goal is to use design to combat the lack of awareness for gastrointestinal diseases and to provide comfort and hope to those that suffer.
224 EAST BROAD BRITTNEY WEISS . SENIOR DESIGN THESIS RICHMOND, VA | 2012
01 02 03 04 05 06
DESIGN PROPOSAL
1
CLINICAL RESEARCH & A NEW FACILITY MODEL
5
CASE STUDIES
21
SITE ANALYSIS
39
PROGRAM DETAILS
65
GREEN ROOF DESIGN
77
01
DESIGN PROPOSAL
“
1 PROPOSAL
Here’s what I hate about GERD...no one can tell me what’s wrong with me.
“
Anonymous GERD patient
Whether required or self-inflicted, dieting is tough. Changing or improving a daily routine as fundamental as eating can be so overwhelming, many Americans avoid it, give up, or do it improperly. Diet and nutrition books or online media will often only paint part of the picture on proper nutrition and finding real help can prove difficult. Being diagnosed with a condition that requires life-long dieting can dumbfound a person, especially when doctors and specialists are often separated and scattered across the city.
What
if there was a space where dieticians and gastroenterologists could better collaborate with their patients?
Could
it also promote interaction between patients to share experiences and information?
Could
care become so collaborative that it encourages community involvement?
How
would it attract and engage the public?
PROPOSAL
3
I plan to design a center where a more comprehensive and collaborative form of healthcare can be practiced. It will primarily provide treatment and support for digestive diseases that affect food intake, such as GERD, Gastroparesis and Celiac Disease. The center will extend its care to also treat food allergies or intolerance ranging from mild to severe and dietary complications that manifest as a result of non-digestive illnesses.
Therefore it will be an informative and engaging space about nutrition for both patients and curious and concerned members of the community who may not want or may not afford an examination from a specialist.
A significant area will be allotted to clinical spaces, including exam rooms and operating rooms for outpatient procedures and offices for dieticians, gastroenterologists, and supporting staff. The center will incorporate and focus on active and preventative care that surpasses common treatment protocol and encourages community involvement in designated spaces.
There will be areas that encourage group learning and experience sharing as well as informative spaces for family members and friends. A rooftop garden will provide therapeutic space as its consumable vegetation supplies a viable in-house resource for teaching kitchens, food labs, and small meals at the center’s cafÊ.
02
CLINICAL RESEARCH
INTRO TERMINOLOGY
5 CLINICAL RESEARCH
GI Gastrointestinal GASTROLOGY + GASTROLOGIST The medical study of the stomach and its structure, function and diseases GASTROENTEROLOGY + GASTROENTEROLOGIST The medical study of the entire digestive system, including the mouth, stomach, esophagus, intestines, and associated organs (pancreas, liver, gallbladder) MOTILITY DISORDER Any disorder affecting the rhythmic contraction of the digestive tract
GASTROINTESTINAL DISEASES + DISORDERS PATIENT EXPERIENCES DIAGNOSTIC PROCEDURES EFFECTIVENESS OF TREATMENTS
GI DISEASES AND DISORDERS While the proposed facility will support the full range of gastroenterology’s needs, its design will focus on catering to malnutrition and discomfort due to chronic digestive diseases and motility disorders, including:
GERD (Gastroesophageal Reflux Disease) A condition in which the stomach contents (food or liquid) leak backwards from the stomach due to a muscle that does not close properly in the esophagus. The disease can present on its own, but is often alongside Gastroparesis. Symptom range: nausea, heartburn, abdominal pain and distention, sore throat, dysphagia Complications: asthma, esophageal narrowing (stricture), ulcers, chronic cough, lung spasms, malnutrition
GASTROPARESIS
CELIAC DISEASE
A neuromuscular disease in which food moves through the stomach slower due to a form of muscle paralysis.
An autoimmune digestive disease that damages the villi of the small intestine and results in malabsorption of nutrients from food. When a person with celiac disease eats or uses a product containing gluten, their immune system reacts by damaging these villi.
Symptom range: severe nausea, vomiting, abdominal pain and distention, palpitations, stomach spasms Complications: electrolyte imbalance, dehydration, weight loss, malnutrition, severe fatigue, bezoars
Symptom range: abdominal pain, decreased appetite, fatigue, ulcers, hair loss Complications: infertility, reduced bone density, malnutrition, neurological disorders and some cancers.
7 CLINICAL RESEARCH
**Note: Though experienced by all from time to time, these symptoms are more severe and often experienced daily by those who suffer from a GI disease
CROHN’S DISEASE
BARRETT’S ESOPHAGUS
ACHALASIA
An autoimmune disorder that occurs when the body’s immune system mistakenly attacks and destroys healthy parts of the GI system.
An precancerous abnormal change in the cells of the esophagus, where the cells morph to mimic those found in the stomach. This is often due to reflux and is usually found in patients suffering from GERD.
A disorder of the esophagus, which affects the ability to move food toward the stomach. A muscular ring, which normally relaxes, can not do so during eating, due to nerve damage.
