Attachment D.8 - CFM- CBOC Prototype Design.pdf

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Department of Veterans Aff airs

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.1

2.0 Project Narrative

Introduction A large part of VA healthcare facilities are the Community Based Outpatient Clinics (CBOC). VA has identifi ed a potential cost and schedule savings through the use of standardized planning and design elements and potentially utilizing off -site construction. Th ese clinic templates incorporate the PACT Space Module developed to support VA’s transition to PACT based on the Patient Centered Medical Home (PCMH) model of care.

Th is study developed standard modules to support a variety of clinic sizes, services, staffi ng and operational needs that are fl exible and allow for future adaptability to changing needs. Th e goal is to develop highly functional and effi cient outpatient clinics at the best dollar value to reduce cost and overall project schedule.

Th e objectives as defi ned in the Statement of Work are as follows:

• Develop standard design for various functional areas within outpatient clinics, referred to herein as “design modules”

• Develop standard designs for three outpatient clinics of graduating size using the design modules.

Projects representing multiple VISNs will be identifi ed by VA prior to award of this task.

Building areas will be approximately 20,000 NUSF, 50,000 NUSF, and 80,000 NUSF

• Insure that standard designs enable and promote off -site construction methods such as volumetric “modular” construction, panelized construction, etc.

Th e three VISNs participating in this study are VISN 21, VISN 8, and VISN 23 and each represents respectively One, Two, or Th ree-PACT CBOC. Each VISN has provided a Program for Design (PFD) which will be utilized to test and fi t the design modules and develop schematic design fl oor plans. Th e designs are based on the existing VA space criteria, standards, and design guides applicable to outpatient clinics;

as well as, the PACT Space Planning Criteria Chapter 262-A, recently completed and PACT Space Module Design Guide currently under development. Th e guidelines in the PACT Space Module Design Guide shall be the guiding principles.

Refer to Section 9 - Appendix for a list of references used throughout this study.

Design Charrettes Th e Project Team is comprised of VA subject matter experts, VA program offi cials, VA Medical Center staff from the three VISNs and the design consultant team. Multiple charrettes, or collaborative working sessions led to the success of the outcomes in this study where all participants worked through design solutions over a period of days at any given time. Th e purpose of a charrette is to serve as a way of quickly generating a design solution while integrating the aptitudes and interests of the diverse group of participants. Th e study is unique in the sense that the charrettes included representatives from three VISNs weighing in on each clinic type, not just their own.

Th is Project Team has been integral in developing the three prototypical PFDs that will be utilized as the basis of design for the design modules, conceptual diagrams and clinic layouts for the One, Two and Th ree-PACT CBOCs. Towards the end of each charrette, time was dedicated to test and fi t each VISNs Programs for Design to validated the fl exibility and modularity of the layouts.

Refer to Section 7 - VA Test and Fit Programs for Design for additional information on the Maui, Brooksville and Rapid City Community Based Outpatient Clinics.

Attachment D.8 - CFM - CBOC Prototype Design

2.2

This page has been left blank intentionally.

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.3

Patient Aligned Care Team (PACT) Th e Offi ce of Patient Care Services, Primary Care Program Offi ce, has implemented a VA version of the patient-centered medical home (PCMH) model at all VHA Primary Care sites, called Patient Aligned Care Teams (PACT). Th is initiative supports VHA’s Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, and is managed by PACT teamlets with the active involvement of other clinical and non-clinical staff .

PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer Emergency Department hospital visits and readmissions. Th e Primary Care Program Offi ce has developed a variety of operational tools to assist Primary Care staff with the transformation to Th e Patient Aligned Care Team.

Although the concept of Patient Centered Medical Home has been around since the 1960’s starting with pediatric care, it had not been translated into primary care until fairly recently.

Th e primary care team consists of the Veteran patient along with all the staff , clinical and administrative, necessary to promote the well-being of the Veteran patient.

Th e team can be described as two parts: the teamlet and the extended care team. Th e teamlet consists of a primary care provider, RN-care manager, Clerical Associate and Administrative Associate; together, they form a partnership with the Veteran.

To coordinate seamless care, all members of the teamlet and extended care team will collaborate with an extended group of medical and support staff , including non-VA health care providers, to meet the needs of the Veteran patient. Extended team members and other consultants work in a coordinated manner with the PACT teamlets and the veterans. Th e teamlet will manage these consultations in order to provide coordinated care and foster smooth transitions between the many facets of the health care system.

For the purposes of this study, a PACT Teamlet is illustrated in Figure 2.1 below.

Provider

1 Team + 2.5 Exam Rooms

Registered Nurse

Figure 2.1

Defi ning Characteristics

PACT

2.1 Patient Aligned Care Team (PACT)

2.4

Key Principles for PACT include:

Patient-Driven: Th e PACT teamlet is focused on the whole person. Patient-preferences guide the care provided to the patient.

Team-Based: Primary care is delivered by an interdisciplinary team lead by a primary care provider using facilitative leadership skills

Effi cient: Veterans receive the care they need at the time they need it from a licensed team functioning at the highest level of their competency

Comprehensive: Primary care serves as a point of fi rst contact for a broad range of medical, behavioral and psychosocial needs that are fully integrated with other VHA health services and community resources.

Continuous: Every patient has an established and continuous relationship with a PACT teamlet.

Communication: Th e communication between the Veteran patient and other team members is honest, respectful, reliable and culturally sensitive.

Coordinated: Th e team coordinates care for the patient across and between the health care systems including the private sector. Th e teamlet consists of a primary care provider, RN-care manager, Clerical Associate and Administrative Associate;

together, they form a partnership with the veteran.

