Healthcare: Market update: New facilities expand healthcare opportunities and access for veterans – Oct 2019

By Ruth Simon McRae

With the strongest and fastest growth of any segment, the healthcare market is more critical than ever to flooring manufacturers. Results from Floor Focus’ designer survey in this issue show that 18% of top projects among surveyed architects and designers (A&D) are medical/acute care, up nearly two-thirds from two years ago, and senior living top projects have more than doubled in just the last year. Also, designers report that the medical/acute care market is the fastest-growing commercial segment, up 38% over last year’s survey.

Contributing to the growth of the healthcare market is the Department of Veterans Affairs’ (VA) vigorous pace of updating and developing new VA outpatient clinics that will give veterans better access to high quality care. Four new VA outpatient clinics in Chattanooga, Tennessee; San Antonio and Lubbock, Texas; and Phoenix, Arizona have broken ground this summer, with materials currently being bid. Developed by U.S. Federal Properties (USFP), the new clinics total 733,563 square feet and are designed to serve a population of 225,000 veterans.

USFP develops, finances, owns and operates the facilities, which are leased to the government. Its long-term partner firm, Hoefer Wysocki, leads the architecture and design of the new healthcare facilities. Together, the USFP-Hoefer Wysocki team also recently completed the VA San Jose Community-Based Outpatient Clinic. Other joint projects currently underway include VA clinics in Colorado Springs, Colorado; Grand Rapids, Michigan; Laredo, Texas; Jacksonville, Florida; and Mobile and Montgomery, Alabama.

Each of the new clinics is connected to a larger VA hospital network, expanding healthcare access to a larger geographic range. The need for additional healthcare for veterans is well known. Veterans receive more than 40,000 new cancer diagnoses per year and experience mental health issues, such as post-traumatic stress disorder, at a significantly higher rate than the general population.

Each clinic is carefully designed for the local veteran population and is visually organized around a design theme woven throughout the interior and exterior spaces that reflect its community character and site.
The veteran population is diverse, with some specific needs. As described by Hosam Habib, Hoefer Wysocki’s director of design, “The stipulation of patients we are dealing with is completely different from the private sector. When veterans go to a VA clinic, they are not only going for healthcare, they are going to meet their colleagues. It’s a destination; it’s a place for them to go on a human level. So we need to translate that in terms of design. The veterans clinics serve patients from all of walks of life, from homeless to those more affluent.”

The diverse population leads to some factors not typically experienced in other healthcare facilities; in addition to infection control, avoiding bedbug infestation is an issue. In response, many of these facilities have eliminated the use of textiles. Although Hoefler Wysocki designers would typically specify carpet for waiting areas in order to create a sense of comfort and enhance acoustics, they have eliminated all soft surface flooring and upholstery fabrics in some VA healthcare facilities.

Another factor is age of the typical veteran. Although traditionally veterans have been assumed to be older, the new demographic has many younger patients. Some of them are injured warriors, who have become veterans in their 20s. This population requires more access to technology. The buildings must have Internet and Wi-Fi, and tablets or phones are typically used for check-in. There is increased usage of telemedicine in care delivery, including services that allow patients to receive specialty care consultation and remote diagnosis from VA providers across the country.

Each VA clinic has a broad range of specialties, including almost every component of a hospital, such as imaging, labs, specialty clinics, women’s health, general practice, mental health, as well as social and dining components. Habib notes, “When you have multiple specialties, you have to understand all kinds of features, for example the sensitivity to sound in mental health, which impacts selection of flooring, wall and ceiling.”

Design needs to be welcoming, not institutional. Habib says, “We don’t want to turn this into a 1960s kind of clinic where all surfaces are white paint and white ceilings. In areas where it is not clinical-public spaces, waiting areas, staff areas, office zones-we try to recommend more welcoming and warm materials. We have seen a lot of new products in hard surface flooring that have the look and feel of carpet, such as LVT that has the appearance of a textile. We are always seeking new products that meet VA requirements yet do not compromise the overall approach, which is to create an appealing and healing environment.”

Habib points out that wayfinding is a key component of the design because some of the facilities are so huge-as large as 300,000 square feet-with a floor plate that could be an acre and a half. He adds, “We try to resist relying on signage and rely more on design components, such as color coding the facility by floor to help patients identify their destination floor and clinic. The color is a visual cue on the macro scale and then on the micro scale to find your exam room or department, it may be marked with large letters or numbers, as part of the design.”

Light-filled corridors are a fundamental part of the design, providing transparency and connection to the outside in order to help users navigate the facility. All corridors or hallways lead to daylight, with windows at the end of hallways and skylights overhead.

CHATTANOOGA, TENNESSEE
The VA Chattanooga Community-Based Outpatient Clinic, part of the Tennessee Valley Health System, is the smallest of the new clinics. At 75,000 square feet, it is still more than two times the size of the current clinic and will serve approximately 25,000 area veterans.

