The role of the hospital campus as the “mother ship” of all services is changing. For some operators, the goal of bringing care closer to patients means adding new types of facilities to their network.

Mervyn Alphonso, managing director of development, NexCore Group (Bethesda, Md.), calls it the “retailing of healthcare.” “As a firm, we look at retail patterns and how some of the big-box retailers such as Target and Walmart are locating their stores based on a certain service area or criteria,” he says. “We’ve seen that trend continue with hospitals, to provide the same level of convenience and access to their patients rather than coming to the main hospital.”

As a result, big-box outpatient centers are starting to dot the healthcare landscape. But the move from big campus to big box isn’t an invitation to just repackage and relocate services into a smaller setting. Instead, it requires careful planning. “We need to think about: ‘How is the hospital or health system going to deliver those services?’ ‘What’s best for the patient care?’ and ‘What’s the big picture?’” Alphonso says.

Doing more with less
in 2009, United Health Services (UHS; Binghamton, N.Y.), a healthcare provider in New York’s southern tier, began the pre-design phase for its first large-scale, off-campus outpatient facility, in Vestal, N.Y. Its objectives were to improve access to outpatient care in an underserved suburban market, expand its patient base, and set a new standard for delivery of services in nonacute hospital settings.

The three-level, 85,000-square-foot multispecialty center would be located in a retail corridor and be a one-stop facility for primary care, rheumatology, cardiology, imaging, walk-in center, women’s center, lab, and pharmacy services.

Early on, UHS partnered with NexCore, which provided project management and advisory services, to evaluate best practices in work and patient flow, layout efficiency, and patient-friendly design spaces, as well as to finalize the program. The architect on the project was Chianis + Anderson Architects (Binghamton, N.Y.).

The three-month facility planning and programming process also led to some operational efficiencies. While the separate practices within traditional MOBs are often self-contained with their own waiting areas and scheduling desks, the trend is moving in the direction of larger group practices and employed physicians. “Many of these functions can now be shared to reduce the overall building area, providing more efficient practice space at less cost,” says Kim Prentice, managing director of development and operations, NexCore Group (Denver).

In the UHS project, the team utilized an open plan where physician groups flow into one another and service areas are clustered together. Each floor houses a centralized check-in/check-out, waiting, and scheduling area, while providers and nurses share work spaces. Because the workstations are located near pods of exam rooms, they improve patient supervision and minimize wasted steps, while also improving collaboration among colleagues.

The pre-design work also enabled the project to design for future needs. For example, a community room and records storage area were designed into the second floor to accommodate future physician practice groups, but while the project was under construction, a cardiology group was added to the facility and filled the two spaces. Because UHS was ahead of schedule to meet the federally mandated transition to EMR, they did not need to replace the records storage area, and the community room remained in another UHS facility nearby.

“It shows the flexibility of the planning modules,” Prentice says. “But that was all part of that initial thinking, to create a flexible design that would accommodate future re-configuration and expansion within the building.”

Warm welcome
As much as the building design focused on improving efficiency and patient care, the facility had to be inviting to patients, too. “We’re talking about getting away from providing outpatient services in a hospital setting and moving them to more cost-effective ambulatory facilities that provide patients with convenience and residential warmth,” Alphonso says.

UHS took advantage of the project to introduce a new brand image, logo, and interior materials palette. The first floor main lobby offers a café, concierge desk, pharmacy, lounge area, fireplace, and WiFi. Warm woods and natural materials are used throughout the public areas, with a grand staircase connecting the main floor to the primary care services on the second floor. Glass-enclosed work stations with color-coded soffits help identify staff areas on the upper floors.

Custom desks in the exam rooms were designed to promote face-to-face interaction between patients and the staff. The desk—affectionately called the “shark fin”—and a wall-mounted monitor are strategically placed to ensure eye contact while staff gathers patient medical information.

To further attract patients, UHS decided to expand its women’s services into the Vestal Women’s Center on the third floor, offering a range of services, from gynecology to mammography suites, in one location.

Measuring success
UHS Vestal opened its door a little over a year ago, and already its results are exceeding expectations. In a release, Joe Cerra, senior vice president of Physician Practice Management at UHS, says the Vestal walk-in center is busier than any of the system’s other centers, surpassing volume projections by 41 percent in 2012.

The location is also attracting new patients, too, including from nearby Binghamton University. The school’s students made up 20 percent of the walk-in traffic during the facility’s first four months of operation.

UHS is also using the $30 million project to kick-start a building refresh by taking elements of the Vestal building’s interior design into existing properties and new facilities.

“It’s a very competitive environment out there and these hospitals and systems are consolidating and acquiring one another,” Prentice says. “So they need to do whatever they can to differentiate themselves and to be more user friendly, more welcoming, and reduce waiting time.”

Anne DiNardo is senior editor of Healthcare Design. She can be reached at


A more in-depth look at this topic and the UHS Vestal project will be shared at the Healthcare Design Conference, (Nov. 16-19, Orlando) in the session "Big Box Integrated Outpatient Centers—Planning, Programming and Implementation.” For more information, visit