Cincinnati Children’s Hospital Medical Center’s (CCHMC) first-floor main concourse has seen a lot of growth in recent years, including the relocation of several clinics to the space, the addition of an entrance to a new research tower, and amenity spaces expanded to include a family resource center. “The concourse kept getting these added pressures,” says Michael Browning, assistant vice president of design, construction, and space management at CCHMC. “It was busier and busier.”

While growth is good, one downside was the impact it had on the arrival sequence for patients and families. Browning says one of the main problems was that the registration and waiting areas for several of the clinic additions encroached on the concourse, condensing the circulation space for the more than 3,000 outpatients and family members arriving on campus daily.

Furthermore, those additions, such as a cancer and blood diseases clinic, were treated almost as “mini design competitions,” Browning says, with each project delivered with a unique design. The result was individual clinics that didn’t necessarily visually link to the rest of the concourse or weren’t very well delineated. Another inherent problem was the building organization, with most visitors arriving to the facility via six different elevators leading from an underground parking garage to the concourse. From there, patients would have to navigate to one of four welcome centers that support the various clinic and inpatient buildings (identified as A, B, C, and D).

However, in some areas, the corresponding welcome center wasn’t immediately visible from the elevators, which created confusion on where patients and families should go. “At some of the arrival points, the elevator doors would open and you’d be looking at a brick wall with paper signs taped to it,” Browning says. “It wasn’t an intuitive entry area.”

Recognizing the need to “step back and look at the entire concourse,” Browning says the medical center conducted some master planning exercises, concluding that it needed to address the main entrance to the hospital. However, the timing wasn’t ideal to undertake a major project at its front door, as the organization was already planning to break ground on a $600 million critical care building on the campus. So instead, Browning set out to sell leadership on a near-term solution to address the arrival sequence and wayfinding within the concourse.

Armed with data from a patient and family experience survey conducted by GBBN (Cincinnati) and Kolar Design (Cincinnati), including observations, concourse flow study and analysis, as well as responses from building users, he made the case that the existing layout and design were confusing and adding to families’ stress. Browning argued that a renovation to address the arrival experience should be considered sooner rather than later. “We were able to sell it a little more by knowing the critical care building was coming, and that the arrival experience was already a problem and we were going to be adding even more to it,” he says.

Looking to simplify

After getting buy-in from CCHMC leadership, phased construction on the project began in February 2016, with GBBN providing full architectural services on the project and Kolar Design providing way-finding, art, graphics, and positive distractions. “It’s rare for urban hospitals to take on this type of front door disruption, without being done in a large project budget or initiative at the time,” says Michael Lied, principal and director of healthcare at GBBN. “I think it’s made a difference for the patient and family experience and improved the existing facility and flow.”

Specifically, the goals of the renovation were to simplify the art and architecture to make it clearer to patients and visitors where they were within the facility and develop new environmental design standards—including colors, materials, and signage—to guide not only the current project but future ones, as well. For example, while the existing wayfinding program included a barrage of signage on the ceilings and floors, the project team decided to simplify the approach. The design relies on existing colors assigned to each building, including orange, blue, purple, and red, to denote key areas via the use of textured column wraps and colored ceiling elements. The signage was also reduced, thanks to the addition of new  digital directories.

The spaces along the concourse between the clinics and buildings were then renovated using a neutral palette to allow the arrival areas and tower entrances to further pop along the concourse. “You can see the colors down the concourse to help you get to the right area,” says Brooke Behnfeldt, principal and senior interior designer at GBBN.

In addition, animal characters were assigned to each building, such as an armadillo for Location A and a dinosaur for Location D. These characters appear in graphics and as kid-friendly sculptures in the arrival areas near the parking garage elevators, to help young patients and families identify the entrance they used and find their way back. The colors and graphics are repeated in the parking garage to further assist navigation from the garage to a specific building entrance.

Recognizing that families often arrive with lots of gear, including strollers, coats, and umbrellas, the project team further improved the concourse experience by designating landing zones off the elevators to give patients and families space to orient themselves and adjust their belongings before moving deeper  into the building. “The landing pads give them a place to decompress for a moment,” Behnfeldt says.

One of the biggest transformations on the project was the concourse area near Location A, a highly traveled entrance where the existing elevator opened to face a water fountain and restrooms and the welcome desk was located behind a wall. To resolve the set-up, the medical center decided to reroute the main parking garage’s entrance to add 2,400 square feet to the area. Then a wall was removed and the elevator door was reoriented to create a more welcoming setting.

“Now when the doors open, you can see the welcome center and you see very clear graphics and artwork that connect the elevator to the visitor welcome desk,” Browning says. “A lot of the exercise was really just clarifying intuitive architecture so you didn’t have to stop and ask a question or rely on signage for help.”

Guide for the future

Browning says one of the most compelling aspects of the project was recognizing that the previous concourse was adding stress to users’ experiences. “We definitely improved the intuitiveness and added a calming sense,” he says. Furthermore, he says the project’s architectural language will be used when the main concourse is extended to connect to the new critical care building. In fact, designers have already started developing the addition’s wayfinding cues, starting with its animal character: a giraffe.

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