Symptoms: joint pain, ulcers, stomach pain, fatigue, persistent diarrhea, cramps, swollen gums Complications: joint inflammation, eye lesions, abscesses, bowel obstruction, malnutrition
Symptoms: heartburn, chest pain, vomiting blood, dysphagia Complications: esophageal cancer, malnutrition
Symptoms: heartburn, chest pain, cough, dysphagia with both food and liquid Complications: weight loss, esophageal tearing, breathing food content into lungs - causing pneumonia
GI diagnostic procedures
Right: The black controller tops of endoscopy tubes
There is a great breadth of procedures that could possibly be used to diagnose GI diseases and disorders, including MRIs and CT scans, but the most common procedures are the following:
BARIUM SWALLOW A chalky liquid containing small amounts of radioactive material (barium) is swallowed in order to coat the digestive tract, affording doctors an outlined view of the digestive organs in an X-ray. The X-ray reveals how well the esophagus is functioning as the liquid passes into the stomach. ENDOSCOPY (also known as an EGD/EsophagoGastroDuodenoscopy) Performed under sedation, a thin fiber-optic tube with a video camera is passed down the throat allowing inspection and biopsies to be taken of the esophagus and stomach lining. CAPSULE ENDOSCOPY (SmartPill/PillCam) Because traditional procedures cannot reach parts of the small intestine, a pill-like capsule is swallowed that transmits video data as it naturally passes through the digestive system. This is used to identify causes of bleeding, detecting polyps, inflammatory bowel disease, ulcers, and tumors of the small intestine.
ESOPHAGEAL MANOMETRY A thin tube is passed down the nose into the esophagus where it measures the pressure generated by contracting muscles as the patient is asked to swallow. ULTRASOUND Soundwaves are used to outline and define the digestive organs COLONOSCOPY A thin tube is passed through the large intestine (colon), functioning much like an endoscopy, to identify abnormal growths, inflamed tissue, ulcers, and bleeding. pH MONITORING A thin tube is passed down the nose through the esophagus to measure acidity levels. Patients must wear this tube and carry a device on them for 24-48 hours.
effectiveness of treatments Often there are no cures for GI disease and disorders. Medications are few and the ones available are often dangerous and temporary or banned by the FDA. There are no significant pharmaceutical advances that focus solely on treating a GI disease, thus medications prescribed are still considered experimental to a degree and are not guaranteed to be effective.
GERD Pharmaceuticals: over-the-counter antacids, proton pump inhibitors, H2 blockers Alternative treatments: anti-reflux operations Diet: smaller meals, avoidance of heart-burn foods (tomatoes, alcohol, chocolate, etc.)
GASTROPARESIS Pharmaceuticals: temporary prokinetics (stimulate movement in the stomach), but can cause permanent muscle damage. temporary antibiotics that stimulate as a side effect Alternative treatments: temporary nerve toxin injections (Botox), electrical gastric pacemakers Diet: smaller meals, low-fiber and fat, no raw fruits or vegetables. Patients will be on a sliding scale of solid-liquid diet, sometimes requiring a permanent feeding tube.
CELIAC DISEASE Pharmaceuticals: temporary corticosteroids Alternative treatments: None Diet: 100% gluten-free
“
Frances Fusili Gastroparesis patient
CROHN’S DISEASE
BARRETT’S ESOPHAGUS
Pharmaceuticals: corticosteroids and other medications
Pharmaceuticals: proton pump inhibitors, NSAIDs (nonsteroidal anti-inflammatory - as in aspirin)
Alternative treatments: bowel resection surgery to remove parts of the diseased intestine
Alternative treatments: laser treatment, surgery, radiation and chemotherapy (once malignant), new treatment of radiofrequency abilation
Diet: No specific diet has been shown to make Crohn’s symptoms better or worse. Recommended diet is often similar to that of Gastroparesis.
Diet: slower eating, avoidance of heartburn food
ACHALASIA Pharmaceuticals: nitrates, calcium-channel blockers Alternative treatments: Botox injections, esophageal surgery, dilation of the esophagus during endoscopy Diet: slower eating, avoidance of heartburn food
11 CLINICAL RESEARCH
“
It is frustrating... because to others I look just fine, yet many days I can barely function.
“
I feel sometimes like giving up, and it scares me. I need to talk to some people that have this, for guidance and support.
“
jek1863 Gastroparesis patient
in their own words
“
I’ve recently been diagnosed ...and [am] finding [it] hard dealing with it. I’ve been reading a lot of...information and some of it I don’t understand.
“
Leanna M. Celiac Disease patient
Patients from The Experience Project reach out and share their stories online in the hopes of creating a community of fellow sufferers. The proposed facility will create a concrete place for these patients to interact and feel understood.
chronic illness & Stress The frustration and hopelessness that patients experience often leads to depression and the addition of chronic stress. When the body’s stress response becomes habitual, urination becomes more frequent and can lead to malnutrition as the body fails to extract key food nutrients in time. Therefore, digestive disorder patients facing frequent stress may experience double the decrease of nutrient absorption that they already desperately need. Based on my findings from recent interactions with gastroparesis patients on online forums, it has become apparent that psychological care may be a necessary part of the program. Whereas dieticians were originally scheduled to extend their care to patient frustrations and guidance through one-on-one and group settings, many may be coming to the center who suffer greatly from deteriorating mental health as a result of their physical condition. Having a psychologist join the gastroenterologist/dietician patient team will be benefical for both patient care and the operational performance of the center’s facility model. While patients are being treated clinically, they will have the opportunity to reduce their stress levels, further aiding the fight against malnutrition.
CLINICAL RESEARCH
13
facility model In order to provide comprehensive treatment, the center will be designed to facilitate interaction between the three major disciplines of medicine, nutritional science and psychology.
