Discovering inspiration at the chance intersection between a personal emergency and a professional opportunity
July 11, 2012 by Yen Ong, AIA, NCARB, LEED AP BD+C
Minutes past a January midnight in 2007, my wife and I found ourselves in an ambulance heading for a prominent Dallas area hospital, projecting possible outcomes with hope and dread for the emergency delivery of our then 30-week-old son.
Upon arrival at the emergency department, we were transferred to a dimly lit, confining observation room via a hypnotic maze of coldly bright, insipid corridors. For the following hours in wait—spent in a viewless, character-devoid space without any direct sight of another human being or the outside world—we had much time to reflect and to escalate our anxieties, to feel helplessly alone and tormented.
It was an ironically insightful set of experiences that highlighted the prevalent underdevelopment of the emotional and aesthetic dimensions of the patient experience in the design of healthcare facilities. The event inspired a transformation of an ongoing project that—after several drafts—had then achieved its most pragmatic functional goals.
The very next draft saw a project infused with a purpose beyond the design of a place to administer care; it became a place that does.
In December 2006, three young physicians set out to establish a new model of care delivery, combining the programs of urgent and emergency care centers under one roof.
The building program included urgent care rooms, special treatment rooms, radiology suites, and critical care suites. Having the specialized expertise and experience in emergency medicine, they envisioned a patient experience-centered environment to support the delivery of high-quality healthcare at record time.
The physicians and 5G Studio developed the joint positions in favor of maximizing efficiency through clear spatial organization and designing architectural conditions that reassure and nurture basic human needs, creating what today is Legacy ER in Frisco, Texas.
Clear spatial organization
The building design articulated operational efficiencies without sacrificing the architectural experience of the patients, the physicians, and the staff. The staff core is centrally positioned to allow unobstructed surveillance and access while allowing staff presence to be sensed by the patients; its layout is rigorously fitted under an elemental ceiling spine that bisects through the interior.
The patient/physician circulation loops around the staff core. It is entered through a triage—a translucent transitive cubic space that links it to the waiting area. Yet another outer loop organizes the treatment rooms, which are configured in a same-handed orientation.
Clarity and efficiency form the framework from which the experiential and spatial opportunities emerge.
Optimal access to natural light and view
Understanding the positive behavioral effects of natural light and exposure to the outdoors, the programmatic components were configured to allow direct visual and daylight access to the exterior from all occupied spaces. When horizontal exterior views are undesirable, tall landscaping elements are placed some distance away from the exterior windows, to create perceptible exterior gardens that screen the views beyond.
Along paths without horizontal exterior views, clear-glazed skylights allow for sight of the sky. In rooms requiring privacy from the exterior, glass panes are acid-etched up to 6 feet and left clear above that to provide a necessary level of privacy without using any secondary system, such as blinds or curtains. It also maintains a direct sightline to the sky. Employing these simple strategies, patients can remain assuredly connected to the world beyond the healthcare setting.
Accessibility and interaction
The doctors fell in love with the proposed design for its openness, clarity, and sensitivity to their passionate goals of elevating the level of patient care. Patients are often reserved from discussing their health concerns openly with their care providers. To penetrate the psychological barriers, the different levels of treatment zones were organized without doors and walls while providing strong spatial and visual cues to distinguish one zone from another.
Ceiling planes and wall articulations were composed in complementary differentiation, planar versus rhythmic, soft versus hard, and transparent versus translucent. Translucent resin panels clad the staff core; the treatment room doors are glazed systems with varying transparencies. In this way, the treatment rooms and the circulation spaces became communicative rooms; the light qualities of one affect the other.
The architecture was intentionally composed to promote patient/physician interaction and to reflect the accessible personalities of the physicians.
Winning the award and the city's approval
The distinctive exterior design—which was a critical aspect of creating a cohesive experience between the exterior and interior environments—faced a significant challenge during its regulatory approval process through the City of Frisco Planning Department. The ordinance had been written such that new buildings in the city were to adhere to the contextual architectural cues of existing structures around the site.
For Legacy ER, this meant two neighboring prototypical buildings, one for a pharmacy store and another for an educational center. The progressive architectural proposal was deemed too uncharacteristic for the site.
What followed was a 5-month-long negotiation with the city, almost resulting in the abandonment of the architectural ambition. As luck would have it, 5G Studio submitted the conceptual design to The Center for Health Design's 2007 Healthcare Environment Awards competition and won the first place award in the Professional Conceptual category.
Among the first individuals notified were the City of Frisco planners who became excited at the prospect of having an award-winning facility in their city. Legacy ER earned the planning department's approval within the very next week.
Refining the patient experience
Progressing through a recursive process of refinement and challenged with a restrictive budget, 5G Studio distilled the guiding principles of the design and developed the sensorial dimensions of the spaces through strategic application of material, color, texture, light qualities, and varying translucencies. The objective was to imbue the facility with a vigilant character on the outside, balanced by a tranquil interior ambience offering a soothing place of respite for patients seeking emergency care.
The primary patient/physician circulation is characterized by translucent green resin panels, rhythmically spaced skylights, and a diamond-polished integrally colored concrete floor slab. Translucent resin panels, layered in hues of green, clad the primary operational backbone of the practice that includes the reception, triage, laboratory, and nurse station spaces.
The primary exterior façade is framed by two masses that appear to float aboveground under a zinc-clad canopy. One of the masses —the waiting area—is located on the south, lined with a clear glazing system on three sides. To its north are the physicians' lounge and exterior patio. The placement of these programs is intentional, to maximize transparencies along the building's most public façade and to warmly welcome incoming patients between the two elements.
Legacy ER now
Since the opening of Legacy ER, the facility had earned The Joint Commission's Gold Seal of Approval for the exemplary demonstration of compliance with the organization's national performance standards of quality and safety; two of the founding physicians—Dr. Jay Woody and Dr. Steve Martz—were named among the best emergency physicians in the Dallas-Fort Worth region for recent consecutive years; and it won the Frisco Star Community Newspaper Best Emergency Care Award for 2009, 2010, and 2011, as voted by city residents, as well as the 2011 Frisco STYLE Best of Business Award.
Legacy ER was also one of 10 global projects selected for the 2011 Architectural Record's Building Types Study on healthcare typology. Their patients have regularly commented on the positive difference in the experience of receiving medical care at Legacy ER.
Designers can responsibly avoid degrading the patient experience with environmentally induced emotional inconvenience and aesthetic starvation. The simple design intentions of Legacy ER were born out of the conviction—solidified by a coincidental sequence of events—that healing can be promoted through the environment of care, thoughtfully by design.