Healthcare Architects and the Rapid Change in MOB Design

April 14, 2014 • Stan Landwehr, AIA

The graying of America and the Affordable Care Act has placed a giant bulls-eye on healthcare facilities. The industry is evolving … rapidly. We, as healthcare architects, must work even closer with providers to develop proactive solutions that allow them to better treat patients while also controlling costs. Nowhere is this more apparent than in the design of today’s medical office buildings (MOB’s).

The recent acceleration of hospital-employed physicians has brought about a change in thinking regarding layout of clinical spaces. Slowly disappearing are the MOB’s with long, narrow corridors leading to individual physician suites and duplication of services. WDM Architects’ design of the MOB space at the Newton Surgery Center organizes several specialty practices (Orthopedics, General Surgery, Endocrinology) around one open and airy waiting room with a single check-in location with space for self-check-in kiosks. This design permits shared support spaces such as billing and staff break rooms; all reducing the overall footprint and building costs.

The heart of the clinical practice, the exam room, is also undergoing evaluation and change.  The old formula for healthcare architects was to simply multiply the number of physicians times three to establish the number of exam rooms. Not today.  Now, designers need to consider the individual practitioner’s methodology and schedule to program an efficient space. The Cardiologists at Platte Valley Medical Group in Nebraska spend much of their patient care time in the hospital or in outreach clinics throughout the state. Coordinating doctors’ schedules to make the most efficient use of clinic time greatly reduced the number of exam rooms required. Creating “universal” exam rooms also uses this same concept of “shared space” across multiple specialties.

The newest concept of shared medical appointments can also impact the number and type of exam rooms. The idea of holding treatment discussions in a small group setting, while not appropriate for all treatment cases, can be advantageous for learning how to manage chronic conditions such as diabetes or asthma. Patients can learn a lot from each other in a group setting through shared experiences with issues such as pregnancy care or side effects of cancer treatments.

The configuration of the exam room itself has also changed.  The ongoing obesity problems in our country along with the increasing size of extended families and caregivers have increased the room size. The implementation of more information technologies into the exam room add more nuisances while something so simple as the fact that the physician needs to face their patient to offer care instructions is often lost in the mix.

Physical space for the providers themselves is also continuing to evolve.  Increasing numbers of “physician extenders” such as PA’s and APRN’s changes the space requirements for Nursing Stations and Physician offices.  Some practices have eliminated private offices for physicians; choosing instead to place physicians and extenders in an open office setting.  In a recent project for Integrity Medicine, this model resulted in a smaller building footprint while offering better coordination of patient care.

Even though the rush to upgrade the character and feel of medical spaces has lessened with the downward trend of reimbursements; physician groups still understand that warm and inviting surroundings put their patients at ease and serve to help them retain valuable staff. Often the interior finish renovations have the added benefit of gaining staffing efficiency as is the case in the remodel of the central waiting room for Hutchinson Clinic. Here multiple check-in stations were replaced with one central reception concurrently with the updating of finish materials.



As healthcare reform continues to evolve, so do the design of spaces we develop for patient care.  However in this time of change, there remains one constant; the continual pressure to reduce project costs while striving to improve patient outcomes.  At WDM Architects, our approach is also constant: “Ask the right questions, listen carefully to the answers, and offer creative solutions to our clients.”