Buildings in Conversation with the City

Four Opportunities for Commercial Offices to Build Connection Among Tenants and the Community

July 9, 2020

Principal, ESI Design, an NBBJ Studio

Editor’s Note: This post was co-authored by Emily Webster, Chris Niederer and Tim Johnson.

 

“Cities have the capability of providing something for everybody, only because, and only when, they are created by everybody.”
― Jane Jacobs, The Death and Life of Great American Cities

As our cities reopen following the pandemic, they feel much quieter than usual. The coronavirus has disconnected us from each other and our urban spaces. Given this shift, how can we re-engage with them in meaningful and effective ways?

One of the first places we will return to will be commercial office buildings, which can serve as powerful catalysts for reconnecting us with our communities. To create more engaged and healthier urban centers, our buildings can provide experiences that celebrate, amplify and augment these spaces. Below we outline a series of experience design ideas and strategies — which can easily shift and evolve — that commercial buildings could employ to reinvigorate civic life.

 

Rethink the Lobby

It is important to prioritize elements that reduce stress for tenants who return to the office building, beyond communicating social distancing protocols. One way is to employ nature’s science-backed calming effects. Numerous studies demonstrate looking at nature — even simulated — is proven to lower blood pressure and heart rate. Digital views of nature that respond to people’s movements can provide a rejuvenating enclave in a busy urban environment — and greet building lobby visitors with delight even when there is no front desk staff present. Immersive installations can provide a comforting animated landscape inspired by local surroundings, with digital flora and fauna welcoming and interacting with visitors as they walk by. Light installations can also simulate the supremely calming experience of sunlight hitting water ripples to create unique meditative moments.

These digital layers could be customized at any time, not only to create a livelier environment, but to act as a communications platform that offers an air of exclusivity never experienced before in a multi-tenant building. Lobby media architecture could be tailored for specific tenants to provide unique branding experiences. In a world with proposed timed tenant entries for high rises, lobbies of multi-tenant buildings could become intimately branded for one tenant’s arrival time via specific messages and graphics for their employees to create a more personalized experience. On the weekend, these displays could engage the surrounding neighborhood by showcasing local public art, environmental data, or educational information.

Meanwhile, digital installations can also reinvigorate lobbies in aging or historically-significant buildings, while also providing visibility to street passerby. Media architecture that changes with the weather, seasons, and other neighborhood inputs can bring dynamism and sophistication to urban icons that a static art piece cannot. Custom human-scale lighting installations can also bring warmth to landmark buildings and transform areas of frequent movement (people entering and exiting) into destinations too by inviting tenants to sit and take in the digital art.

 

Address the “Front Porch”

Consider the space outside your commercial building. How can you create a more welcoming presence that invites not just tenants, but passersby to stay and linger in a safe and socially-distanced manner? While a plaza filled with seating and chairs provide places for people to sit, consider an element of surprise or serendipity to maintain engagement. Temporary graphics and pop-up interactive digital “sculptures” which can also serve as seating, exercise equipment or play structures for children, can encourage people to explore and linger in their neighborhood throughout the week and weekend.

Design that engages the senses — through thoughtful and dynamic exterior lighting, soundscapes, landscaping and water features installed outside commercial buildings — could help reunite us with our cities. Interactive multistory digital façades can enliven barren spaces while offering a sense of respite for building tenants and the community. An LED light trellis can become a living wall, simulating dappled light through trees via data-driven animations. This type of installation can transform a former concrete wall into soothing lights to create a peaceful moment, both during the day and at night, at the center of a busy city.

Neuroscience shows “prospect and refuge” — the ability to both survey a space and also find shelter — is hardwired into our brains. More permanent exterior design solutions could provide this. For example, iconic entry canopies can protect people from the elements, while small roofed structures placed in plazas can create socially-distanced niches for reading, lounging and people-watching, as well as areas for farmer’s market stalls. To redefine the street-front, immersive digital entry portals can serve as a neighborhood anchor and branding experience. An exterior-interior multimedia installation can create a new identity that is both a lighting surface, content display and architectural enhancement. Unique digital displays can wrap around building exteriors and move into the interior to offer a dynamic media element that can evolve as needed. Etched glass layered on top of different LED resolutions can create a seamless digital experience that renews an aging building.