One PACT CBOC

- 4 teamlets

-4,800 uniques

Two PACT CBOC

- 8 teamlets

-9,600 uniques

Three PACT CBOC

- 12 teamlets

- 14,400 uniques

Figure 2.2

PACT Space Module Overview

Space Planning Module Overview Th e three CBOC Prototype Programs for Design have been developed to include PACT modules for Primary Care. For the purpose of this study, the One-PACT CBOC will include a 1 PACT module; the Two-PACT CBOC will include 2 PACT modules; and the Th ree-PACT CBOC will include 3 PACT modules. Refer to Figure 2.2 below.

Each PACT Space Module consists of 8 exam rooms, 4 consult rooms, 2 women’s health rooms and 1 procedure room. Group Rooms and Shared Medical Appointment Rooms are also a key spaces included in the PACT footprint. Refer to Section 3 - Prototype Programs for Design for specifi c information pertaining to the PACT Space Modules.

During the working sessions, the Project Team determined that the number of PACT modules did not defi ne the size of the Two and Th ree-PACT CBOCs, but rather, the size was driven by the multi-specialty care services provided within that prototype. CBOC clincis provide a wide ranging and variable set of services and these overall array of services drives the space planning and space allocation.

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.5

2.2 CBOC Prototype Planning Assumptions

Introduction Th is study incorporates planning assumptions from several sources, to include reference documents provided by VA, interviews with VA subject matter experts at the participating VISNs and VACO, input from core steering group members, and data available from VISN 17 VA Service Delivery Planning and Master Planning eff orts. Th ese assumptions establish the foundation for the One, Two, and Th ree-PACT CBOC Prototype PFDs.

Population

• Each PACT teamlet empanels approximately 1,200 unique users.

• Each PACT Space module as illustrated accommodates up to four teamlets (PACT - Primary Care Space Planning Criteria Chapter 262-A, dated July 24, 2013).

• Th e One-PACT CBOC supports approximately 4,800 primary care unique users (4 teamlets).

• Th e Two-PACT CBOC supports approximately 9,600 unique primary care users (8 teamlets). Additionally, it supports approximately 19,200 unique users with specialty care services. Th e specialty care population is comprised of its own primary care patients, plus unique users from two additional One-PACT CBOCs (or equivalents) in the geographical area (9,600 + (4,800 x 2) = 19,200).

• Th e Th ree-PACT CBOC supports approximately 14,400 unique primary care users (12 teamlets). Additionally, it supports approximately 28,800 unique users in the geographical area with specialty care services, similar to the Two-PACT CBOC. Th e specialty care population is comprised of its own primary care patients, plus unique users from three additional One-PACT CBOCs (or equivalents) in the geographical area (14,200 + (4,800 x 3) = 28,800).

2.6

Scope of Services Services included in each CBOC prototype were selected by fi rst reviewing their frequency of occurrence in the previously published Feasibility Study for the Development of Standardized Designs for Outpatient Clinics (National Institute of Building Sciences, 2013), then refi ning the service mix through the planning charrette process.

• Th e One-PACT CBOC includes the following clinical and administrative services:

– PACT Primary Care

– Mental Health

– Pharmacy

– Laboratory

– Logistics

– Canteen

– Audiology

– Police + Security

• Th e Two-PACT CBOC includes the following clinical and administrative services (services not included in the One- PACT CBOC are bolded):

– PACT Primary Care

– Mental Health

– Audiology

– Eye Clinic

– Physical Medicine and Rehabilitation (PM & R)

– Home Based Primary Care

– Prosthetics and Sensory Aids

– Pharmacy

– Laboratory

– Radiology

– Logistics

– Canteen

– Engineering

– Police & Security

– Clinic Management

– Ancillary Diagnostic Services

– Business Services

• Th e Th ree-PACT CBOC includes the following clinical and administrative services (services not included in the Two- PACT CBOC are bolded):

– PACT Primary Care

– Mental Health

– Audiology

– Eye Clinic

– PM & R

– Multi-Specialty Care/Ancillary Diagnostic Services

– Dental

– Home Based Primary Care

– Prosthetics and Sensory Aids

– Pharmacy

– Laboratory

– Radiology

– Logistics

– Canteen

– Engineering

– Police & Security

– Clinic Management

– Business Services

Multi-specialty care is intended to be fl exible in the types of specialties accommodated. Data from other VISN Service Delivery Planning studies suggest that the Th ree-PACT CBOC specialty care population supports either full time or part time cardiology, pulmonary medicine, podiatry, orthopedics, urology, and tele-dermatology. Tele-health is included as part of the PACT Space Module in all CBOC sizes. It may become a principle route for which specialty care is delivered in a CBOC setting.

Refer to Section 4 - Planning Components + Modules for specifi c information pertaining to the layout and equipment layouts by service.

Key assumptions and space requirements are summarized by service and CBOC Prototypes on the following pages.

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.7

One PACT CBOC Two PACT CBOC Three PACT CBOC

692 DGSF 4,302 DGSF 5,624 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC

9,454 DGSF 18,718 DGSF 27,982 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC

190 DGSF 2,409 DGSF 4,058 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC

0 DGSF 2,903 DGSF 5,411 DGSF

PACT Primary Care

Programming Assumptions:

• One-PACT CBOC: 4 teamlets

• Two-PACT CBOC: 8 teamlets

• Th ree-PACT CBOC: 12 teamlets

Audiology and Speech Pathology

Programming Assumptions:

• One-PACT CBOC:

- Hearing Aid Programming/Fitting

• Two-PACT CBOC:

- 2 providers,

- 1 technician

• Th ree-PACT CBOC:

- 3 providers, 2 technicians

- vestibulography

- electrophysiology

Mental Health

Programming Assumptions:

• One-PACT CBOC:

- 1 provider/coordinator in addition to embedded

PACT

- 1 group therapy room

• Two-PACT CBOC:

- 8 providers/coordinators

- 2 group therapy rooms

• Th ree-PACT CBOC:

- 12 providers/coordinators

- 3 group therapy rooms

Eye Clinic

Programming Assumptions:

• Two-PACT CBOC:

- Fitting and Dispensing Room

- Photography/Imaging Room

- Pre-Testing Room

- 2 providers, possibly 1 trainee

- 2 techs

• Th ree-PACT CBOC:

- Fitting and Dispensing Room

- Photography/Imaging Room

- Pre-Testing Room

- Blind Rehabilitation (VIST)

- 4 providers, possibly 2 trainees

- 4 techs

2.8

Programming Assumptions

• Two-PACT CBOC:

- 1 provider

• Th ree-PACT CBOC:

- 2 providers

0 DGSF 2,356 DGSF 4,689 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC

0 DGSF 1,839 DGSF 2,614 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC One PACT CBOC Two PACT CBOC Three PACT CBOC

0 DGSF 0 DGSF 3,709 DGSF

y

One PACT CBOC Two PACT CBOC Three PACT CBOC

0 DGSF 730 DGSF 912 DGSF

Physical Medicine and Rehabilitation Dentistry

Programming Assumptions:

• Th ree-PACT CBOC:

- 6 operatories

- panoramic/cephalometric room

- prosthetics laboratory

- 2 Dentists

- 2 Hygienists

Multi-Specialty Care/ Ancillary Diagnostic Services

Programming Assumptions:

• Two-PACT CBOC:

-support and teaming space for Ancillary Diagnostic Services based on PACT model

• Th ree-PACT CBOC:

- 6 exam rooms (1 is podiatry)

- cardio/pulmonary exercise area

- cast room

- tele-health room

Home Based Primary Care

Programming Assumptions:

• Two-PACT CBOC:

- 1 team room

- 1 storage room

• Th ree-PACT CBOC:

- 2 team rooms

- 1 storage room

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.9

Programming Assumptions:

• Two-PACT CBOC:

- Storage

- Mailing Room

- Prosthetics Clerk Offi ce

• Th ree-PACT CBOC:

- Storage

- Mailing Room

- Prosthetics Clerk Offi ce

152 DGSF 1,740 DGSF 2,864 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC

0 DGSF 631 DGSF 631 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC

0 DGSF 1,170 DGSF 3,450 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC

One PACT CBOC Two PACT CBOC Three PACT CBOC

745 DGSF 1,307 DGSF 2,113 DGSF

Prosthetics & Sensory Aids Radiology

Programming Assumptions:

• Two-PACT CBOC:

- 1 general radiology room

• Th ree-PACT CBOC:

- 1 general radiology room

- 1 bone densitometry

- 1 mammography

- 1 ultrasound

- 1 radiography / fl uoroscopy room

Pharmacy

Programming Assumptions:

• One-PACT CBOC:

- Automated Drug Dispensing System (ADDS) Room

• Two-PACT CBOC:

- 1 Dispensing

- 2 Prescription drop-off windows

- Filling + Assembly

- Storage

- Consult Room

• Th ree-PACT CBOC:

- 2 Dispensing

- 2 Prescription drop-off windows

- Filling + Assembly

- Storage

- Consult Room

Pathology and Laboratory Medicine

Programming Assumptions:

• One-PACT CBOC:

- 2 phlebotomy stations

- point of care testing

- specimen collection toilet

• Two-PACT CBOC:

- 4 phlebotomy stations

- point of care testing

- specimen collection toilet

- small shipping and receiving area

• Th ree-PACT CBOC:

- 5 phlebotomy stations

- point collection of care testing

- specimen collection toilet

- small shipping and receiving area

- chemistry section

2.10

Programming Assumptions:

• One-PACT CBOC:

- Beverage, Snack, and Food Machines

- Limited Seating

• Two-PACT CBOC:

- Café Shop

- Customer Area

- Offi ce/Storage

- Seating Area

• Th ree-PACT CBOC:

- Café Shop

- Retail Space

- Customer Area

- Offi ce/Storage/Food Prep

- Seating Area

One PACT CBOC Two PACT CBOC Three PACT CBOC

502 DGSF 1,322 DGSF 1,322 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC

593 DGSF 1,406 DGSF 3,093 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC

0 DGSF 304 DGSF 304 DGSF

190 DGSF 524 DGSF 524 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC

Canteen

Engineering

Programming Assumptions:

• Two-PACT CBOC:

- Biomedical engineering repair shop

• Th ree-PACT CBOC:

- Biomedical engineering repair shop

Logistics

Programming Assumptions:

• Space requirements dependent upon proximity to parent VA facility and number of outpatient visits

• One-PACT, Two-PACT, and Th ree-PACT requirements estimated

Police and Security

Programming Assumptions

• One-PACT CBOC:

- operations room

• Two-PACT CBOC:

- Holding room

- operations room

- safe

• Th ree-PACT CBOC:

- Holding room

- operations room

- safe

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.11

Programming Assumptions

• Two-PACT CBOC:

- CMO and Nurse Manager Offi ces

• Th ree-PACT CBOC:

- CMO and Nurse Manager Offi ces

0 DGSF 547 DGSF 669 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOCOne PACT CBOC Two PACT CBOC Three PACT CBOC

0 DGSF 380 DGSF 380 DGSF

1,034 DGSF 2,326 DGSF 3,435 DGSF

One PACT CBOC Two PACT CBOC Three PACT CBOC

Clinic Management

Lobby/Common Areas

Programming Assumptions

• One-PACT CBOC:

- volunteer alcove

- wheelchair storage

- vestibule

• Two-PACT CBOC:

- volunteer alcove

- wheelchair storage

- vestibule

- male/female public toilets

• Th ree-PACT CBOC:

- volunteer alcove

- wheelchair storage

- vestibule

- male/female public toilets

Business Services

Programming Assumptions

• Two-PACT CBOC:

- 4 workstations

• Th ree-PACT CBOC:

- 4 workstations

2.12

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.13

2.3 Structural Bay Overview

Structural Bay Overview Regardless of the clinic size, shape, or desired fl ow, all spaces are to work within the modules and are confi gured with a standard column grid to allow for fl exibility as spaces respond to future needs and growth. By utilizing an optimal column grid, in response to the program for design, one is able to place the walls in such a way that the columns do not impact the clinical layout. Structural columns placement are critical to consider early in the design process to avoid columns in odd places within a room. Lack of doing so, may impact patient/ staff fl ow within a room, the equipment layout and required clearances. After multiple studies, the optimum column grid selected as the preferred course of action is 31’-10” x 31’-10”, illustrated below. Th is grid allows for standard 125 square foot universal rooms with a six foot clinic corridor.

Universal Room Th e universal room concept is simply to state that the 125 SF space can readily change from exam rooms, consult rooms, offi ces, etc. Th e universal room accommodates multiple clinical modalities; primary care, specialty care, women’s health, mental health, eye clinic, podiatry, etc. Th e primary goal is to support fl exible use in clinical areas. Th e secondary goal is to support general ease of space planning and systemetizing. Th e following is a list of spaces that may fi t within the criteria for a universal room:

• Exam Room

• Specialty Exam Room

• Consult Room

• Flex Offi ces

• Mental Health Consult Room

• Clinic Management Offi ce

• Tele-health Room

• Clean Room

• Equipment Room

Refer to Section 8.2 Adaptation Diagrams to understand the trade-off s when considering off -site construction versus traditional construction methods.

125 SF

EXAM/

CONSULT

256 SF

CONFERENCE

125 SF

EXAM

68 SF

PROCEDURE

TLT

125 SF

EXAM

125 SF

EXAM

125 SF

EXAM

183 SF

PROCEDURE

125 SF

EXAM

125 SF

EXAM

125 SF

EXAM

31' - 10" 31' - 10"

32' - 0" 32' - 0"

0"

143 SF

EXAM/

CONSULT

292 SF

CONFERENCE

143 SF

EXAM

68 SF

PROCEDURE

TLT

219 SF

PROCEDURE

143 SF

EXAM

143 SF

EXAM

143 SF

EXAM

106 SF

EXAM

106 SF

EXAM

106 SF

EXAM

106 SF

EXAM

32' - 0" 32' - 0"

0"

127 SF

EXAM/

CONSULT

259 SF

CONFERENCE

127 SF

EXAM

68 SF

PROCEDURE

TLT

186 SF

PROCEDURE

127 SF

EXAM

127 SF

EXAM

127 SF

EXAM

127 SF

EXAM

127 SF

EXAM

127 SF

EXAM

31' - 6" 31' - 6"

6"

122 SF

EXAM/

CONSULT

250 SF

CONFERENCE

122 SF

EXAM

68 SF

PROCEDURE

TLT

176 SF

PROCEDURE

122 SF

EXAM

122 SF

EXAM

122 SF

EXAM

122 SF

EXAM

122 SF

EXAM

122 SF

EXAM

Figure 2.4

32’-0” x 36’-0” Grid

Figure 2.5

32’-0” x 32’-0” Grid

Figure 2.6

31’-6” x 31’-6” Grid

Figure 2.3

31’-10” x 31’-10” Grid

2.14

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.15

2.4 Conceptual Diagrams - Overview

Conceptual diagrams are the fi rst set of diagrams that an architect will create in the planning process. Th ey are also be used to understand the impacts as the design changes and develops. Such diagrams were utilized in the development of the planning modules, components and the three prototype clinics. Th e typical conceptual diagrams utilized for this project included process fl ow diagrams, block & stack diagrams and computer modeling.

Process fl ow is illustrated in bubble form, identifying typical steps a patient may take within a clinic. In this type of diagram, potential bottleneck locations can be identifi ed, effi ciencies can be improved and patient travel distances are better understood. Block and Stack diagrams is an exercise that studies the massing spaces as they relate to one another and off ers opportunities for identifying desireable departmental adjacencies. After utilizing process fl ow and block and stack diagrams, assumptions can be validated once diagrams are created with computer modeling. Computer modeling allows view the spaces in a three-dimensional format. Th ese types of diagrams inform one another and enable the design process.

Th ese diagrams are utilized in the planning process to:

• Understand the typical clinic fl ow (patient/staff /service/ supply)

• Improve clinic effi ciencies

• Identify potential bottle necks

• Improve patient experience

• Smooth patient fl ows

• Improve staff work fl ow

• Improve travel distances

• Identify proper clinical adjacencies

• Improve overall clinical layout

Th e following pages utilize diff erent forms of diagrams such as fl ow diagrams, axonometric diagrams, Th ree-Dimensional renderings and linear diagrams to illustrate the planning processes used throughout the course of this study.

2.16

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.17

2.5 Typical Patient/Staff Flow

Typical Patient/Staff Flow Th e following patient fl ow diagrams represent’s a patients experience and movement. During the multiple design charrettes and user interviews, patient fl ow was explored to understand where choke points may occur, ways to minimize a patients travel distances as well as understanding patient interactions with various staff members.

Refer to Figure 2.7 which illustrates a process fl ow diagram in a linear form.