CLINICAL DIAGNOSTICS
Phytotherapy, or the study of plant extract use, is often seen as an alternative to Western medicine. Here it will play a necessary partner, using plants and herbs to combat malnutrition and pain management where current clinical research has failed to provide adequate medication.
PSYCHOTHERAPY PHYTOTHERAPY
LEARNING RESEARCH TEACHING EXPERIMENTATION
It will be taught, not just prescribed, in a hands-on approach that creates therapeutic activity, thus its placement alongside psychology.
GASTROENTEROLOGIST RADIOLOGY TECHNICIAN NURSE
CERTIFIED NUTRITION SPECIALIST (CNS) AND/OR REGISTERED DIETICIAN HERBALIST GARDENER
PSYCHOLOGIST LICENSED COUNSELOR
patient team model GARDENER
GASTROENTEROLOGIST
HERBALIST
PATIENT
THERAPIST
DIETICIAN
CHEF
CLINICAL RESEARCH
15
LEVELS OF COMMUNICATION PRIMARY
DIETICIAN
THERAPIST
GASTROENTEROLOGIST
SECONDARY
SUPPLEMENTAL
GARDENER
HERBALIST
CHEF
PRIMARY
The most important level of communication happens within the patient team. Functioning much like an atom with rings oribiting a nucleus, care is centered on the patient as the gastroenterologist, dietician, and therapist collaborate together and work one-on-one with the patient. The dietician and therapist will represent the supplemental figures and will likely work together more often.
SECONDARY
Though not primary in regards to the patient, the communication that happens at this level is crucial to the success of the patient team. Here is where the dietician and therapist will interact with the supplemental figures to coordinate workshops with a dietary and/or therapeutic focus. The gastroenterologist will likely not partake in secondary communication, focusing on the clinical side of the center.
SUPPLEMENTAL
The communication on this level is less focused on specific patient cases and occurs more in relation to general patient education and operational flow between the roof garden and the test kitchens and cafe. The herbalist and gardener will generally work together as a team and will have patient interaction, along with the chef, during educational classes and workshops. The herbalist, however, will be available for personal appointments.
CLINICAL RESEARCH
17
BIOPSYCHOSOCIAL MODEL After completing the infrastructure models I have proposed for the center, I came across a perspective in my research known a biopsychosocial, noted by the American Psychological Association (APA) as a strategy for the psychological treatment of chronic illnesses. My approach is a variation of this strategy to be used as the basis of protocol for each sector in the center. The existence of this model is a firm validation that a collaborative clinic should be designed.
BIOLOGICAL
psychological HEALTH
sociological
The biopsychsocial model, when in practice, stems from psychology and looks at biological and sociological factors through its own lens, defensively treating them from a distance.
GASTROENTEROLOGIST
By creating a similar version of this system that is more integrative, I hope to create greater collaboration and multi-disciplinary input, letting patient teams treat on a proactive level that is less reductionistic and detached.
PATIENT
THERAPIST
DIETICIAN
CLINICAL RESEARCH
19
03
case studies
CASE STUDIES
21
BROOKLYN INFUSION CENTER Memorial Sloan Kettering Cancer Center New York, NY | ZGF Architects OLD TOWN RECOVERY CENTER Portland, OR | SERA Architects UCLA OUTPATIENT SURGERY Los Angeles, CA | Michael W. Folanis Architects NOMA FOODLAB Copenhagen, Denmark | 3XN
BROOKLYN INFUSION CENTER 557 Atlantic Avenue Brooklyn, NY 11217 Memorial Sloan-Kettering Cancer Center (MSKCC)
Firm | ZGF Architects Completed | Oct. 2010 7,745 SQ.FT
An experimental satellite to MSKCC’s Manhattan hospital, the Brooklyn Infusion Center was built as a prototype in which to explore both patient-centered approaches and behind-the-scenes operations for innovative cancer care models. The Center provides close neighborhood care for more than 15% of MSKCC’s chemotherapy-receiving patients who reside in Brooklyn while relieving space at the Manhattan site. Normal 1.5 hour patient waiting time is further cut through a “chemo-ready” approach where blood work and registration is done in advance so that medication can be prepared and transferred between main hospital and satellite before patient arrival. This operational model frees up what would normally be used as a waiting and registration area, allowing the Center to utilize the front as a neighborhood area for community outreach and gallery space for patient stories and local artist exhibitions. The storefront allows the Center to become a greater part of the neighborhood as it blends in with the eclecticism of the area.
CASE STUDIES
23
ZGF Architects looked at the overall space as a public forum, drawing inspiration from the neighborhood parks and stoops in Brooklyn. The central corridor of the Center was designed to be an indoor garden space, offering space for socialization and spontaneous activity between patients. Seating and wall placement provide 4 strategic spaces of partial enclosure, fusing public and private enclave. If patients prefer, there are 12 sizeable treatment rooms, or “pods”, that incorporate interactive systems for on-line social engagement and provide patient control over lighting and room temperature. Wendy Perchick, chief of strategic planning and innovation at MSK, noted that, “So often, people are infantilized by the system that takes care of them, so you give back wherever you can.” Lighting was an important consideration in the overall design as well. LED lights run along the garden area and mix with daylight from the storefront to create a warm and diffused space. The pods are closed off with embossed glass doors, which let in the light while allowing nurses to check on their patients. *Parson’s New School for Design, Chicago’s Institute of Design, and IDEO were consulted on this project
PROPOSAL
1
natural + LED light
communal circulation main circulation
separate ancillary entrance + space
clinic space
solitude
patient entrance
community storefront
interactive corridor
OLD TOWN RECOVERY CENTER 727 West Burnside Street Portland, OR 97209
Firm | SERA Architects Completed | 2011 45,000 SQ.FT
CASE STUDIES
27
The Old Town Recovery Center (OTRC) functions as an extension of the Old Town Clinic, which provides outpatient care for the mentally-ill, homeless and low-income residents of Portland. The facility desired to break away from traditional healthcare design, which often comes across as a bleak, sterile environment.