 

Be a Good Neighbor

To help reactivate the city and extend the network of building users on a daily basis, commercial buildings could host a series of rotating platforms that artists can use to enliven empty or underutilized commercial space. In addition to independent artists, these vacant commercial spaces could also allow cultural institutions to show more of their collections. In New York City, the Museum of Modern Art only has space to display 30% of its full collection — which contains more than 200,000 pieces — while the Guggenheim Museum only shows 3% of its works. By distributing these artworks throughout the city, taking advantage of newly released real estate, museums could utilize highly visible spaces and extend where and how people see art. For example, the Rijksmuseum store at Schiphol Airport in Amsterdam utilizes empty retail space, and was the first art museum in the world to open a new branch at an airport.

Art walks have long been a popular urban event. In this spirit, commercial buildings could go a step further and develop partnerships with local civic or business improvement districts (BID) or even each other to bring amenities outdoors and repurpose underutilized areas, sidewalks or vacated parking spaces for outdoor dining, pop-up retail and more. In New York, the Madison Square Park Conservancy produces a popular culinary pop-up market, Mad Sq. Eats, which draws local restaurants from around the city into an underutilized plaza. This program brings the kitchen to the street to not only create a welcoming public outdoor dining experience, but also bring greater visibility to the community and neighboring businesses.

Temporary educational signage posted on or near commercial buildings can also encourage people to reconnect with their urban communities. For example, sidewalk decals can provide self-guided tours that help people learn about the history and significance of local architecture. Philadelphia’s robust wayfinding system features color-coded maps throughout its diverse urban neighborhoods to spotlight the city’s iconic built environment, orient visitors and help locals better navigate their city.

With dramatic drops in car traffic due to stay-at-home orders, some cities are temporarily and permanently closing their streets to serve pedestrians, bikes and other social-distanced activities. Some of these spaces have transformed into neighborhood greenways or linear street “parks.” Adjacent commercial buildings can take advantage of these areas to better connect tenants, residents and visitors alike. To create a safer pedestrian environment, LED mesh street overlay lights can provide greater visibility and direct cars away from these areas at night.

 

Build Community via the Skyline

Commercial buildings can create conversations with their cities and differentiate themselves in a crowded skyline. Digital exterior screens, perhaps even sponsored by tenants, can convey engaging messages for the city that could rotate monthly. Large-scale media installations across a set of buildings can create an expansive canvas for storytelling.

While cities and buildings have used crown lighting to show support for holidays, the expression is limited to colors and patterns. What if urban residents and visitors could contribute imagery, or words, to the installation? Could there be an audio component that people could tune into to hear stories or oral histories? Through these elements, city residents could see themselves represented in the buildings that surround them. Currently, the artist Jim Campbell captures daily recordings of city life in San Francisco and displays them on the top of the Salesforce Tower, which can be seen up to 20 miles away at night. National Geographic has projected wildlife photography on buildings around the world, from the Empire State Building to the United Nations headquarters via its Photo Ark initiative.

What if we transformed our skylines through user-generated content and through community engagement? To create space in the skyline that reflects the people who inhabit each urban neighborhood allows residents to simultaneously become the directors, performers and audience of these installations. By prioritizing the collective and setting aside our individualism, we may better unify our communities. Ultimately, it’s not about how a building can stand out on the skyline — it’s about how our buildings can contribute to the greater good of the city to become part of the identity and fabric of our city centers.

 

In Summary

The coronavirus has changed the urban experience and the way we interact. To create more livable and resilient cities, commercial office buildings are an important piece of the puzzle. They must open themselves up to their communities and engage their urban centers in more expressive ways, through opportunities that support social engagement, culture, health and wellness. The resulting economic benefits, but also social and environmental ones too, could help reposition a building’s assets and strengthen our neighborhoods.

 

How are you and your organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy ESI Design, an NBBJ Studio.

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The Coronavirus Pandemic Has Boosted Telehealth; Here’s How Existing Spaces Can Support Virtual Visits

July 2, 2020

Partner, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

This post initially appeared on Forbes. It was co-authored by Teri Oelrich and Bryan Langlands.