The design concept for the VA Chattanooga Clinic is “A Beacon of Hope.” The building has a single story with a 32’ glass and wood structure marking the main entry. From the inside lobby, visitors have abundant daylight views through expansive walls of glass.

“Chattanooga is an interesting and unique clinic because it was an undeveloped site, green trees everywhere,” says Habib, “yet there was no big influence or context around it, so we created our own context. We made it park-like, with the clinic nestled into the park, and included amenities like outdoor dining. In order to bring the site to life, we used wood cladding inside and timber outside the building.”

Chattanooga was the only one of the clinics that did not report an issue with bedbugs, allowing for the use of carpet. Type 6,6 solution-dyed patterned loop carpet tile was selected for the lobby waiting areas. Flooring in the lobby is an LVT plank in a two-color pattern. “The lobby is an abstract linear pattern that also incorporates a 5’ line to allow privacy for people approaching the reception desk. Carpet in that area is also a linear pattern and incorporates teal, navy and yellow accents,” says Lyndsee Johnson, designer at Hoefer Wysocki.

Carpet tile has been specified for office areas. Patient corridors and exam rooms will have wood-look LVT plank flooring with homogenous sheet vinyl with heat welded seams specified for treatment and procedure rooms. The physical therapy gym has thermoset rubber tile in a hammered texture.

SAN ANTONIO, TEXAS
The VA San Antonio Community-Based Outpatient Clinic, part of the South Texas Veterans Health Care System, is one of the largest and most comprehensive outpatient clinics in the Texas region. At 236,595 square feet, it serves 150,000 veterans and 80,000 active duty personnel.

Using the visual design concept of “A Healing Embrace,” the sweeping curve fronts the building with a two-acre footprint. As Habib describes, “San Antonio is a growing region, and this project is an expansion of an existing medical center. We wanted to highlight the importance of this project with a large curved statement that expresses a feeling of welcoming visible from the highway. Yet, we needed to create human scale within the massive footprint. [We considered] how to make it seem more compact. The circle is the most compacted space you can create. So we arranged circulation along the curved concourse to make distances shorter.”

Set among extensive native plantings in a lush, park-like, pedestrian-friendly setting, the exterior of the building is clad in Texas limestone and glass. An atrium floods the lobby with natural light and visually connects the upper floors with the main level. As with the clinic in Phoenix, the climate of San Antonio created challenges in material selection.

Habib notes the care taken with choices of color and materials, especially flooring. “A lighter color flooring in a climate like Phoenix or San Antonio may create an uncomfortable level of light or glare, so mid-range tones are recommended,” he says. “We did daylight analysis with an outside consultant on the floor plane to make sure color and materials will diffuse light. This includes a lot of computer modeling, data in graphic format, showing where the issues and hotspots are in order to ensure the building is not just looking good, but that it functions properly.”

Designers specified all hard surface and resilient flooring products for VA San Antonio. The lobby will have 12”x24” color-body porcelain tile. Patient corridors feature an LVT plank in an abstract geometric pattern. Exam rooms are wood-look plank; treatment and procedure rooms are homogenous sheet vinyl with welded seams. Surgery treatment, dental and lab areas will have a PVC-free resilient flooring with heat-welded seams. Square-format LVT tiles in a crosshatch type pattern are planned for provider offices.

LUBBOCK, TEXAS
The design theme for the new Lubbock VA Community-Based Outpatient Clinic is “A Healing Partnership” because of its collaboration with Texas Tech University and the campus location. Part of the Amarillo VA Health Care System, the 124,696-square-foot clinic expands the quality and healthcare services offered to 300,000 veterans who otherwise might have to travel as much as 200 miles to access some specialists.

VA Lubbock was designed to seamlessly integrate with the Texas Tech University campus while maintaining a distinct identity. As part of the university, the clinic needed to comply with campus guidelines in terms of design and selection of material, in addition to VA guidelines. Design parameters required Spanish design with architectural features such as arched openings, high roofs, and stone or stucco materials.

Inspired by the university’s rich history and well-preserved Spanish Renaissance Revival architecture, the clinic has a brick veneer exterior and clay tile roofing. A two-story glass curtain wall forms a majestic entry while flooding the interior with daylight, offering views of the surrounding Texas Tech Health Sciences Center and University Medical Center and creating a visual connection between the upper and lower concourses.

Poured terrazzo is specified in a three-color pattern to define areas in the first floor lobby. The second floor lobby will have large 18”x36” LVT tile flooring in colors and patterns similar to the terrazzo pattern. LVT plank in a wood-look design is specified for the lobby waiting area, patient corridors and exam rooms. As in the other clinics, sheet vinyl is used in treatment and procedure rooms, and rubber sheet flooring is used in dental and pharmacy areas to avoid staff leg fatigue. The physical therapy gym is hammer-textured rubber sheet tile.

PHOENIX, ARIZONA
The VA Phoenix Community-Based Outpatient Clinic is remarkable in both scale and location. At 275,157 square feet, it is one of the largest outpatient facilities in the United States.

