Healthcare Design Magazine

Dual Design

by Jennifer Kovacs Silvis

Spine Institute and Orthopedic Center, Glendale, CA

Spine Institute and Orthopedic Center, Glendale, CA

The team at Puchlik Design Associates of Pasadena, California, was faced with a unique objective when it was brought on to design the Spine Institute and Orthopedic Center at Glendale Adventist Medical Center in Glendale, California.

The fruition of 10 years of planning by the large urban hospital, the facility would become one of the few specialty spine clinics in the Greater Los Angeles area, and the only one of its kind in the San Gabriel Valley, to serve the outpatient needs of both spine and orthopedic patients. For better efficiency and to provide more collaboration to physicians at the hospital, the facility is housed in an adjacent medical office building (MOB) and connected by bridges providing access between the two structures.  

Serving both unique patient populations, the hospital requested there be dual design components for the two services, including separate reception areas for orthopedic and spine patients. “They wanted the patients to have a sense that it was a unique center to them. From the patient perspective, they wouldn’t necessarily know that they were sharing the space,” says Jeanmarie Zimmerman, AIA, ACHA, CID, EDAC, design director and associate at Puchlik Design.

Ownership also had a goal in mind of creating a signature facility with a design aesthetic unusual for a traditional MOB clinic space. “They were looking for a hallmark facility that was upscale and had a spa-like quality in terms of the finishes that were being provided,” says Peter Schubin, AIA, project manager at Puchlik Design.

Added challenges to the project included a very specific budget, an aggressive completion schedule, and the MOB itself, where there were just 5,800 square feet dedicated for the institute. 

The design-build project set out to accommodate several physicians and specialists within the space, including a “hoteling” office dedicated for multiple specialty care providers when they are onsite. The Puchlik Design team consulted heavily with doctors and staff when designing the facility, working through the program and even changing it a bit to add more exam rooms. The space also was designed with the possibility in mind that expansion could occur at some point, with the orthopedic waiting room potentially being eliminated—as a result, that space specifically needed to be designed in a way so it could seamlessly become additional exam space for the spine side in the future.

And then there was the actual floor plan, which proved to be a significant design obstacle. “The physicians at inception of the project had a program of spaces they wanted us to incorporate. That program didn’t necessarily line up with the tenant space they had leased, and we looked at other options in terms of accessing additional space. But, ultimately, we were able to come up with a plan that met almost all of their plans within the space they wanted to lease,” Schubin says.

“Sometimes the things that constrain you end up being the design challenge that inspires the rest of the design,” Zimmerman adds. “The way the overall floor plan of the MOB was laid out, it didn’t leave a lot of nice opportunities for waiting entrancing, specifically on the spine side. It’s a very tight, odd floor plate where we wanted to put the waiting room, so we ended up using that geometry of the space—we actually cut in a little bit so there would be a more visible entrance off the elevator core and the bridge that connects directly to the hospital.”

The result is a unique main entry at a key visual point, both across from the pedestrian bridge connecting to the main hospital and across from the elevator serving the MOB. Spine and orthopedic patients access the office from different entrances, again, with separate waiting rooms. Upon entering the exam areas, patients encounter what the team dubbed a “crossroads concierge,” where there is a “nurse navigator” stationed to escort patients to the exam rooms and serve as a central point for outgoing patients to ensure they schedule follow-up appointments. Spine exam rooms extend to the left of the crossroads concierge station and the orthopedic rooms to the right. “The layout actually resembles a ribbon, and where the ribbon ties is this common area where the nurse navigator resides,” Schubin describes.

Earth, sea, and sky

The specific patient population that is being served inspired the design from the first point of patient access, including the reception counter providing first-time visitors privacy; careful furniture selection for seating of the orthopedic and spine patients; and a welcome center offering coffee, fruit, and other options. With an overarching design intent of putting patients first, the plan set out to support patient needs from entrance to exit, providing physical comfort and peace of mind.

Exam rooms feature either direct or borrowed daylighting through sidelights that bring natural light into the inner core spaces, and the tight rooms are made to feel more spacious through maximized ceiling heights and tall doors. The design tactic helped achieve the goal of a luxurious, open space. “There was some skepticism about whether that would fit the budget until [ownership] realized it wasn’t that much more for these subtle things that gave it a much more elegant look,” Zimmerman says.

Also due to the limited amount of space available in the exam rooms, casework was kept to a minimum; however, the casework was used to bring in a deep chocolate accent color. A solid surface was used for the sink, with a freeform backsplash used to pick up on additional blue accent colors. “The three walls in the exam room are cream color, with one accent wall and a piece of artwork. Then, every exam room has a splash of resilient flooring inlay; it’s almost like the flooring finish bleeds through all the exam rooms. As you walk down the corridor, if the exam rooms are open, you have a sense of continuity,” Zimmerman says.

taff areas also feature daylighting and were designed to have a separate entrance from patients so physicians could come and go privately. A common staff back office is strategically placed between both the spine and orthopedic reception to facilitate transfer of information between the two clinics and to share common equipment. Three total nurses’ stations are centrally located to ensure staff is in proximity to all patient areas and easily found by patients.

Artwork selection was also made by the Puchlik Design team. Packages were put together that represented the established thematic elements of “earth, sea, and sky” and then presented to the executives and doctors at the institute. “We proposed a lot of different things, and some of them they didn’t react to well, but then we found others. The artwork was done on a fairly modest budget. There were certain pieces that were more key … but there is quite a bit of art in this space. It is collaborative with the finishes, and every exam room has a piece of art in it, which was a joy to do,” Zimmerman says. The “earth, sea, and sky” theme was also continued through the use of various finishes, including glass tile mosaics, mixed metallics, frosted glass, and carpet featuring a wave-like pattern. Lighting also played a predominant role in the interior design, with pendant and wall sconces dubbed the “jewelry” of the space.

In the end, though the design was different than anything the hospital had incorporated previously, its success spoke for itself.

“We explored new finishes and materials that weren’t used anywhere in the facility, either in the acute care hospital or the MOB. The hospital actually considered the final product so successful that they are considering it as a standard for the entire facility,” Schubin says. HCD