PROJECT NAME / Melinda French Gates Ambulatory Care Building LOCATION / Seattle OWNER / Children’s Hospital and Regional Medical Center TOTAL FLOOR AREA / 168,000 square feet of new construction; 80,000 square feet of renovation for adjoining hospital area NUMBER OF FLOORS / Five (levels three through seven) NUMBER OF EXAM ROOMS / 105 CONSTRUCTION COST / $72 million (new construction and renovation) GROUNDBREAKING / March 2004 OPENING / March 2006 (renovation of adjoining hospital area scheduled for August 2007 completion)

Artist Bryn Barnard spent three months painting “Sound Garden” for the Melinda French Gates Ambulatory Care Building at Children’s Hospital and Regional Medical Center in Seattle. The mural, which stretches 120-feet long and 20 feet at its highest point, shows underwater life native to Puget Sound. It is one of several pieces by Northwest artists at the facility, which opened last March.

Working in an unused space in a high school industrial arts building near his home on San Juan Island, Wash., Barnard used brushes as small as a tiny size 00 to paint antennae and other minute features on the vast canvas. The details are at child height so kids can enjoy the mural up close, making new discoveries each time they see it. He also included several much larger images, to be enjoyed from a distance.

As the mural is meant to complement noted Native American artist Marvin Oliver’s “Mystical Journey,” a 6-ton steel and glass sculpture of a mother and baby whale that hangs as the centerpiece to the ambulatory care center’s atrium, Barnard decided not to use a whale as the focal point of his mural—but a giant Pacific octopus, with its lively, swooping tentacles, seemed perfect. “An octopus is really fun because you can do all these beautiful curves, and it’s a really malleable form,” he says. 

The hospital received his initial sketch with enthusiasm, but one concern. Before he could set to work, his design had to pass muster with some of the most important members of the project’s planning team—children who use the building. “It’s got to be OK for the kids. We don’t want it to be scary,” says Ruth Benfield, FACHE, the hospital’s vice president for facilities development and psycho-social services.

The project’s art coordinator, Deborah Paine, enlarged the sketch to 6 feet long and asked children in the hospital’s day care center what they thought of it. “Well, they named the octopus Candy,” says Benfield, laughing. “So we were pretty sure it wasn’t going to be scary.”

The kids similarly previewed a model of Oliver’s work, to ensure the size of the whale sculpture would not be overwhelming. Having children vet the building’s major artworks is just one example of the care taken to ensure the facility, designed and built by Dallas-based architecture firm HKS Inc. and Sellen Construction Co. of Seattle, would embody the watchwords of evidence-based design, as a true family-centered, patient-focused environment.

Consolidation

Concern for families was a guiding principal of the project, which was done to consolidate hospital clinics. In 50 years of growth at the institution, clinics had been spread across campus, Benfield says. “They weren’t adjacent to the lab or radiology—many of the services you’ll need to use as a clinic patient.”

Over 60 percent of the children treated at the hospital have chronic illnesses, requiring visits to several different specialists. “With all the paraphernalia that comes with kids, let alone handicapped kids,” says Benfield, it was difficult for parents, patients and siblings to “truck down two blocks to get their radiology exam and then truck back two blocks to get their clinic visit.” The hospital wanted to create a single center for families to come to in order to see the disciplines they needed.

The clinics were grouped in one building not only to make doctor’s appointments easier for families to manage, but to make appointments easier to get in the first place. Consolidating the clinics makes the center more efficient, addressing a shortage of pediatric subspecialists. “We wanted to make sure our faculty attending physicians and other providers were able to see as many children as possible in a compact time, to help us with what’s really a significant access problem,” Benfield says.

Prior to the new building’s construction, patients could wait up to three months for a nonemergency appointment, says Jeff Stouffer, AIA, principal and senior vice president of HKS. He says the wait time has been reduced by two-thirds since the ambulatory care building opened, and that hospital personnel believe the new facility can help them lower it to one week.

The new design is also more convenient for those who work there. Stouffer says physicians have remarked that it is easier to consult with clinicians who are down the hall rather than across campus. Doctors and staff whose clinics had outgrown their existing locations have also benefited from the space afforded them in the new building.

Central location

Although the hospital operates several outlying clinics, it was important that the specialists who work at the ambulatory care center remain at a central campus location.

Due to the complexity of the cases at the hospital, it could not afford to duplicate services at each satellite clinic. For example, the craniofacial program includes doctors from 47 different disciplines. Patients may have a CAT scan and see a speech pathologist, pediatrician, otolaryngologist and plastic surgeon all in one day. “You simply can’t deliver that kind of care in multiple sites,” says Benfield.

Grouping specialists near the hospital enables surgeons with unique expertise to move quickly from the clinic to the operating room. Therefore, the project team decided to build the ambulatory care building adjacent to the existing hospital.

A parking garage was built on-site, then two wings of the hospital were demolished to clear space for the ambulatory care building. Physicians and staff with offices in those wings were relocated to temporary, modular buildings for the duration of construction (see sidebar Project Saves Time...).

During construction, the parking garage served as a convenient location for crews to build extensive mock-ups of exam rooms and the building’s newly designed circular, centralized registration area, called the “pinwheel.” This gave staff the opportunity to comment on the design of the pinwheel and practice and refine workflow procedures for maximum efficiency.