 

Telehealth — healthcare delivered remotely — has been offered for decades, yet only 11% of Americans used it in 2019. Not surprisingly, as COVID-19 changes the way we interact in all aspects of life, many patients are swiftly embracing virtual healthcare, with 46% of U.S. consumers now using telehealth. At a New England academic medical center, the telehealth utilization rate for routine health visits jumped from 1% before COVID-19 to 85% today. Meanwhile, more than 75% of Baylor Scott & White Health’s clinic visits are now virtual.

What will this mean for the future of healthcare? Below we look at the current telehealth landscape and how it will transform the physical design of clinics and other healthcare spaces.

Telehealth opportunities

Telehealth is particularly helpful for chronic disease management, post-hospitalization care, preliminary evaluation, follow-up visits and preventative care. There are three key types of care available: 1) Live telehealth allows physicians and patients to communicate in real-time, typically through video or phone. 2) Remote monitoring enables providers to monitor patients’ health data, such as blood sugar and blood pressure, via mobile medical equipment. 3) “Store-and-forward” telehealth is the electronic transmission of medical data and information, such as documents and x-rays, through a secure messaging portal to a provider or specialist.

Telehealth can keep patients out of the emergency room who aren’t sick and do not need to be there — those referred to as the “walking worried” or the “walking well.” This is critical to alleviate surges from the coronavirus pandemic. Telehealth can also “pre-sort and triage” patients, allowing doctors, specialists and other healthcare professionals to virtually prepare before they arrive at the hospital. It also allows healthcare systems to divert those who should not be seen at an emergency department to an appropriate venue such as an urgent care center — saving costs and provider capacity, and reducing the overall length of stay for all emergency department visits.

Telehealth services show key benefits for patients. The first being cost savings: Research shows access to telehealth can decrease emergency room trips. The average emergency room visit costs $1,734 and the average doctor’s visit is $149, while the average telehealth visit costs $79. Care is also much faster. Since there’s no travel required and shorter wait times, consultations are streamlined. Patients can take less time away from work or home duties and are not as exposed to delays. This is also a cost savings to employers as employees do not have to take hours off for a clinic visit.

These factors also translate to a convenience for patients who live a long way from the nearest healthcare center, and enables older adults and people with disabilities to receive improved access to care. The final benefit is improved health outcomes: with telehealth, there is no exposure to contagious illnesses in the waiting or patient room, and these services also translate into fewer missed appointments, better access and better patient follow-through. All of these can increase patient wellness, especially for chronic conditions.

In addition to providing benefits for patients, telehealth visits also make life easier for healthcare providers. Telehealth consultations are typically 20% shorter than traditional in-person appointments, which can  allow providers to see additional patients. Unused exam rooms can be converted to support higher revenue generating procedural care, and telehealth also lowers caregivers’ exposure to illnesses. The combination of these means that providers can boost revenues and expand their patient base while providing higher levels of care.

The impact of telehealth on the design of clinics and hospitals

The increased use of telehealth services can change how healthcare providers design and use their spaces. Here’s a few different ways this can be realized:

More efficient use of space

With an increased demand for telehealth, clinics can reduce the number of exam rooms and apply the square footage to higher-value areas like procedure rooms or multi-purpose rooms that can be used for different procedures. For example, the standard clinic exam room is 100 to 120 square feet dependent on specialty, while a telehealth room for a provider can be smaller, at around 80 square feet. Without exam room equipment, a telehealth room only requires a desk with a computer monitor and camera, appropriate lighting and audio equipment, and enough space for a provider and possibly support staff. An increase in telehealth and decrease in exam room numbers could also result in a reduction in support space needs and staff for reception, patient check-ins and check-outs, the size of medical rooms, nursing stations and waiting areas.

Bringing doctor’s offices back into communities

In recent years, many doctors’ offices have been moved off-site or eliminated altogether. However with the emergence of telehealth, the doctor’s office may have a resurgence, in the form of a space that is part office, part exam room. Going forward, a doctor who spends a day in the clinic may spend half the time seeing patients in person and the other half seeing patients remotely.