The result is a fusion between primary care and holistic wellness center. The center is permeated by biophilic design with a central, three-story atrium garden. Though inaccessible, rooms and circulation paths are focused around the space, offering calming views of greenery. SERA Architects stressed that a therapeutic environment is crucial for improved patient outcomes via a reduction in patient stress.
atrium interior circulation
29 CASE STUDIES
Four strategies were implemented in the design: - reduce or eliminate environmental stressors - provide positive distractions - enable social support - give patients a sense of control atrium clinic space
ucla outpatient surgery center Santa Monica, CA
Firm | Michael W.
Folanis Architects
Completed | Feb. 2012 50,000 SQ.FT
curtain wall atrium
CASE STUDIES
31
The center stands as Folonis’ ode to California Modernists,
automated parking garage
buildings that turn daylight into materiality and focus on outdoor/ indoor connection. To draw attention to the outdoors, the architect used a point-fixed curtain wall with spider mullions to create a more delicate suspension system. Perforated metal sunshades are used on the western facade to shield from the harsh afternoon sun. Folonis pushed the prep and recovery areas to the glazed perimeter walls and used clerestory windows to light up sterile corridors. To combat wayfinding, the stairs are centralized in an open atrium to connect all three floors and organize the space.
prep and recovery get western sun exposure; ORs receive indirect light between corridors
- Michael W. Folonis
CASE STUDIES
What it means to me: This is a very scary place. How can I change this experience?
“
“
33
NOMA’s FoodLab originated in a housebout floating above Copenhagen’s waters, where regional ingredients were fused together to create a new Nordic cuisine. A side project of NOMA, voted the best restuarant in the world, chef Red Redzepi moved the lab above his restaurant to act as an “engine of inspiration”. The design is a result of the building’s historic nature, which required that nothing be attached the large pine columns or brick walls. The response was the creation of freestanding installations to serve as shelving and room dividers. Storage units help break up the warehouse floor into smaller areas of dining, kitchen, office, and linen storage that are divided, but still connected.
NOMA FoodLab Copenhagen, Denmark NOMA Restaurant
Firm | 3XN Completed | 2011 2,153 SQ.FT
While FoodLab was to be used initially as a study solely on test kitchen programming, I discovered a link of connected division in the open floor plan to the corridor of Brooklyn’s Infusion Center,
both creating distinction/singularity and collaboration/togetherness simultaneously.
- Chef Red Redzepi
CASE STUDIES
“
“
We are committed to an ethos of cooperation, knowledge sharing, and open-source research, and collaborate with various other local and international projects.
1
TRADITION SCIENCES
NOMA
HUMANITIES
CHEFS HOME COOKS
NOMA
INDUSTRY
pine columns installations circulation
library/dining office kitchen dining
PROPOSAL
1
04
SITE ANALYSIS
SITE
39
SITE MAP HISTORICAL BACKGROUND FLOORPLANS + DIAGRAMS ELEVATIONS + SECTIONS LIGHT STUDIES MATERIALITY
SITE
41
PRIME LOCATION
Situated at the corner of 3rd Street and East Broad, 224 E Broad is an ideal location for an satellite ambulatory facility that can complement and support MCV’s hospital and medical campus, a close 8 blocks away. Public transportation runs along Broad Street with stops almost directly across from the building. A 75-car parking lot and recessed porch offer optimal access for commuters. 224 E Broad VCU MCV medical campus, Gateway Building [Endoscopy suite, floor 4] Interstate !-95 Broad Street
HISTORical background 4|24|1963 1965
Permit #38164 is filed to build an office and parking attendant’s house at 224 E. Broad St. Completed and opened as Virginia Federal Savings & Loan Association At this point the bank was holding over $6.4 million in assets. The president of the bank had a private apartment built on the roof.
1990
Ownership transferred to United Way Services
2004
Dormant
2016
Eligibility for National Register of Historic Places
SITE
43
Architect | Cunneen Co. Interior Designer | Hermann Uhl Style 2nd International, with references to Le Corbusier and Mies van der Rohe
Total Square Footage.......................37,500 gross MEP Core...........................................4,480 Basement*........................................6,820 recessed Porch area.........................5,110 Levels | 4 + basement Parcel Square Footage | 11,930.26 Acreage | 0.274 zoning | B-4 Business (Central Business) occupancy | 262 *The basement offers space for expansion, and is
already designed with offices, safes, and restrooms
total Designable Space............28,374 net floor 1.....................................5,974 net floor 2....................................10,972 net floor 3....................................10,972 net floor 4....................................456 net total program........................28,168 net scheduled to design................19,538 net (with 30% circulation at 8,512 sq.ft.)
completed green roof.............10,320
PROPOSAL
1
224 E Broad 75-car parking lot Broad Street public transportation route
EXTERIOR |
Rear entrance to be used by commuters and all post-operative patients.
