CAYUGA MEDICAL ASSOCIATES

A collaboration between the DEA5305 Health and Healing Studio and DEA3510 Architectural Programming class, we worked with Cayuga Medical Associate (CMA) to develop a programming document and design recommendations for an interior fit-out of an outpatient facility at 1020 Craft Road, Ithaca, NY 14850. The redesign incorporates evidence-based design solutions to develop a medical outpatient facility that fosters patient-centered care and operational efficiency among four distinct departments.

timeline: oct - dec 2021
site:1020 craft road, ithaca, ny
programming team: rebecca ames, olivia bruno, jai khanna, connie lin, natalie verdiguel, gavin ratliff
programs: revit, enscape, adobe photoshop

prompt work with Cayuga Medical Associates (CMA) and our assigned programming team to transform 1020 Craft Road into a large multispecialty clinic with shared common spaces and services/functions. CMA is planning to develop a comprehensive space plan that allows the following practices to function in the same clinic space: Dermatology, Gastroenterology, Endocrinology, and Rheumatology.

background

Founded in 2006, Cayuga Medical Associates (CMA) is a multispecialty employed physician group affiliated with Cayuga Health System (CHS). CMA has over 150,000 patient visits per year across 23 specialties, 22 locations, and 3 counties. CMA has over 400 employees, approximately 150 providers and 250 staff.

Their aim is to be a driver of integrated health services in the local community, and empower people and employ capabilities to equitably improve the well-being of the communities they serve.

Currently, Cayuga Medical Associates is looking to consolidate 22 locations within leased spaces throughout Tompkins County and surrounding counties in an effort to reallocate 50% of their medical departments and utilize shared resources.

 

the site

This building is located in Ithaca, NY at 1020 Craft Road and is surrounded by 1-2 story residential buildings. The facility is currently divided into three suites: Suite A (currently Dermatology and Women’s Health), Suite B (Cayuga Medical Center lab), and Suite C (currently Women’s Health). For the purposes of this project, Suite B will remain as is and Suite A and C will undergo a redesign to include the four medical departments: Dermatology, Gastroenterology, Endocrinology, and Rheumatology.

site diagram

1020 craft road, google earth

 

current spatial configuration of outpatient facility

 
 

the idea

From the initial programming provided by the team at the beginning of the project, the preliminary design concept I had developed was centered around the idea of symbiosis and how these unique departments were coming together into one facility and sharing resources to increase efficiency and deliver high-quality care. As the program developed, there was a greater emphasis on delineating the departments to retain their unique identities, so the idea of sharing resources across departments such as support spaces was not as critical. However, the foundational idea that all departments are striving towards providing a cohesive and high-quality patient care experience remained and was especially evident in the shared public spaces and the patient spaces, which ultimately guided the design direction for this project.

 

symbiosis concept model

 

programming

The programming team I worked with developed a set of design goals after identifying the problems, takeaways, and design considerations found from observations of the site and interviews with key stakeholders. The team identified the following:

Problem Statement: Spatial constraints of existing facilities within the Cayuga Health system are requiring the reorganization of several departments into their 1020 Craft Road outpatient location.

Key Takeaways: Administrators desire interconnectedness between departments, but practitioners see no need for this. Navigation, wayfinding, and optimal utilization of space are currently the greatest design faults.

Major Design Considerations: Hallway windows could help orient patients and subsequently assist in wayfinding. Clear signage and differentiation between departments could assist in navigation. Space is not optimally allocated; some exam rooms and storage spaces are unnecessarily large, while other rooms are too small to comfortably accommodate providers.

design goals

  1. Streamline: The facility should provide a streamlined experience for patients and an efficient workplace for providers, combining functional areas with similar system requirements (Salonen et al., 2013).

  2. Organize: The building should have a clear organizational structure, with clear delineation between departments (Prowler & Vierra, 2008). 

  3. Flow: Effective wayfinding techniques should be incorporated into the space for easy navigation and patient empowerment (Carpman & Grant, 2016).

  4. Patient Experience: The building should be patient-centered, incorporating elements that facilitate communication and comfort for both patients and staff (Salonen et al., 2013).

spatial blocking

Based on the problems identified and the performance requirements suggested by the programming team, I used that information to block out how the spaces could be best configured to support the needs of patients and staff members. The team developed two proposals for how the space could be reconfigured.

Option 1
Includes all four departments but reduces the square footage allocated to each department.

Option 2
Excludes the Gastroenterology department and increases the square footage for the remaining three departments.

As seen in these diagrams, the shared public space across the 3 departments is centralized and located at the main entrance where patients will first arrive, and there is also a clear delineation between departments to preserve their unique identities in either option.

