Framework for Design Excellence
Integration
The location for this new community clinic on the ground floor of a commercial building in an active and vibrant urban neighborhood was a deliberate choice on behalf of Children's National and is part of a larger initiative to expand services away from the main hospital and integrated into neighborhoods across the city. The street level presence also gives prominence and visibility to Children's National and the importance of pediatric care as a community amenity. The interior of clinic is open, bright, and airy using materials and lighting to reinforce the clinic as a place of health and care for children.
Equitable Communities
The clinic is conveniently located on the main commercial avenue in the neighborhood and easily accessible by metro, bus and on foot from the surrounding residential areas. Residents of the Columbia Heights neighborhood are from a diverse range of racial / ethnic & cultural backgrounds and the clinic design needed to appeal to all equally. Representatives from Children's staff and the neighborhood had input on the selection of materials, colors, integrated graphics, signage, and artwork to help ensure a clinic that felt welcoming and inclusive. The clinic also connects with nearby community organizations and amenities to help form and promote a network of neighborhood services that promote health and well-being for area residents. All spaces within the clinic meet ADA requirements for accessibility and dedicated exam rooms are provided that accommodate wheelchairs.
Ecosystems
By re-purposing a long vacant commercial space the clinic has extended the life of an historic and well-built structure. The building shell was kept largely intact and improved only through more efficient windows, doors, and insulation. Parking needs for both staff and patients is minimized because of proximity to public transit and other community amenities. On the interior great attention was paid to lighting design and acoustical treatment to enhance privacy, help reduce stress, and showcase the clinic as an elevated and respectable community resource.
Water
With the re-use of an existing urban site the need for landscaping and watering was eliminated. Within the building low-flow fixtures for staff and visitors were used to reduce overall water use within the space.
Economy
Children's has a target program and facility size for its community clinics which is based on optimizing the size of on-site care staff into "pods" who are assigned to a group of exam rooms. These operational requirements were studied to produce an efficient layout that both worked within the physical constraints of an existing building and maximized the area dedicated to patient services. Materials, lighting, furnishings, and equipment were all selected to balance first and longer-term maintenance costs which help ensure that available funding can be directed toward the primary mission of patient care.
Energy
LED lighting with integrated controls, including occupancy/vacancy sensors were used throughout. The mechanical system consists of a Variable Refrigerant Flow system and dedicated outside air unit with heat recovery. The VRF system allows for more efficient simultaneous heating and cooling in different areas of the clinic through a shared refrigerant loop and all systems are controlled by a central controls system for remote off-site monitoring and controls at the clients central facility maintenance division.
Well-being
Public areas of the clinic have high ceilings, long interior views, and visual connection to the exterior street activity. Interior lighting is largely performance ambient lighting to enhance the volumetric sense of space and sense of cleanliness of public and patient areas. Acoustical separation of patient areas is carefully detailed to ensure privacy. Acoustics in the open work areas for staff have integrated sound-masking that modulates based on the intensity of room use. Private staff work areas are located remote from noise-producing activity and are enclosed by acoustically damping walls. Even with limited access to exterior windows, interior offices for clinic staff have visual connection to the outside through direct views, borrowed lights or skylights. The staff commons is an open, flex area that serves as a break room, social space informal meeting area away from the public side of the clinic. The staff commons also has a large window and exterior balcony to allow staff connection to the outside without having to leave the building.
Resources
Special attention was paid to the selection of materials and products used in the clinic. Products such as paints, coatings, flooring, ceilings, wall coverings were used that have zero to minimal off-gasing and promote a healthy indoor environment. Preference was given to materials with recycled content that also demonstrate a high level of durability and ease of cleaning.
Change
Exam rooms were sized and configured to accommodate multiple types of care allowing the clinic staff to vary as needed the function of individual spaces. Work areas for staff are largely unassigned, flex areas that can be adapted to different staffing needs depending on operational decisions and clinic capacity.
Discovery
Post occupancy services were provided by the design team for 14 months after the start of operations. During this time multiple site visits were made to review how the clinic was being used and evaluate the potential need for training or minor revisions to physical components of staff or patient areas. Care and maintenance procedures for flooring and other finishes were reviewed and corrected as needed to ensure intended performance and compliance with warranty requirements. The VRF system was a first for Children's and a significant post-occupancy commissioning process was needed for the first year to ensure proper on-site operation and remote monitoring. Periodic surveys of clinic staff have been utilized to better understand how the layout of the clinic effects their ability to provide care and work efficiently. This collected information is being used by Children's to inform future similar projects.