PROPOSAL
1
floor 1
VESTIBULE
RECESSED PORCH
UP
UP
ELEVATOR basement - 4 UP
UP
UP
WOMEN’S
Renovation Area
Column Grid
MEP Core
ELEVATOR basement - 3
MEN’S UP
UP
UP
UP
UP
N
Elevator Corridor Exterior Circulation Secondary Entrance
Major Interior Circulation
floor 3
49 SITE
floor 2
UP
DN
DN UP
UP
UP
DN
Major Interior Circulation Area of Change (staircase is extended on floor 3 to provide roof access)
DN
MEP CORE
UP
[Mechanical, Electrical, Plumbling] This core area of the building houses all of the major circulation between floors.
CEILING HEIGHTS
8’ 6” WITH ACT
12’ 0”
17’ 0”
17’ 0”
BASEMENT FLOOR 1-4 [ROOF]
UP
FLOOR 1: LIMITED FLOOR 2-4 [APARTMENT + ROOF]
E
MEP CORE DN
APARTMENT
E
SOUTH ELEVATION
UP
MECHANICAL
DN
FLOOR 4
51 SITE
ROOF ACCESS
DN
UP
UP
*colors used to understand structural patterns
SITE
53
interior|
View of floor 3 after demolition, facing the east facade
PROPOSAL
1
floor 2 daylight study
7AM
7AM East
10AM
10AM East
6PM
12PM
4PM
2PM 12PM East
SITE
57
2PM East
4PM South
2PM South
6PM South
Light pours in from the East facade. Taken between the hours of 12-2PM.
*3rd floor before demolition
*3rd floor after demolition
PROPOSAL
1
East facade, 12PM
South facade, 12PM
Southwest, 12PM
existing materiality
1 2 3 4 5 6
pebble brick
exterior flooring for recessed porch
stainless steel elevators, doors to stairs
brushed steel cladding for exterior walls and columns
carrera marble wall cladding of vestibules, elevator wall accent, column cladding,
walnut casework elevator wall accent, doors and cabinetry throughout
black anodized aluminum framing for glass windows and doors
7 8 9
translucent glass divider wall between some offices
stone flooring on first floor
black slate
exterior wall accent cladding
1
2
3
4
5
6
7
8
9
PROPOSAL
1
interior|
View of elevator lobby on floor 1
PROPOSAL
1
05
PROGRAM
PROGRAM
65
PROGRAM REQUIREMENTS CLINICAL OFFICES PUBLIC
PROGRAM OVERVIEW The proposed spaces at 224 E Broad will be broken into 3 basic categories:
clinical
Due to patient safety issues regarding privacy and sanitation, clinical spaces will be confined to a designated area on the 3rd floor.
offices
Office spaces are located mostly on the 2nd floor to provide separation from the clinical realm, while remaining near to accessible patient areas.
public
The 1st floor and roof are reserved solely for the public spaces which promote community interaction. Areas within the 2nd and 3rd floor are designed more for public use by patients.
clinical, public and office space.
total program........................28,168 net scheduled to design................19,538 net (with 30% circulation at 8,512 sq.ft.)
completed green roof.............10,320
clinical offices public
vestibules informational reception lounges
gastroenterologist registered dietician mental health therapist herbalist
teaching kitchens nutrition lab cafe
medical director asst. medical director clinical manager financial counselor kitchenette staff conference rooms treatment team rooms research lounge
nutrition library classrooms group therapy rooms green roof with vegetable and herb gardens, spaces for reflection, group therapy and classes, one-on-one sessions and public gathering
67 PROGRAM
non-clinical restrooms can be found in public program
public
exam rooms pre/post OP area procedure rooms radiography/fluoroscopy patient restrooms staff restrooms kitchenette | break area locker rooms nurse stations registration, in | out waiting lounge soiled utility clean utility PYXIS areas nurse alcoves | enclaves IT room wheelchair storage stat lab hot lab
offices
clinical
*housekeeping areas to be included on each floor (can be found in clinical program)
clinical
ROOM
exams room
QTY. 10
SQ. FT. 120
PROXEMICS patient restroom, PYXIS, stat lab
FF+E / EQUIPMENT cabinet/counter space with clinical sink, exam table, 2 chairs and/or bench, 1 stool, meeting desk with flat screen, mobile lamp, lightbox, duplex receptacles for general and biohazardous waste, dispensers mobile procedure gurney, handwashing station, storage, linen storage, dictation desk, patient lockers
pre|post op
6
80
procedure room, nurse station, patient restroom
procedure room
3
200
pre/post OP, nurse station
mobile procedure gurney, medical gas station, countertop pyxis machine with locked drawers, ultrasonic sink, communications system
radiography/ fluoroscopy
1
300
toilet, hot lab
radiation control booth with counter and seating, communications system, radiographic machine, add 2 3’x4’ dressing room areas with hooks, bench, mirror, gown and personal effects storage, lockers
patient restroom
4
50
staff restroom
2
50
kitchenette|break staff locker room nurse station
regisration, in| out
1
150
1
200
2
300
1
300
sq. footage to design
2050
