January 12, 2017
HealthLinc, a Federally Qualified Health Center, was beginning to outgrow its small facility in the Hilltop neighborhood of Valparaiso, Ind. It applied for and received a $5 million Health Resources and Services Administration (HRSA) grant to fund the renovation of a 16,900-square-foot building that had been vacant for two years. The replacement site is only one and a half miles from the previous one, which meant that the service did not have to uproot its existing clientele from the area.
Time to Expand
HealthLinc had begun in Valparaiso as a free clinic. Serving patients from nine counties, the older building was being outpaced by an increased demand for health care services. According to HealthLinc CEO Beth Wrobel who submitted the HRSA grant proposal, the Valparaiso clinic was experiencing a twelvefold increase in patient encounters. The replacement building is at a location favored by the city because it flanks both residential and commercial neighborhoods, but it needed considerable infrastructure remediation, such as floor cuts to allow for sink installations in each exam room. The existing floor slabs contained areas of significant sloping, which indicated poor, subgrade preparation; however, it was determined that renovation of that building would be less costly than building a new one. The director of operations was able to overcome these obstacles to meet the prescribed criteria.
The facility meets two critical objectives: helping the uninsured or underinsured patients obtain health care and reducing — as much as possible — the reliance on the emergency departments of conventional hospitals as clinics of last resort.
The HRSA application process was labor-intensive and time-sensitive. A design team from Shive-Hattery supported Wrobel and her board as they developed the plan, showing areas of renovation and new construction. The plan development was coordinated with rough cost estimates from contractors to help strengthen the credibility of the grant request and to show how much additional funding would be needed to supplement the grant. It was the project team’s first venture in designing a facility that combined so many patient services into building: medical, optometry, dental, wellness education and pharmacy.
Among the challenges posed by renovating a vacated building was its lack of exterior insulation. Energy codes required continuous insulation on the building envelope. To achieve compliance with local design ordinance requirements and HIPAA requirements, the design team coordinated its efforts with the city of Valparaiso. The design is a model of energy conservation compared with that of its predecessor, which translates to reduced fixed costs and a social responsibility merit badge for the corporation. As a partnering effort to support the mission of HealthLinc, the city facilitated construction of a commuter bus stop for easier access to HealthLinc — buses arrives at HealthLinc every hour.
Guiding the Patients
Also important was to be able to direct patients’ movements throughout the facility, so that they were clearly routed to the appropriate waiting or check-in area upon arrival. To ease the distractions for caretakers, the design provided a convenient flow for clinical staff and patients, and allowed for cross-trafficking between patients and staff wherever possible.
When entering the grounds from the bus stop or the curb cut, patients can see clear signage indicating where to go for parking and entry. The canopy protruding from an addition at the front of the building is a visual focal point that draws attention to the patient entrance, and an awning underneath it provides a sunscreen. The pharmacy, which is not part of HealthLinc, is positioned in front of the building, but has an interior entrance adjacent to the waiting room. Large bay windows allow daylight to illuminate the pharmacy’s interior.
The clinic’s waiting room and reception area is the pinwheel center of all services — including the education room and pharmacy — that flow off the reception area. The waiting room received intense design engineering through the use of solid-surface transaction tops, contrasting wall colors and large text messaging. Careful attention was given to accent lighting and seating, which is divided into modules separated by Plexiglas partitions. There are no impersonal back-to-back, uncomfortable seating arrangements, and the floor finish combines contrasting colors and textures. The staff has easy visibility into the waiting room and can quickly respond to any difficulties a parent my have with cranky or anxious children.
Interior decor and surface textures were selected to help calm patients; e.g., comforting images such as the tree motif rendered in Plexiglas on the walls. The children’s area contains an aquarium. Color codes aid patients in navigating to treatment areas. To accommodate HIPAA requirements to protect patient privacy during interviews, the design team assured that patient flow through the building allowed for adequate privacy. Individualized cubicles were built along a corridor that was separated by a wall from the common waiting area. This design also made certain that patients would not leave the clinic before rescheduling or remitting their copayments.
As part of its strategy to reduce overuse of emergency departments, HealthLinc partnered with Porter Health Care System to provide wellness education and outreach to the community that emphasizes the convenience and accessibility of its location. Such partnerships have become more common with the advent of the Affordable Care Act.
The new center now serves nearly 22,000 patients and has 23 medical rooms, four behavioral health rooms, 12 dental rooms, two vision rooms, along with an 1,800-square-foot multigenerational conference room that is available for meetings of community groups. Having all these services grouped at one location, along with a connected pharmacy, has created a one-stop convenience for clients.
With the expansion, HealthLinc Valparaiso can care for 4,000 new patients, with 14,200 new encounters in the first year alone. Reflecting on the project, Wrobel explains, “By utilizing Shive-Hattery as our architect, we have a highly efficient design which supports our certification as a patient-centered medical home. In addition, they created a look that is welcoming to patients and has become the HealthLinc brand for our other clinics."
The "Designing a Health Center to Serve an Expanding Patient Base" article originally appeared on December 7, 2016 on the Health Facilities Management magazine website.
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