Th e typical clinic fl ow diagrams illustrate some of the most common fl ow for a patient as one enters the clinic until one exits, such as:

One-PACT CBOC:

• Patient with Appointment/Walk-in

• Patient with a Lab Visit Only

• Patient with a Group Visit or Shared Medical

Appointment

• Patient/ Family Member or Volunteer

Two-PACT CBOC:

• Patient with Appointment/Walk-in

• Patient with Appointment + Pharmacy Visit

• Patient with Specialty Appointment

Three-PACT CBOC:

Th e Th ree-PACT CBOC builds off the Two-PACT CBOC with similar patient and staff fl ows. Although these clinics are scalable, the design of the clinic creates a sense of familiarity for the patient and fl ows are intended to be the same despite the larger size.

Refer to Figures 2.8 - 2.15 for common patient fl ow scenarios.

2.18

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.19

Figure 2.7

Optimal Patient /Staff Flow Mapping

Flow Mapping - Optimal

PATIENT MAKES

APPOINTMENT /

FOLLOW-UP

APPOINTMENT IS

CONFIRMED

PATIENT

LEAVES

TESTING/

SAMPLES

PATIENT WALKS

THROUGH

LOBBY

VESTIBULE

PATIENT

CHECKS IN AT

RECEPTION

PATIENT

WAITS

PATIENT

CHECKS IN AT

KIOSKS

PATIENT

LVN PICKS UP

PATIENT

LVN TAKES

PATIENT TO

HEIGHTS AND

WEIGHTS ALCOVE

PATIENT GOES TO

GROUP THERAPY/

SHARED

MEDICAL APPT.

RN MEETS

PATIENT

NEEDS

PROVIDER

SEES

PATIENT

PATIENT SEES

ADDITIONAL

PROVIDERS

LVN TA`KES

VITALS

CLINICAL

REMINDERS

LVN ROOMS

PATIENT IN

EXAM/

CONSULT

PATIENT

ARRIVES AS

A WALK-IN

BLOOD

DRAW

TELEHEALTH

VISIT

VISITING

PROVIDER

GOES TO LAB

Typical Patient/Staff Flow

2.20

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.21

2a

Patient arrives at clinic through vestibule into lobby

Patient with appointment checks-in at reception or check-in kiosk; Patient without appointment walks in and checks-in at reception.

Information Sheet is completed and patient waits to be called

If Patient is not roomed right away, they remain in the waiting area until an LVN rooms them

Patient is taken to Heights + Weights (H+W)

Patient is roomed in an exam room or consult depending on nature of the visit

Patient is cared for, follow-up appointments are scheduled in the same room and needs are met

Patient leaves the clinic6

Typical Patient/Staff Flow Patient with Appointment + Walk-in

One-PACT CBOC

Figure 2.8

Flow Mapping

2a

2.22

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.23

Clerk notifi es RN of patient arrival

LVN is notifi ed of patient arrival through patient kiosk system

LVN picks up patient in waiting room and taken to height and weight alcove

Patient is roomed in an exam room or consult depending on nature of the visit

LVN takes vitals and gives patient clinical reminders, cares for patient, follow-up appointments are scheduled and needs are met

If patient’s needs cannot be met by the RN, the RN consults the provider for additional treatment options

After briefi ng with the RN, Provider sees patient for additional treatment

Typical Patient/Staff Flow Staff with Patient

One-PACT CBOC

Figure 2.9

2.24

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.25

2a

Patient arrives at clinic through vestibule into lobby

Patient checks-in at reception or patient kiosk

Patient waits, if necessary in the Lobby/ Commons Area

Patient gets blood drawn or additional testing samples

Patient need is met and patient leaves the clinic

Typical Patient/Staff Flow Patient with Laboratory Appointment

One-PACT CBOC

Figure 2.10

2.26

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.27

4 1

Patient arrives at clinic through vestibule into lobby

Patient checks-in at reception or patient kiosk

Patient attends shared medical appointment or patient education courses

Patient need is met and patient leaves the clinic

Typical Patient/Staff Flow Patient with Group/Shared Medical Appointment

One-PACT CBOC

Figure 2.11

2.28

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.29

CAR

Typical Patient/Staff Flow Patient/Family Member or Volunteer

One-PACT CBOC

Family member arrives with Patient to the clinic and pulls up to the patient-drop off area.

Family member enters the clinic through the vestibule.

Family member or volunteer retrieves a wheelchairs to assist the patient and returns to the patient drop-off area.

Family member or volunteer assist patient into the wheelchair and enters through the vestibule into the clinic

Patient checks-in at the kiosks or reception desk

Family member returns to vehicle to park the car in the adjacent parking lot

After check-in, patient is either roomed right away or waits in the Lobby/Commons Area if necessary

* Th is scenario assumes valet parking is not available at this CBOC

Figure 2.12

Flow Mapping

2.30

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.31

2a

Typical Patient/Staff Flow Patient with Primary Care Appointment

Two-PACT CBOC

Figure 2.13

Flow Mapping

Patient arrives at clinic through vestibule into lobby

Patient with appointment checks-in at reception or patient kiosk; Patient without appointment walks in and checks-in at reception. Information Sheet is completed and patient waits to be called

If Patient is not roomed right away, they remain in the waiting area until an LVN rooms them

Patient is taken to Heights + Weights (H+W)

Patient is roomed in an exam room or consult depending on nature of the visit

Patient is cared for, follow-up appointments are scheduled in the same room and needs are met

Patient stops by the canteen and socializes

Patient leaves the clinic

2.32

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2a

2.33

Typical Patient/Staff Flow Patient with Primary Care Appointment + Pharmacy Visit

Two-PACT CBOC

Figure 2.14

Flow Mapping

Patient arrives at clinic through vestibule into lobby

Patient with appointment checks-in at reception or patient kiosk; Patient without appointment walks in and checks-in at reception. Information Sheet is completed and patient waits to be called

If Patient is not roomed right away, they remain in the waiting area until an LVN rooms them

Patient is taken to Heights + Weights (H+W)

Patient is roomed in an exam room or consult depending on nature of the visit

Patient is cared for, follow-up appointments are scheduled in the same room. Th e Patient received a prescription for medications.