Reinventing the waiting room

With the use of smart phone apps, the traditional waiting room could be transformed. In non-urban settings, the parking lot can serve as a waiting room for many patients. In urban settings, appropriate waiting areas could have limited seating capacity and organized so each patient has their own personal space. While some clinics have responded now by introducing plexi-glass partitions between chairs, and an abundance of hand-hygiene stations — this is a temporary solution.

These could be replaced in due time with solutions that use furniture and screening mechanisms designed for privacy and separation, with patients organized in small groupings of one to three people. Mechanically, we could see requirements for clinic and doctor’s office waiting rooms match those of emergency and radiology departments with negative pressure and increased air changes per hour exhausted outdoors.

Adding telehealth to the workplace

For many patients who worry about exposure to Covid-19, telehealth consultations at home can provide safe alternatives to in-person visits. Even when the pandemic retreats, these telehealth consultations could also take place in specialized places outside the home, such as offices and higher education campuses.

Dedicated rooms for virtual health visits on a corporate campus, for example, would provide patient convenience, privacy and time savings, and require less square footage than a more traditional health clinic. A wellness room within an office can easily be converted into a telehealth room with modest financial investment, requiring nothing more than good lighting, acoustical separation, a computer with a decent sized monitor and an internet and phone connection.

Barriers to telehealth utilization

Despite the benefits of telemedicine, there are a few things that are preventing it from being more widely adopted. First is the perception that telehealth is less effective than in-person care. This perception has kept some people from utilizing these services, but this should change as more people use it. A 2019 study shows satisfaction with telehealth has increased, with 62% saying the quality of care was the same as an in-person visit.

Another challenge is in the regulatory landscape. While some health insurance companies, as well as Medicare and Medicaid, may cover or reimburse telehealth visits, telehealth coverage laws vary between states. Moreover, people who are uninsured may not have access to the technology needed for telehealth appointments. This is something that needs to be addressed. If not, those under- or uninsured — who may benefit greatly from telehealth — will continue to be excluded.

Telehealth services have been critical during the coronavirus pandemic and a crucial supplement to in-person medical care. As more patients and providers become comfortable with remote care for some services, it is important to consider its impact on healthcare real estate and the overall patient experience.

Telehealth used to be the “on ramp” of the healthcare freeway system. Now it’s in the “passing lane,” overtaking some long-established traditional modes of care delivery. Telehealth is here to stay, and we need to plan for it.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Tim Griffith.

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How to Make Ambulatory Care Centers More Adaptable

Six Ways to Prepare for the Next Pandemic by Reconsidering Healthcare Design Guidelines

May 26, 2020

Senior Associate, NBBJ

bitarnoelia

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

Editor’s Note: This post was co-authored by Noelia Bitar and Paula Buick.

 

The number of outpatient centers has increased dramatically in recent years, but as scheduled appointments were canceled during the coronavirus, this valuable real estate stood empty. Because ambulatory centers already have basic healthcare infrastructure in place, they potentially could flex to accommodate an inpatient surge; however, many of these facilities were designed to meet only the minimum requirements of current codes — like the FGI Guidelines, which establishes national standards for the design and construction of healthcare facilities — and as a result their ability to be adapted for inpatient care is limited.

As we think about building new ambulatory care centers, a few design considerations, above and beyond code minimums, could make it easier for these facilities to flex to meet future inpatient surges or post-acute care needs. Given funding constraints, it may be challenging to incorporate all of these features into every ambulatory care center; however, these are some of the options a health system might consider:

1. Build public spaces that allow for easy conversions. If utilized during a surge event, ambulatory care centers would likely transition from opening only during a set number of hours each day to a 24/7 service, which, because inpatient care requires more staff than outpatient, would require an overall increase in staff on all shifts. This increase would require additional support areas, which will impact the design of public spaces. These spaces should be designed so lobbies can be converted for triage (screening, testing, queuing, etc.) and patient waiting areas converted into “team work areas” where care team stations, staff amenities (lockers, lounges) and clinical support services can be located outside of patient areas that might be required to be isolated. The code currently requires waiting areas to have a ratio of 1.5 to 2 chairs per patient care room, but it does not specify a square footage per chair; we find that 25 square feet per chair is a good standard for providing additional future space flexibility in waiting areas.

