Friday
April 16, 2004
The Ambulatory Health Care Center at Davis-Monthan Air Force Base near Tucson, Ariz., fits into the military base it serves and the desert geography it occupies.
The single-story building seemingly grows out of the earth, with its standing-seam metal roof gradually sloping upward. The facility features a dramatic multifaceted roofline that allows daylight to penetrate deep into patient-care and office areas.
The one-story building sweeps horizontally, which provides design advantages but also creates some challenges.
To break up the design and make the health facility's exterior more approachable, the architect wanted to remove the possibility of monotony. So, light is used to modulate the mass of the building, and exterior massing and layers provide a constant shifting of shade and shadow. Skylights, courtyards, sunscreens and structural elements bring scale and rhythm to the large, repetitive floor plan.
The facility's design has been lauded by architects and the military. It was recognized by the American Institute of Architects' Orange County, Calif., chapter in 2003 for its outstanding design and won a U.S. Air Force Citation Award in 2000 for design excellence.
Part of this "design excellence" stems from the center's innovative floor plan, which features four identical pods, one of which is dedicated to flight medicine.
With nearly 113,000 patient visits annually, the facility needed operational flexibility. When one pod is overbooked, exam rooms in other pods can quickly be used.
The design also has a functional logic for the way physicians and staff move and work within the facility.
Professional offices are separated from patient areas by a long corridor running lengthwise. This arrangement allows the medical staff to move to any pod without going through waiting rooms. "Staff offices are in a room with partitions so that we can interact," notes Captain Francisco Trejo, a physician's assistant at the facility. "This fosters learning and promotes collaboration. We have a place to discuss some of the difficult cases and ask questions. That promotes good quality care."
Another advantage of the design is the inclusion of mechanical/electrical rooms in each module, so any of the four pods can be shut down as needed--when, for example, a significant number of troops are shipped out. Shutdown of a pod saves both energy and money.
The facility design also allows for new construction without disturbance to the existing facility. Additional modules can be added as needed, expanding the center's ability to serve patients, but also preserving the design by repeating the pattern.
Each of the pods is identified by a jutting entryway set at an angle. The outdoor walking path is punctuated by rows of 4-foot-high columns that reduce the scale of the building.
The demanding desert environment was a primary influence on the building's design: Sun control and energy conservation in the Arizona desert are indispensable, as summertime temperatures can reach 120 degrees Fahrenheit.
The building is sheltered from the southern sun by deep overhangs, and there are only a few windows on the west. Windows on both the east and west sides feature vertical perforated metal louvers that control low sun angles.
Comfort was also a consideration in designing the exterior. Sheltered courtyards for patient waiting and staff functions have been formed along the south edge of the building with bermed earth that slopes up to meet the roofline. A courtyard on the north side provides a sheltered entrance.
The facility's clerestory windows and skylight shafts filter and soften the intense desert light before it penetrates deep into the interior. This is not only efficient, but those who use the facility find the floods of natural light emotionally satisfying.
Within the facility, warm, natural colors and materials enhance the effects of the natural lighting. "It's almost celestial," says Trejo.
The facility houses teams of family practice, pediatric and gynecological health providers. Consequently, multimedia interaction cubicles feature self-check-in, self-assessment, history reviews and updates, educational inquires and self-screening.
The primary-care wellness pods replace the typical 90-square-foot exam rooms with a 130-square-foot interaction station that accommodates medical examinations, blood draw, family counseling, mental health counseling, multimedia education and telemedicine. This prevents patients from having to travel for these functions.
Those who use the facility daily point out numerous design features--both practical and aesthetic--that have worked well to enhance patient comfort and provide a level of efficiency strikingly different from the sterile environments often associated with health care facilities.
"Many patients have commented on how impressed they are with the center," Trejo says.
He attributes this view partly to the outpatient health center's open design and the positive effects of sunlight. In addition, the design is conducive to a good experience because patients "flow in through the front entrance to a large waiting area, and they move through the entire process in an efficient semicircular fashion."
The center's design also simplifies wayfinding. The building is very readable, allowing people to easily find their destinations. Signage that reinforces this ease of navigation features blue, copper and silver color-coded guides to facility destinations.
Patients can sit and relax in a friendly atmosphere while they wait for their appointments, notes Senior Airman Julie Morris, an administrative health service manager. "It feels very homey. The furniture is comfortable, and it looks like a place you would go in the civilian world." Even check-in areas are private, she says. All rooms are centrally located, so patients don't have to walk far to exam rooms.
And more importantly, says Morris, the center fosters the idea that patients are getting first-class care.
Donald W. Caskey is a senior vice president in the facilities division of Carter & Burgess, Costa Mesa, Calif.
Name: Davis-Monthan Air Force Base Ambulatory Health Care Center
Location: Tucson, Ariz.
Owner: U.S. Air Force
Type: New construction
Architect: Carter & Burgess
Landscape architect: Wheat Scharf
General contractor: Valenzuela Engineering
Interior design: Carter & Burgess
Construction cost: $10 million
Size: 42,000 square feet
Materials: Steel frame, sand-blasted concrete blocks, metal roof, glass
Start date: January 2000
Completion date: October 2002