Patient leaves exam room and makes their way to the Pharmacy. Th e patient received a consultation at the drop-off window.

Patient briefl y waits in the lobby while the prescription is being fi lled.

Patient needs are met and patient leaves the clinic.

2.34

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.35

Typical Patient/Staff Flow Patient with Specialty Care Appointment

Two-PACT CBOC

Figure 2.15

Flow Mapping

Patient arrives at clinic through vestibule into lobby

Patient is early for their appointment -they use the public restroom

Patient checks in at the kiosks or checks in at the ASDM Reception.

Patient is picked up from the waiting room and taken to the Audio/Exam for a hearing test

Patient is cared for, follow-up appointments are scheduled in the same room.

Patient leaves exam room through the lobby following their appointment

Patient needs are met and patient leaves the clinic.

2.36

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.37

2.6 Clinic Growth - Block and Stack

SINGLE PACT

MODULE

COMMONS/

LOBBY

EXAM/ CONSULT

ROOMS

PACT+EXTENDED

WORK AREA

EXAM/ CONSULT

ROOMS

LOGISTICS

STAFF SUPPORT

GROUP ROOM/

SHARED APPT

RECEPTION

LAB

COMMONS/

LOBBY

ENTRY VESTIBULE

MAIN ENTRANCE

SERVICE

ENTRANCE

Figure 2.16

One-PACT CBOC

One-PACT CBOC Prototype Th e One-PACT CBOC is a single PACT Module as illustrated to the right. It breaks down into simple components as illustrated below. Th is includes the front Commons area that serves as the public greeting and waiting space. From this area patients enter into the single PACT module. Adjacent to the Commons area, is the main reception area, group rooms/ shared medical appointment roomsand the lab. Beyond this zone, is the primary care clinical and support functions.

Th is single PACT Module becomes the starting point for developing the Two-PACT and Th ree-PACT CBOCs. Th e following pages illustrate diff erent options explored referred to as:

• Linear

• L-Shaped

• Flare

• Two-Story

Th e block and stack options selected for this course of action are referred to as:

• L-Shaped Preferred

• Two-Story Preferred

2.38

Linear Two-PACT CBOC Prototype Th e One-PACT CBOC Prototype is the single building block of the PACT module that when duplicated/multiplied becomes the basis of the Two-PACT CBOC. Th e image to the right illustrates the single PACT module expanding into the Linear Two-PACT CBOC option with a second PACT module added. Adjacent to the second PACT Module is the Mental Health Component.

Th is component is in addition to the embedded mental health that is already integrated in each PACT Module. Th e Ancillary Services Diagnostic Module is added adjacent to the fi rst PACT module. Th e Commons area is the long, front bar across the entire clinic tieing the modules together and developing an identity for the CBOC.

Th e second level is the mechanical penthouse.

Th e arrows illustrate areas of opportunity for growth.

Refer to Section 5 - Proposed Prototype Layouts for additional information.

COMMONS/

LOBBY

SINGLE PACT

MODULE

LOGISTICS

ANCILLARY SERVICE

DIAGNOSTIC MODULE

SINGLE PACT

MODULE

MENTAL HEALTH

MODULE

ONE PACT CBOC

PENTHOUSE

ROOF

ROOF

SINGLE PACT

MODULE 1

SINGLE PACT

MODULE 2

MENTAL HEALTH

MODULE

SERVICE

ENTRANCE

ANCILLARY SERVICES

DIAGNOSTIC MODULE

LOGISTICS

COMMONS/

LOBBY

ENTRY

VESTIBULE

MAIN ENTRANCE

FUTURE

GROWTH

FUTURE GROWTH

FUTURE

GROWTH

Figure 2.17

Two-PACT CBOC - Linear

First Level

Second Level

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.39

Linear Growth Two-PACT CBOC Prototype to Three-PACT CBOC Prototype:

Expansion of the Two-PACT CBOC into the Th ree-PACT CBOC Prototype occurs by adding an additional PACT Module. Th e block plan illustrates additional bays added to the Ancillary Services Diagnostic Module for the growth of those services and the addition of a Dental Component at this scale. Th is fl exibility also enables modular expansion of other services such as Pharmacy, Laboratory, etc.

Th e third PACT Module is placed to the front of the Commons. Placing this additional PACT Module in this position decreases patient and staff travel distances within a clinic versus placing this module in a linear arrangement with the fi rst two modules. With this confi guration, the blocking begins to wrap and create the “L” shaped for the Th ree-PACT Prototype.

Th e second level is the expansion of the mechanical penthouse.

Refer to Section 5 - Proposed Prototype Layouts for additional information.

SINGLE PACT

MODULE 2

SINGLE PACT

MODULE 1

SINGLE PACT

MODULE 3

MENTAL HEALTH

MODULE

MAIN ENTRANCE

SERVICE

ENTRANCE

ANCILLARY SERVICES

DIAGNOSTIC MODULE

LOGISTICS

COMMONS/

LOBBY

ENTRY

VESTIBULE

PENTHOUSE

SINGLE PACT

MODULE

ROOF

ROOF

ANCILLARY

SERVICE

DIAGNOSTIC

MODULEELEEEEEEEEEEULE

TWO PACT CBOC

Figure 2.18

Th ree-PACT CBOC - Linear Growth

2.40

SINGLE PACT

MODULE 1

SINGLE PACT

MODULE 2

MENTAL HEALTH

MODULE

MAIN ENTRANCE

SERVICE

ENTRANCE

MOBILE TECH PAD

ANCILLARY SERVICES

DIAGNOSTIC MODULE

MEP

LOGISTICS

COMMONS/

LOBBY

ENTRY

VESTIBULE

FUTURE GROWTH

FUTURE

GROWTH

L-Shaped Two-PACT CBOC Prototype:

Th e L-shaped option also expands from the One-PACT CBOC and grows into the Two-PACT CBOC. In the diagram illustrated to the right, the Mental Health Component is placed along the exterior edge of the building. By locating the component here, the patients benefi t from natural daylight as well as views to the exterior. Th e Lobby/Commons Area remains a consistent front bar tieing the modules together and form an identity for the CBOC.