From these preliminary blocking diagrams, both myself and the programming team came to the conclusion that it would make the most sense to proceed with Option 2. After consulting with the CMA stakeholders, there was a consensus among them that it would be ok if only a few of the departments were relocated, rather than all four. The following is a finalized bubble diagram that outlines the experiential sequence, program adjacencies, and departmental pod layout for Option 2.

bubble diagram, created by the programming team

 

design solution

Continuing to work off the previous blocking diagrams and iteratively working towards a design that would best support the three remaining departments (Dermatology, Endocrinology, and Rheumatology), we came to this final configuration for the redesign of the outpatient facility:

Blocking Approach:

  • Centralized public space and check-in area located at main entrance to enhance patient arrival experience 

  • Providing clear delineation between departments to preserve unique identities

  • Each department will have access to their own support spaces to reduce travel distances and increase staff efficiency (Vos and van Merode, 2007)

  • Departments are placed around perimeter of facility for access to ample natural light and views of nature (Salonen et al., 2013)

floor plan

Working off the previous blocking diagram, this is the finalized floor plan that was developed. Visitors will enter through the main entrance and will be greeted by the waiting room and check-in area. Each department has access to their own support spaces to minimize travel distances for staff members, such as clean and soiled rooms and storage spaces, and a majority of the exam rooms and private offices are located along the perimeter of the building for access to natural daylighting and views of nature. Each department also has access to their own nurse station and staff break room to best support the staff members and their specific departmental tasks. 

rendered floor plan

One of the key aspects of this project was incorporating evidence-based design solutions. The following rendered floor plan shows the different ways in which research was incorporated into the design of different spaces.

Some of the spaces that recur throughout the facility will share similar design elements but will be slightly modified according to the department they belong too. Some of these rooms include the nurses station, private offices, exam rooms, staff break rooms, and telehealth booths, and each will be adjusted accordingly to signify the department’s identity.

The waiting area, private offices, conference room, and telehealth booths will all be equipped with performance carpeting that minimizes contaminants, maximizes safety, enhances comfort, and provides acoustic privacy.

All of the clinical spaces have resilient healthcare performance flooring that is scratch, stain, and scuff resistant and provides tactile warmth through the use of wood patterns. These spaces also include flexible furnishings that can adapt to different work settings.

Lastly, each department will have a corresponding color palette that will be used to support wayfinding on the walls and create a cohesive environment that supports patient navigation within the space. 

material palette

Waiting Room

The entrance to a medical facility is the physical transition from exterior to interior, and how it is designed as part of the entire entry sequence can greatly impact patient and family experience. The consideration of details speaks to the sensitivity of the providers and the awareness of patient needs, such as the inclusion of bariatric seating, clear signage, positive distractions, and contextual design elements.

Exam Rooms

Creating a calm and comfortable atmosphere in exam rooms is crucial to reducing stress and anxiety amongst patients, whether that be through the incorporation of biophilic elements or through adaptive seating options. Furthermore, features such as mobile workstations and modular healthcare casework designs can support physicians to work efficiently and effectively.

Staff Spaces

Spaces dedicated to medical staff are crucial to support their physical, mental, and social needs throughout the workday. Providing areas for rest, eating, and socialization are key opportunities to increase staff efficiency, morale, and retention. Furthermore, staff spend significant amounts of time walking and standing throughout the day, so providing fatigue-reducing flooring is a key consideration in the design.

landscape design

This is the site plan provided by my classmate Gavin who was the project’s landscape designer. Based off the number of exam rooms programmed into the design, there are 55 parking spots and 3 accessible parking spots available for visitors, and there is a one-way travel path for traffic. Surrounding the facility includes a variety of landscaping elements include an exterior waiting room adjacent to the main entrance, a rain garden, and a woodland park along the perimeter of the site.

landscape design plan

exterior “waiting” area

rain garden

interior renderings

waiting room

This is the waiting room that visitors will see when they first enter the facility. Some of the key design elements include a residential-style waiting room with a variety of inclusive seating options that are oriented in a way to create clear divisions in the space and provides clear site lines to the registration area. The check-in desks are ADA accessible and include barriers between each counter to ensure patient privacy.

rheumatology exam room

Each exam room incorporates colors that correspond to each department, for example, since rheumatology is branded with a green color palette, several elements within the room express this such as the bariatric chairs, the interior wall, and the mobile physician workstation. The room also incorporates biophilic elements such as nature-based artwork, an organic backboard pattern on the casework, and wood elements to reduce stress and increase patient comfort. All exam rooms include a recliner that aims to reduce stress for both patients and clinicians while increasing physical and emotional connectedness, and the armrests provide patients with mobility issues easier access in and out of the chair.

endocrinology staff break room

This is an example of one of the staff rooms, this one is specifically the one located in the endocrinology department. All of the break rooms have access to natural daylight and views of nature, this room specifically faces the rain garden mentioned earlier on the site plan. Additional features include ergonomic and mobile chairs, performance flooring that provides tactile warmth and amenities such as a communal fridge and coffee machines that staff can utilize during breaks. 

staff conference room

Lastly is the staff conference room that is located centrally in the facility. The aim of this space is to encourage interaction across all three departments so incorporating flexibility and adaptability was the main focus. It includes work tables and ergonomic chairs that can be easily reconfigured to accommodate different types of work settings and a mobile whiteboard to support collaborative work. There’s integrated technology within the space such as the wall-mounted screen for presentations and virtual conferencing. Acoustic privacy is provided by the performance carpeting and visual privacy via the 3form resin wall system that features an organic, biophilic pattern. 

design summary

The design of the new medical outpatient facility incorporates evidence-based design solutions to foster patient-centered care and operational efficiency among the four distinct departments.

Summary of Design Considerations

  • Deinstitutionalization

  • Biophilia & positive distractions

  • Wayfinding & navigation

  • Patient and family experience

  • Optimization, efficiency, flexibility

  • Branded and cohesive environment