total sq. footage
4130
(1) - exam rooms, (1) - pre/post OP and procedure room area, (1) - lab room/registration with pass-through for specimens, (1) - radiographic/fluoroscopy (R/F) room situated near both nurse’s stations, kitchenette/break room nurse station, kitchenette/break room, staff locker room nurse station, restroom kitchenette/break room (1)- pre/post OP, procedure rooms (1)- kitchenette, exam rooms waiting lounge, stat lab, restroom
cabinet/counter space with regular sink, microwave, coffee/tea maker, refrigerator, small tables that can be grouped together for meetings, armless chairs personal lockers with lock, full-length mirror, bench, split M/F mobile, armless task chairs, computers, areas with 6’ counter for patient intake, clinical sink, small refrigerator mobile, armless task chairs, privacy partitions, small area with print/fax
exams room
pre|post op
procedure room
natural adjustable artificial between high and low, low/no natural 2x4 fluorescents and indirect perimeter
PRIVACY PLUMBING PUBLIC ACCESS CONSIDERATIONS high
Y
N
highmedium
Y
N
3’ 6” clearance at sides and front of exam table, meet Phase II Recovery standards, 4 ft clearance at sides and front of gurney
high
monolithic floor Y
N
overhead fluroescents and indirect perimeter lighting
high
N
N
patient restroom
artificial
high
Y
low
staff restroom
artificial
high
Y
N
natural
low
Y
N
artificial
high
N
N
radiography/ fluoroscopy
kitchenette|break staff locker room nurse station
registration, in | out
69
2’ 8” clearance at sides and front of exam table, door swing direction, window frosting, wall space for dispensers, accomodate 27”x34” ultrasound
10’ ceiling, 7’ high lead glass viewing window, 83”H x 44”W door frame, control area on right side, 6’ private alcove outside for reading and dictating results floor-mounted toilet, ADA floor-mounted toilet, ADA
lockable door communications system,
(1) - indirect natural, (1) - artificial with no/low natural
low
natural or diffused
high between stations
PROGRAM
LIGHT
Y
N
N
N, except high access to counter
out area to be on clinic side, place waiting area chairs far enough back, 30-34” countertop
clinical
ROOM
waiting lounge
soiled utility
QTY. 1
1
SQ. FT. 500
100
PROXEMICS
FF+E / EQUIPMENT
registration, restroom, stat lab
mix of mobile and soft seating, coffee and side tables, lamps, flat screens, area for exam waiting and stat lab waiting, children’s area, literature storage
clean utility, procedure rooms, stat lab
air and suction tubes, countertop, scrub sink, auto reprocessor machine (possible attachment to clean utility room air and suction tubes, countertop, scrub sink, autoclave machine, tall drying cabinet
soiled utility, procedure rooms
clean utility
1
100
nurse alcove
4
30
dispersed
it room
1
200
NA
wheelchair storage
1
50
pre/post-op, clinic exit
NA
restroom, registration, soiled utility
counter for computer, clerical functions, test tube racks, specimen containers and centrifuge; full refrigerator and freezer, printer, clinical sink, 2 phlebotomy rooms with pneumatic blood-draw chair, glove dispenser, storage
stat lab
pyxis | supply closet hot lab housekeeping
1
2 1 4
sq. footage to design 1650 total sq. footage 1810
400
vary between soft seating, counters at seat and counter height, communications system, computer PAC system, servers, small workstation with task chair
(1) - pre/post OP, nurse’s station (1) - large pyxis machine (1) - countertop pyxis (1) - central to exam rooms machine, both with locked and unlocked drawers, storage and counter space clinical sink, lead-lined undercounter fridge, radioR/F procedure room 50 active workbench with steel counter, wipe test counter, radioisotope calibrator, storage space 30/100 central, 1 per floor (2 in clinic); storage shelving, mop sink one of clinic rooms to be next to procedure room and at 100sq ft 50
waiting lounge
high
PRIVACY low
PLUMBING PUBLIC ACCESS CONSIDERATIONS N
Y
tech access, adequate outlets, children’s corner away from door swings
71
monolithic floor
soiled utility
low/diffused/none
low
Y
N
clean utility
low/diffused/none
low
Y
N
nurse alcove
NA
medium
Y/N
low
low
N
N
NA
low
N
NA
high accessibility
none - medium
high
Y
low
monolithic floor, 34” counter height, accessioning area within lab or attached to end of registration, A/C control
pyxis | supply closet
artificial
low
Y
N
locked door, consider double entry from two corridors
hot lab
artificial
low
Y
N
34” counters, place away from traffic,
housekeeping
artificial
low
Y
N
(1) - placed near procedure rooms
it room wheelchair storage stat lab
artificial
monolithic floor general servers vs. EMR and radiologic data storage locked door, anti-static flooring, interior walls
PROGRAM
LIGHT
offices
ROOM
QTY.
SQ. FT.