Th e Ancillary Services Diagnostic Module is added to create an L-shape and shorten the travel illustrated in the Linear option.

Logistics and some of the mechanical, electrical and plumbing (MEP) requirements are located in the corner of the L-shape away from the clinical functions. Similar to the Linear option, a penthouse is utilized for the majority of the mechanical system.

Th e location of Logistics and MEP functions allows the L-shaped option to grow the clinical functions, adjacent to the Mental Health Component, as illustrated with the arrow on the diagram below.

Figure 2.19

Two-PACT CBOC - L-Shaped

COMMONS/

LOBBY

SINGLE PACT

MODULE

MEP

LOGISTICS

MOBILE TECH PAD

ANCILLARY SERVICE

DIAGNOSTIC MODULE

SINGLE PACT

MODULE

MENTAL HEALTH

MODULE

ONE PACT CBOC

PENTHOUSEROOF

ROOF

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.41

SINGLE PACT

MODULE 1

SINGLE PACT

MODULE 3

SINGLE PACT

MODULE 2

MENTAL HEALTH

MODULE

MAIN ENTRANCE

SERVICE

ENTRANCE

MOBILE TECH PAD

ANCILLARY SERVICES

DIAGNOSTIC MODULE

MEP

LOGISTICS

COMMONS/

LOBBY

ENTRY

VESTIBULE

PENTHOUSE

ANCILLARY SERVICE

DIAGNOSTIC MODULE

ROOF

ROOF

ROOF

L-Shaped Growth Two-PACT CBOC Prototype to Three-PACT CBOC Prototype:

Th e Two-PACT CBOC Prototype expands into the Th ree- PACT CBOC Prototype. Th e block plan on the right illustrates the additional PACT Module added to the end of the primary care clinic with an expansion to the Commons Area.

Logistics and some of the mechanical, electrical and plumbing (MEP) requirements remain located in the corner of the L-shape away from the clinical functions. Th e penthouse would expand to accommodate the demand of the additional program.

Th e block plan illustrates additional bays added to the Ancillary Services Diagnostic Module for the growth of those services and the addition of a Dental Component at this scale. Th is fl exibility also enables modular expansion of other services such as Pharmacy, Laboratory, Radiology etc.

COMMONS/

LOBBY

SINGLE PACT

MODULE

TWO PACT CBOC

Figure 2.20

Th ree-PACT CBOC - L-Shaped Growth

2.42

SINGLE PACT

MODULE 1

SINGLE PACT

MODULE 3

SINGLE PACT

MODULE 2

MENTAL HEALTH

MODULE

MAIN ENTRANCE

SERVICE

ENTRANCE

MOBILE TECH PAD

ANCILLARY SERVICES

DIAGNOSTIC MODULE

COMMONS/

LOBBY

ENTRY

VESTIBULE

MEP

LOGISTICS

PENTHOUSE

PENTHOUSE

ANCILLARY SERVICE

DIAGNOSTIC MODULE

ROOF

ROOF

ROOF

COMMONS/

LOBBY SINGLE PACT

MODULE

TWO PACT CBOC

Figure 2.21

Th ree-PACT CBOC - Preferred L-Shaped

Preferred L-Shaped Three-PACT CBOC Prototype Th e Preferred L-shaped option also expands from the One- PACT CBOC and grows into the Th ree-PACT CBOC.

In the diagram illustrated to the right, the Mental Health Component is placed along the exterior edge of the building.

By locating the component here, the patients benefi t from natural daylight as well as views of a potential healing garden.

Th e Lobby/Commons Area remains a consistent front bar tieing the modules together and form an identity for the CBOC. Th e main diff erentiator over the L-Shaped option described previously is the intersection of the PACT Module and the Ancillary Services Diagnostic Module. By merging this knuckle, the most effi ciency is achieved in terms of Building Gross Square Feet and Net Usable Square Feet.

Th e Ancillary Services Diagnostic Module is added to create an L-shape and shorten the travel distances illustrated in the Linear option.

Logistics and some of the mechanical, electrical and plumbing (MEP) requirements are located in the corner of the L-shape away from the clinical functions. Th e penthouse is utilized for the majority of the mechanical system. Th e location of Logistics and MEP functions allows the L-shaped option to grow the clinical functions, adjacent to the Mental Health Component, as illustrated with the arrow on the diagram below.

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.43

Two - Story Two-PACT CBOC Prototype:

Th e Two-PACT Two-Story option illustrated on this page splits the Program for Design equally between the two fl oors.

In addition to the Two-PACT Modules on the fi rst fl oor, the Lobby/Commons Area remains a consistent front bar tieing the modules together and form an identity for the CBOC.

Th e second level includes all of the Ancillary Services Diagnostic Module as well as the Mental Health Component.

A penthouse would be included on the third level.

Many of the programs located on the second fl oor, such as Radiology, Laboratory and Pharmacy needed to be moved to the fi rst fl oor to have the proper adjacency to the PACT Modules. Th ese moves left very little program on the second fl oor. It was determined that a two story option for the Two- PACT CBOC was not optimal and therefore not viable.

