By Amy Carter and Susan Sakiyabu
As we saw hospitals fill with critical patients throughout the pandemic, this fueled the growing demand for ambulatory surgery centers (ASC), which have become an integral part of the rapidly evolving health system. With people seeking care in countless places and many rethinking where to receive services, healthcare providers need to be accessible and holistic to attract and retain patients. Leveraging spaces that historically have been retail or office provides an opportunity to expand services offered and reach where patients are pursuing outpatient care. To convert vacant or underutilized properties into facilities that support a positive and efficient experience for both patients and staff, here are five strategies to consider:
1. Plan for growth accordingly.
Utilizing an existing retail or office space provides the added benefit of leasing the right required square feet for immediate needs (with potential to expand the area in the future) or taking on a larger lease with plans to fit out later. Be sure to evaluate both options. How will you grow? Will there be a need for additional operating rooms? Will there need to be a clinic to support the surgical program? Think about the progression of growth and infrastructure needed to support an ASC to avoid being restricted in a plan. In working with United Urology Group, Gensler designed a single operating room clinic in Superior, Colorado, with a plan to add a second operating room beside it in the future. After finding that the proforma for the area supported a second operating room straightaway and confirming this with state regulations, the team strategically incorporated the future operating room into the permit documents. With future growth accounted for in the design, the impact to the documentation schedule was minimal.
2. Right size operating rooms and pre-/post-bays.
More types of procedures are being done in an outpatient setting when hospitals are overstretched. Even if these procedures are not being performed at your facility today, consider designing for orthopedics, robotics, lasers, and imaging equipment that may be necessary in the near future since these services require more space to operate safely and efficiently. When it comes to the determining the operating room size, FGI guidelines can be re-written several times, but in all versions, the area and dimensions given are just a minimum. All instruments stored in the operating room will need a “home,” so the sterile field around the patient table remains clear.
3. Conduct due diligence for site selection.
Not all buildings are suitable to house a licensed ASC, so determine the state health departments and the client’s licensure requirements upfront. Alternatively, the right building maybe found in surprising places! For Chesapeake Urology, Gensler successfully converted an old Rite Aid into a standalone surgery center in Salisbury, Maryland. When selecting a site, consider evaluating key structural details, such as:
- Column bays. Test fit your largest spaces, such as operating rooms, first. If you cannot find at least a 20’ by 20’ clear area for the number of operating rooms the program calls for, the building may be a non-starter.
- Ceiling height. In addition to determining the amount of plenum space available, the need for booms or equipment in the operating room will also indicate what clear space is required. Be sure to do the math early on. For example, if the ceiling space is tight, a pre-fabricated distribution system may be a useful space saving tool versus individual lights and ductwork in the operating room.
- Roof space. For fresh air considerations, an air handling unit serving an operation room must be adequately separated from any exhaust source.
- Elevator. This must be sized appropriately for a stretcher.
- Stair. If designing within a building not suited for healthcare, consider a ground floor location with a proper area to install mechanical equipment to provide air into the space. Additionally, ensure a ground floor lobby can accommodate bariatric wheelchairs.
4. Prioritize care team spaces.
The staff experience is equally as important as the patients, so the facility must instill confidence in safety and wellbeing. Think through the right-sizing of pre- and post-care stations for the duration of the procedures to be performed. Having the right number of bays will ensure a convenient journey that supports collaboration and easily brings services to the patient. Understanding the impact of key metrics on operating room efficiency is important to optimize utilization and reduce costs, particularly in freestanding ASC.
5. Plan for patient and family amenities.
Many patients and their families prefer to stay out of the hospital, if possible, which is why outpatient surgery facilities are becoming so popular. Consider the amenities already located within the retail site (i.e., is there a shopping plaza or café within walking distance or attached to the building), which will help determine what type of amenities are required for families in the waiting room. As we found in our Outpatient Healthcare Experience Index, the patient’s first impression of the facility’s exterior and check-in process are all part of the arrival experience, so be mindful of how close parking is and if a dedicated area needs to be negotiated with the landlord to create an easy drop-off and pick-up area. For a better overall patient experience, create a separate entrance for stretcher bound patients.
With the right planning, retail and office spaces can be successfully converted into healthcare facilities and surgery centers. As either a strategy for private specialized practices, or as part of the hub-and-spoke model for a health system, looking to retail centers or office buildings can bring healthcare closer to the population it serves.
Amy Carter is a healthcare planner at Gensler focused on improving patient, family, and caregiver experiences in healthcare delivery. With a master’s degree in Healthcare Interior Design her in-depth knowledge of healthcare design, strategy, and planning she creates spaces that are innovative, effective, and compliant.
A design manager at Gensler, Susan has nearly 20 years of experience in architecture and design across diverse project types and scales, including academic, laboratory, residential towers, and clinical healthcare facilities. Having recently designed a LEED Platinum 350-bed hospital in San Diego, she continues to grow her healthcare design reach by working on projects within large-scale several heath systems across both the east and west coasts.