PROXEMICS
gastroenterologist
9
150
registered dietician
9
150
therapist
10
200
herbalist
2
150
gardener
1
120
medical director
1
120
asst. medical director, clinic
desk, filing cabinet, 3 seats
asst medical director
1
96
medical director
desk, filing cabinet, 2 seat
clinical manager
1
120
central to clinic
desk, filing cabinet, 2 seats
financial consultant
1
120
registration in/out
desk, filing cabinet, 3 seats
radiologist
1
150
gastroenterologists, dieticians
kitchenette LOUNGE
1
200
central to offices
research lounge
1
300
offices, team rooms
staff conference
1
300
offices
treatment team room
5
150
offices, research lounge
sq. footage to design
2176
total sq. footage
7276
dieticians, therapists, treatment team rooms gastroenterologists, therapists, treatment team rooms gastroenterologists, dieticians, treatment team rooms gardener, green roof herbalist, green roof
FF+E lightbox, desk, filing cabinet, flat screen, 3 seats and/ or bench lightbox, desk, filing cabinet, flat screen, 3 seats and/ or bench desk, filing cabinet, flat screen, 4 seats and/or bench desk, filing cabinet, 3 seats, shelving, counter space desk, filing cabinet, 2 seats, shelving, counter space
lightbox, desk, filing cabinet, flat screen, 3 seats and/ or bench cabinet/counter space with regular sink, microwave, coffee/tea maker, refrigerator, small tables that can be grouped together for meetings, armless chairs computer desks, task chairs, bookcases, soft seating, coffee table, side tables, task lamps conference desk or small, groupable tables, seating for 10-15+, projection, writeable surfaces circular meeting desk, 3-5 task/mobile seating, flat-screen with hook-up
PRIVACY PLUMBING PUBLIC ACCESS CONSIDERATIONS
gastroenterologist necessary
natural, diffused if
high
N
N
registered dietician necessary
natural, diffused if
high
N
N
therapist
natural
high
N
N
herbalist
natural
high
N
N
gardener
natural
high
N
N
high
N
N
high
N
N
N
N
medical director natural not required asst medical director
indirect natural
clinical manager natural not required natural, diffused if
high
financial consultant necessary
high
N
N
radiologist necessary
high
N
N
natural, diffused if
kitchenette LOUNGE
natural
research lounge
natural
staff conference treatment team room
natural, but not required natural, but not required
dining and lounging, soft illumination low
Y
high
N
high
N
N
high
N
low
73 PROGRAM
LIGHT
N create as a relaxing space N consider accessiblity from clinic
public
ROOM
QTY.
SQ. FT.
vestibule
2
80
informational reception
1
100
gathering area, vestibules
lounge
2
300
library, classrooms
teaching kitchen
2
1,000
nutrition lab, cafe
nutrition lab
1
500
teaching kitchens, cafe
cafe
1
600
reception, gathering area
nutrition library
1
300
offices, lounge, classrooms
classroom
2
500
lounge, library
2
300
offices, classrooms, lounge
Men’s restroomS
2
140
Women’s RESRTOOMS
2
150
group therapy room
sq. footage to design 5,150 total sq. footage 6,440
PROXEMICS exits
centrally placed in non-clinic areas, 1 per floor centrally placed in non-clinic areas, 1 per floor
FF+E wheelchair alcove, grip flooring and/or walk-off mats reception desk, 1-2 task chairs, computers, print/fax, bold graphic information, mix of mobile and soft seating, coffee and side tables, lamps, flat screens adequate counter space, hoods, stove-tops and wall ovens, full refrigerator and freezer (quantity of each TBA), store-away bar seating, shelving and storage, handwash sink, dishwasher, trash area, same as teaching kitchen - smaller scale, counter space for chemical evaluation, computers seating and tables for roughly 40 people, register area, display cases, drink stations (self and barista), trash computer desks, task chairs, bookcases, soft seating, coffee table, side tables, task lamps computer desks, task chairs, bookcases, soft seating, coffee table, side tables, task lamps counter area for refreshments
2 toilets, 2 urinals 4 toilets
LIGHT
PRIVACY
PLUMBING PUBLIC ACCESS CONSIDERATIONS
75
natural
N
N
Y
informational reception
natural
N
N
Y
lounge
natural
N
N
Y
teaching kitchen
natural, diffused if necessary
N
Y
medium
nutrition lab
natural, diffused if necessary
N
Y
low-medium
natural
N
Y
Y
immediate connection to kitchen, consider pass-through area, how to show menu
N
Y
create as a relaxing space
N
N
Y
option to close off light if room has access, acoustics for projection
high
Y
Y
high
Y
Y
Y
Y
cafe nutrition library classroom group therapy room
PUBLIC restroomS PRIVATE RESTROOMS
natural natural, not necessary natural, diffused if necessary
artificial artificial
low, quiet
high
1 for allergies/gluten-free, consider hood design and firewall protection, monolithic floor, stainless steel
PROGRAM
vestibule
monolithic floor, stainless steel
07
GREEN ROOF DESIGN
LE CORBUSIER’S 5 POINTS OF ARCHITECTURE
LE CORBUSIER’S VILLA SAVOYE
PROPOSAL
1. Freestanding support pillars 2. Open floor plan independent from the supports 3. Vertical facade that is free from the supports 4. Long horizontal sliding windows* 5. Roof gardens
77
*not found at 224 E Broad
The role of the center’s roof has been discussed as a transformation into a refreshing outside area for therapy, relaxation, urban agriculture, and the public. The vegetation is mostly comprised of vegetables and herbs used in activites on other floors, especially those deemed beneficial for phytotherapy. That and obvious operational/energy cost benefits aside, a green roof is particularly fitting at this location from a theoretical design perspective.
COLUMN TREE
The influence of Mies van der Rohe and Le Corbusier is evident in the structure, particularly elements of the Villa Savoye; thus a green roof acts as a sort of tribute and addition to the architectural ideals already in place at the site.