Ultimate flexibility

The building’s clinical areas were designed for ultimate flexibility and collaboration.  Clinics that meet five days a week or have specialized equipment needs have dedicated spaces. The remaining clinics meet in a multispecialty clinic space that changes daily. “One day the craniofacial group may take 25 exam rooms, but the next day there could be a much smaller clinical group, like neurology, and they may need only five or 10,” says Stouffer. “Even the signage out in the waiting room changes.”

Exam rooms are 110 square feet each, with room for families, strollers and wheelchairs. A cushioned bench in each exam room provides space for children and parents to sit together.

The design of the exam room, and many other parts of the building, was based on input from families of clinic patients. A Family Advisory Council meets regularly at the hospital. The council was an integral part of the design team, says Stouffer.

Design features requested by parents include quick access to the outdoors, which is provided by the accessible garden situated next to the clinics. Large exterior windows with views of the outside world were included to help patients and families feel a sense of normalcy. A play area was built into the facility to keep siblings busy and entertained. Waiting areas also provide a variety of activities, such as a stage, a reading area and built-in toddler toys. The building has a separate waiting area, where food and drink are not allowed, for children undergoing procedures that require fasting.

Building an outpatient pharmacy next to the ambulatory care exit was another idea that originated from parents. Previously, the hospital had one pharmacy, which Benfield describes as being located “in the bowels of the inpatient facility.” Not only did parents have to be pretty savvy to find it, but inpatient activity took precedence over outpatient needs. The separate outpatient pharmacy is more convenient for ambulatory patients and families.

Aiding navigation

The ambulatory care building ties into the existing hospital, which is currently being renovated, and the new parking garage. Each of the three floors of the parking garage connects directly to a floor of the ambulatory care building, so parents and kids can walk straight into that building from any level of the garage. There is an information desk located in the same place on every floor of the new building. From there, families can be directed to the appropriate floor for their appointment. The clinic floors are visible across the ambulatory care building’s three-story atrium, further simplifying wayfinding, which was a major design concern for the project due to a steeply sloped site.

“On one side of campus you’re at a ground entrance on the sixth floor, and on the other side of campus you’re at a ground entrance on the first floor,” Benfield says. “It can be very confusing.”

To help families navigate the campus, the hospital has themes for each of the facility’s entrances and public elevator cores. The ambulatory care building’s parking garage and main entrance, as well as the elevators that lead from the hospital building to the ambulatory care building, are whale-themed. The large whale sculpture in the building’s atrium underscores the theme. “Even if the parents forget, the kids don’t,” Benfield says.

This theme is expanded upon throughout the ambulatory care building. Each of the clinic hallways ends with a wall-sized picture of a sea animal, by photographer Jon Gross. Coordinating medallions are included in the hallway flooring. Different colors of neon cove lighting also distinguish the hallways. Such details help adults and kids find their way around.

The building contains several other sea-themed artworks designed to distract, amuse and soothe children and parents. Besides Barnard’s mural, which includes sand-carved glass panels with undersea imagery by Irene D’Aloisio, the facility features porthole-shaped paintings by Kelly Stanton and a mural by Susan Point illustrating the “Circle of Life.” Custom art-glass sconces by Tray Cool Glass of Ramah, NM, and lighting fixtures by James Nowak, which resemble fanciful sea creatures, help add to the theme.

The facility’s poured terrazzo flooring is even inlaid with images of underwater plants and animals. The inlaid designs create pathways to various locations within the building, such as the information desk, registration and elevators. “We’ve seen kids jumping from starfish to starfish,” says Stouffer.

About wearability

The poured terrazzo flooring was chosen for its long-term wearability, as well as its decorative qualities. The continuous surface also creates a smoother and quieter ride for strollers and wheelchairs. “They have quite a bit of porcelain tile in the other parts of the hospital, so we proposed poured terrazzo. The long-term costs are much better,” Stouffer says.

Wearability was an important issue in choosing materials, finishes and furnishings for the building, given the pediatric patient population.  The walls of high-traffic areas are tiled with porcelain and have custom-designed crash rails made of a combination of wood and Corian, and the outside corners of walls are protected by acrylic coverings. Children can run their hands along the carved glass sections of the “Sound Garden” mural without hurting themselves or the art because the surface of the carving has been smoothed and polished to remove sharp edges and the glass is sandwiched to a tempered backing layer.

The facility’s murals are painted on canvas and applied like wallpaper, so they can be removed if necessary to move or repair a wall. Precast concrete and metal panels on the building’s exterior harmonize with the painted plaster and stucco of the existing structure but require far less maintenance, even in Seattle’s rainy climate.

Commitment to care

Seattle architect Rich Murakami is chair of the Family Advisory Council.

He stresses the importance of the physical environment in calming the anxiety surrounding clinic visits. “It’s not just a normal visit to the pediatrician; you’re dealing with some special condition,” Murakami adds.

He also says he appreciates the hospital for going to the effort of consulting parents in the design of the new building. “I’m thankful that they’re really committed to family-centered care.” 

Amy Eagle is a freelance writer who is based in Homewood, Ill. She is a regular contributor to Health Facilities Management magazine.

This article first appeared in the May 2007 issue of HFM.

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