Seattle-based Group Health Cooperative’s Puyallup Medical Center was looking to create a medical home model while expanding its portfolio of clinics and enhancing or replacing existing clinic facilities. Its first undertaking, an outpatient medical center in Puyallup, Wash., was designed by CollinsWoerman (Seattle) as a prototype, using an integrated care and facility design (ICFD) standard to be used for up to 14 additional clinics in the Group Health family.

CollinsWoerman worked closely with more than 200 Group Health staff members, from doctors and nurses through operations and administrative staff, in a series of Lean 3P design events, designed to inform the architectural and interior design process by melding it with the effective clinical and business practices already in place at Group Health. As the team generated new design solutions, every element, from how patients make appointments to where the blood pressure monitor is located in each exam room, was first tested by patients and providers in a full-scale, cardboard mock-up of the facility that had been built in a local warehouse. As improvements were identified, adjustments were made, tested, and retested until optimal efficiency and patient satisfaction and well-being were achieved.

The development of the delivery model and the design and construction of the pilot clinic combined the use of integrative process with related performance incentives/penalties for the architecture and contractor team, the Lean process, BIM, and LEED for Healthcare. The Puyallup Medical Center has been awarded LEED Gold for Healthcare status; it's the first such certification in the country.

Multifunctional clinic space needed to be adaptable to primary care, specialty care, and in-room treatment. The team utilized standard exam/treatment room design, but in a standard “care pod,” which provided flexibility. The specialty carts and equipment were then located within these specialty pods. To reduce travel distance for patients and providers, exam/treatment rooms were located closest to the points of entry. On-stage/off stage work areas were designed to locate providers closest to their work.

Phil Giuntoli is a principal and healthcare practice leader for CollinsWoerman (Seattle). He can be reached at

Team members on the Puyallup Medical Center project include:

  • Owner/developer: Benaroya Co., Group Health Cooperative
  • Owner representative: CB Richard Ellis
  • Architect: CollinsWoerman
  • General contractor: GLY Construction
  • MEP partners—design-build: UMC, Prime Electric, Patriot Fire Protection
  • Exterior envelope partners—design-assist: PCS, All New Glass, Northshore Sheet Metal, Wayne’s Roofing
  • Structural partners: PCS Structural (structural engineer), B+B Steel (structural steel supplier), Superior (steel erection), Harris/Central (rebar)