A peripheral walking path follows the structure’s boundaries, while central paths create a symmetrical connectivity between core and center. AREA TO BE COMPLETED IN PHASE II
The core is flanked by 4 trees that act as a natural continuation or translation of the concrete columns underneath.
herbalist office gardener office greenhouse
The material palette includes concrete, stone, oxidized steel, wood, and patinated copper.
SEATING GATHERING AREA
GROUP LOUNGE
Reveals in stone pavers follow this grid pattern, based off column/window placement
LAWN Circulation Paths
A
DN DN
n SEATING
DN DN
1 PROPOSAL
Green roof plants that aid in digestion or alleviate some symptoms:
Ginger
Peppermint
Thyme Tarragon
SECTION A
“Space and light and order. Those are the things that men need just as much as they need bread...” LE CORBUSIER
sources & CREDITS BookS Kliment, Stevens A. (2000). Healthcare Facilities. New York, NY: John Wiley & Sons. Malkin, Jane. (2002). Medical and Dental Space Planning. New York, NY: John Wiley & Sons. Marberry, Sara O. (1997) Healthcare Design. New York, NY: John Wiley & Sons. Lee, T. H., & Mongan J. J. (2009). Chaos and Organization in Health Care. Cambridge, MA: The MIT Press.
magazines & periodicals Becker, F., Parsons, K., & Sweeney, B. (2008). Ambulatory Facility Design and Patients’ Perceptions of Healthcare Quality. Health Environments Research & Design Journal (1.4) Bell, M., & Spohn, J. (2010). An Urban Clinic – Connecting with Community. Contract Magazine Online: Designing for Health. Retrieved from http://www.contractdesign.com/contract/design/Designing-forHealth-1573.shtml Foges, Chris (2012). Recipe for Success. Architectural Record. Retrieved from http://archrecord.construction.com/projects/ recordinteriors/2012/noma-foodlab-gxn.asp Kim, Sheila (2012). Old Town Recovery Center. Contract Magazine Online. Retrieved from http://www.contractdesign.com/ contract/design/features/Old-Town-Recovery-Ce-7863.shtml# Raskin, Laura (2012). Light Touch. Architectural Record. Retrieved from http://archrecord.construction.com/projects/Building_types_study/healthcare/2012/ucla-outpatient-surgery-oncology-ctr-michael-folonis.asp Syrkett, Asad (2012). Healing Close to Home. Architectural Record. Retrieved from http://archrecord.construction.com/projects/building_types_study/healthcare/2012/Memorial-Sloan-Kettering-Cancer-Center-ZGF-Architects.asp
presentations Easter, J. (2011). Design for Improving the Healing Process. [Presentation]. Paper presented at the 7th Design & Health World Congress & Exhibition. Boston, MA. Evanson, S. (2008) Design Thinking for Innovative Healthcare Service. [Presentation]. Paper presented at the Annual AHRQ Conference. Bethesda, MD.
manufacturer research articles Guido-Clark, Laura. (2011). Color and Healing: The Power of Color in the Healthcare Environment. Retrieved from KI Healthcare website http://www.kihealthcare.com/design.aspx Herman Miller. (2010) Coordinating Care in an Age of Chronic Illness. Retrieved from Herman Miller Research website http://www.hermanmiller.com/research/topics/all-topics.html Herman Miller. (2011) Designing for Change: Ambulatory Care Facilities on the Move. Retrieved from Herman Miller Research website http://www.hermanmiller.com/research/topics/all-topics.html Herman Miller. (2009) Furniture Standards for Healthcare Facilities. Retrieved from Herman Miller Research website http://www.hermanmiller.com/research/topics/all-topics.html Herman Miller. (2008) Lean Healthcare. Retrieved from Herman Miller Research website http://www.hermanmiller.com/research/topics/all-topics.html Herman Miller. (2010) Measuring How Far Nurses Walk: A Step in the Right Direction. Retrieved from Herman Miller Research website http://www.hermanmiller.com/research/topics/all-topics.html Parameswaran, L., & Raijmakers, J. (2010). People-focused Innovation in Healthcare. Retrieved from Philips Design website http://www.design.philips.com/philips/shared/assets/design_assets/pdf/nvbD/ july2010/people_focused_innovation_in_healthcare.pdf
other Richmond Parcel Mapper. Retrieved from http://map.richmondgov.com/Parcel/
PHOTOGRAPHY CREDITS Front cover: Tyler King 1. http://fitnesshealthpros.com/wp-content/uploads/2012/11/How-to-get-rid-of-stomach-pain.jpg 2. http://www.wiu.edu 3. http://www.storiesof.us 4. http://thisisphil.files.wordpress.com/2008/10/img_1724.jpg 5. http://law.marquette.edu/facultyblog/wp-content/uploads/2011/04/PatientComplaintHandlingSoftware.jpg 6. http://www.aaf-eu.org/wp-content/uploads/2012/09/pharmaceuticals.jpeg 7. http://www.asahq.org 8. http://www.carlsberggroup.com 9. http://www.archrecord.com 10. http://www.archrecord.com 11. http://www.archrecord.com 12. http://www.archrecord.com 13. http://www.architypereview.com 14. http://www.archrecord.com 15. http://www.archrecord.com 15. http://www.archrecord.com 16. http://www.djcoregon.com
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37. Tyler King
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40. Tyler King
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Back cover: Tyler King
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*All other imaged not credited were self-taken or created