2. Design exam rooms to flex beyond outpatient care needs. The minimum clear floor area required for patient exam rooms per the guidelines is 80sf, but as we design for future flexibility, we could see a shift to allow for stretchers to be used in these rooms. Taking into account the appropriate clearances that might be required, 120 square feet is a more appropriate minimum, and sometimes 140 square feet for multidisciplinary-based team care.

Medical gases such as oxygen and vacuum could be included in at least some exam rooms, even though the code does not require any medical gases in a standard exam room. The addition of medical gases in general ambulatory centers will allow for these rooms to flex when needed.

Because telehealth is important not only for expanding access to care but also for helping to reduce exposure to contagion for both patients and staff, it would be beneficial to integrate technology and design that supports telehealth or teleconsults into more exam rooms. While the outpatient guidelines offer dedicated spaces where telemedicine could take place, such as a bay, cubicle or room, including it in every exam room would provide additional support. Consider elements such as:

  • Monitors with fixed cameras or mobile carts for telehealth and remote consults to be able to remotely view and communicate with patients
  • Communication tools, including “nurse-call” that is voice-activated (the current code does not require nurse call devices in exam rooms)
  • Television for patient distraction and education

Larger 4′ (or 48″) door openings could be the new norm for the exam room and all patient areas — even though door openings serving occupiable spaces are usually a minimum clear width of 34″, or 41.5″ where stretchers are used, and 4′-door openings are typically only required in the path of travel to public areas and in areas where care will be provided for patients of size. Using sliding doors or double-leafed doors could accommodate a wider opening without impacting the design of the room.

Even though an exam room, by code, requires privacy for patient consultation, integrating a transparent material like a narrow light or half window with integral blinds would allow it to flex into an observation room, which by code requires patient visibility. Sliding glass doors with a translucent film could be used to maintain privacy while providing light into the corridors during normal exam-room use, but the film could easily be removed and allow for transparent glass, if the room needed to flex for observation.

3. Plan for an isolation zone within outpatient care areas. An entire floor or section of an ambulatory care floor could be designed to become a negative pressure area. Rooms would need to identified for transforming into donning/doffing PPEs, and with a one-way entry and exit flow.

Similarly, while Airborne Infection Isolation (AII) exam rooms are only required in specific programmatic ambulatory needs, having the option to accommodate a patient who has screened positive for an airborne infection may be advantageous in the surge response plan. A minimum number of AII exam rooms could be required, along with an adjacent room or space to serve as an ante room or vestibule. And don’t forget that patient isolation can function at multiple scales.

4. Expand corridor widths to allow multiple flows. Although outpatient guidelines only require 6′ corridors in areas where there is use for stretcher transport, if corridor widths were required to be a minimum of 6′ throughout, they could accommodate stretchers and other circulation needs, and support PPE carts outside rooms, EVS cart parking, patient transportation etc.

5. Choose the soiled workroom over the soiled holding room. Most outpatient general facilities only require soiled holding rooms in exam areas, as they are only used for temporary storage of soiled materials and supplies — as opposed to more intensive soiled workrooms, which include additional plumbing and space in which staff can work. However, choosing to include the soiled workroom in outpatient settings will also allow for cleaning or disposal of soiled items with the multiple sinks required by code for inpatient care.

6. Add redundancy in infrastructure. Including additional electrical power in public areas like waiting rooms and exam rooms makes it possible to support additional equipment loads such as physiological monitoring, mobile diagnostic equipment, emergency power and more. Likewise, HVAC systems ideally would be flexible enough to accommodate 24×7 patient care, additional cooling for increased staffing, thermostats in each exam room or the modest increase in air changes per hour — from 4 to 6 — required by code for inpatient settings. Most general ambulatory centers like medical office buildings do not require these types of redundancy per code requirements.

Many of these features will entail additional costs. However, there are also significant costs associated with leaving an ambulatory care space idle because it is unable to meet unexpected care needs like the Covid-19 pandemic. Some additional upfront investment may be necessary but doing so will ensure that these centers will be ready to flex when the next emergency arises.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Sean Airhart.

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