Design for the VA Phoenix clinic was inspired by Arizona’s vibrant color palette, striations, elevations and geological formations. Deep fissures carved into the facades and roof of the building align with the rugged terrain. Integrated into its site in order to capture surrounding mountain views, the five-story clinic includes multi-specialty and telehealth clinics, an education center, pathology and imaging, one of the largest outpatient mental health clinics in the valley, and a full kitchen and canteen for staff and patients.

A key factor in the design is Phoenix’s climate. As Habib describes, “This region has intense heat, intense sun. The question was how to accomplish transparency and wayfinding yet also to be careful about not allowing too much heat. The temperature can be up to 115 degrees. This is not an environment that is friendly to an all-glass building. So we designed the building by creating this second layer of skin in front of the glass concourse, with trapezoidal and perforated fins in order to efficiently and economically manage heat gain and ensure comfort.” Dappled light filters through the louvered panels into the cool interior, embodying its design concept, “A Healing Oasis.”

The facility is located in Phoenix’s Valley Metro light rail Gateway district and includes access to public transit, pedestrian connectivity, shading and other features required pursuant to the prevailing City of Phoenix Walkable Urban Code.

The VA Phoenix clinic utilizes a combination of hard and soft surface flooring. The lobby is poured terrazzo with insets of patterned tip-sheared loop carpet tile in the lobby waiting areas. Provider offices and counseling rooms also take advantage of the comfort underfoot and acoustics of carpet, with a design of carpet tile planks in a textured multilevel loop pattern. Bathrooms have poured epoxy resin flooring. Patient corridors and clinical spaces all utilize homogenous sheet vinyl, and rubber tile again provides ergonomic support to staff in the pharmacy.

SAN JOSE, CALIFORNIA
USFP and Hoefer Wysocki recently completed The VA San Jose Community-Based Outpatient Clinic. Part of the VA Palo Alto HealthCare System and replacing an older and smaller clinic built in 1996, the 95,000-square-foot facility serves 250,000 veterans and 80,000 active duty personnel in the area.

Visible from the adjacent freeway, the clinic was situated to maximize daylight and provide views of Mount Hamilton and the surrounding Santa Cruz mountains from all three floors. “This facility was designed as a ‘healing oasis’ with a park and outdoor recreational areas,” says Habib. “The concept is based on incorporating air, light and space so the design becomes a part of the healing process for patients. In addition, the campus features a memorial park to honor and thank veterans for their service.”

VA San Jose was awarded LEED Silver certification for its many sustainable features, including its optimal site orientation for passive solar design. The building’s exterior is wrapped in wood and metal panels and is encircled by a pedestrian-friendly landscape.

The VA San Jose has medium scale 12”x24” porcelain tiles in the lobby, with some waiting sections defined by Upofloor’s Xpression Clean Wood PVC-free resilient plank flooring in a wood-look pattern. Other lobby waiting areas and provider offices have the linear patterned loop Shaw Analog and Glitch carpet tile with EcoWorx backing. Clinical spaces have PVC-free sheet flooring with heat-welded seams from Shannon Specialty Floors’ Barenaked CS collection. The physical therapy gym has Ecore’s Ecofit rubber athletic flooring.


GREEN GLOBE CERTIFICATION
The four new VA clinics are built to attain Green Globe certification, a third-party process that includes both design documentation review as well as an on-site verification visit. It begins at a 1,000-point threshold, which will vary from project to project depending on non-applicable credits. Certification is based upon the percentage of the maximum obtainable credits achieved (35% to 54% is one globe, 55% to 69% is two globes, etc.). A project team works together with a Green Globe reviewer to provide the documentation they need to verify credit requirement compliance. Once the project is complete, the reviewer interviews the team on site and investigates the built product to award final certification.

Credits related to flooring are found in both the Indoor Environment and Materials and Resources sections of the rating system.

Ashley Eusey, PE, LEED AP, GGP, sustainability specialist at Hoefer Wysocki, reports, “The flooring industry has done an excellent job staying ahead of the building industry in the creation of Environmental Product Declarations (EPDs). These are steadily becoming a sustainability standard and assist in achieving credits under multiple rating systems, including Green Globe. Another area flooring has been ahead of the curve is in production of low VOC products. Whether it’s underfloor membranes, sealants, adhesives or the flooring itself, almost all products are well below VOC requirements. This too aids in gaining credits under the Indoor Environment sections of most rating systems.”

When asked to compare LEED and Green Globe, Eusey replied, “Green Globe is a third-party sustainability rating system created by the Green Building Initiative. Unlike LEED, there are no prerequisites, but there are non-applicable credits as well as more reviewer interaction. The certification also has an on-site review component to verify actual performance of the design. LEED and Green Globe are both excellent rating systems for verifying that an owner gains a return on their investment in sustainability. Each system has its own strengths and weaknesses, and given the client’s goals and preferences, Green Globe was a better fit for the VA’s projects.”


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