However, it was acknowledged that the two story option could be viable depending on the program growth. In some cases, depending on the remoteness of a particular clinic and the workload, a more robust ancillary service may determine a larger than usual footprint, such as, Multi-Specialty Care, to justify the expansion.

COMMONS/

LOBBYENTRY

VESTIBULE

SINGLE PACT

MODULE

SINGLE PACT

MODULE

ONE PACT CBOC

COMMONS/

LOBBY

ANCILLARY SERVICE

DIAGNOSTIC MODULE

MENTAL HEALTH

MODULE

PENTHOUSE

ANCILLARY SERVICE

DIAGNOSTIC MODULE

SINGLE PACT

MODULE

(FIRST FLOOR)

SINGLE PACT

MODULE

(FIRST FLOOR)

MENTAL HEALTH

MODULE

COMMONS/

LOBBY

ENTRY

VESTIBULE

MAIN ENTRANCE

SERVICE

ENTRANCE

FUTURE

GROWTH

FUTURE

GROWTH

Figure 2.22

Two-PACT CBOC - Two-Story

2.44

PENTHOUSE

SINGLE PACT

MODULE

(FIRST FLOOR)

SINGLE PACT

MODULE

(FIRST FLOOR)

SINGLE PACT

MODULE

(FIRST FLOOR)

MAIN ENTRANCE

SERVICE

ENTRANCE

ANCILLARY SERVICES

DIAGNOSTIC MODULE

ANCILLARY SERVICES

DIAGNOSTIC MODULE

MENTAL HEALTH

MODULE

COMMONS/

LOBBY

Two - Story Growth Two-PACT CBOC Prototype to Three-PACT CBOC Prototype:

Th e Two-PACT CBOC Two-Story Prototype easily expands into the Th ree-PACT CBOC Prototype. Th e diagram to the right illustrates a single PACT Module added to the fi rst fl oor of the Two-PACT option. However, due to the prioritization of program functions that are required to be located on the fi rst level, although not optimal, the additional PACT module might be on the second fl oor with the Mental Health Component.

Th e additional ancillary and diagnostic services are added at the second fl oor.

Th e penthouse expands to accommodate additional the utility demand of the added program space.

Figure 2.23

Th ree-PACT CBOC - Two Story Growth

COMMOMOOMMOMMOOMMOMMOMMOMMOMMMMMMOMMCOMMOOMMOMMOMOMMMMMMMCOMMMCOMCOMMMCOMMMMMMMMMMMMCOMMMOCOMMMMMMOMMCOMMMMMMC MMMMMMMCC MMMONS/ONOOONOOONOOOOOOOOOOOOOOOOOOOOO

LOBBLOLOLOLOLOLLLOLLLLOLLOLLOLLLLOLOLOLOLLLLLLLOLLOOOOOLOOOOOOOOOO Y

SINGNGNGGGNGGNGGGNGGGNGN LE PLE PPPPPPPPPPPACTACTACTACACTACACTACTACTACTACTAAAACTACCTTTTTTTT MODMODMOMMOMOMOMOMOMOMODMMOMMMODOOOO ULEULEENTRENEEEENTRENTENENTRNNTRNTRNTRNTRNTRNTRNTRTTNTRTNTRENTRNTRENTRENEENENTNNTNTNTTTTTNTREENNNNTRNTRTTRTRRNTRNTRNNTRNTRNN RRRRRNTRNTRNNTRNTNTNTRNNTRRRRNTRNTRNN RNTRNNTRNNTRRRNTRTRTRTRRRTTTRNTTTNTTTRRRRRRRRRRRN RRRRN YYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYYY

VVEVEVEVESVE TSTSTESTSVESTTSTESESTVVVEVEVEEEESTSTESTSTTTTTTTESTTVEEESTESTSSSSTSTSTTSTTSTTTTTVESTTVVVEEEESTESTSTSTSTSTTSTTTTTVVEEESTTVESTESTVV SSSTTTTTTVV SSSSSTSSTSTVESSESSSSESTTTSVESSTSTESSTVEE TVEEVESTTTTVVEE TVESTTVVEEE TVVEVVVVVV IBULBBUBUIBUULBULBUBUUBUBULIBUUUIBULUIBUIBUBBULBUBUBUBUIBIBIBBBIBULBUUIIIBULBUUIBIIBBBBBBBBIBIBBUBUBULBBBBBUBBBBBBBBBIBULBBBBULBIBULBUBBBULBULIBUBULBBUBULBULIBULBUUUBUBBBBUUULUIBBBBULUUULUBBBBBUULBBBBUU EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE

TWO PACT CBOC

(2 Stories)

COMMONS/

LOBBY

ANCILLARY SERVICE

DIAGNOSTIC

MODULE

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.45

Preferred Two - Story Three-PACT CBOC Prototype Th e Two-PACT Two-Story option illustrated on this page splits the Program for Design equally between the two fl oors.

In addition to the Two-PACT Modules on the fi rst fl oor, the Lobby/Commons Area remains a consistent front bar tieing the modules together and form an identity for the CBOC.

Th e second level includes all of the Ancillary Services Diagnostic Module as well as the Metal Health Component.

A penthouse would be included on the third level.

Many of the programs located on the second fl oor, such as Radiology, Laboratory and Pharmacy needed to be moved to the fi rst fl oor to have the proper adjacency to the PACT Modules. Th ese moves left very little program on the second fl oor. It was determined that a two story option for the Two- PACT CBOC was not optimal and therefore not viable.

PENTHOUSE

ANCILLARY SERVICES

DIAGNOSTIC MODULE

(FIRST FLOOR)

MAIN ENTRANCE

SERVICE

ENTRANCE

ANCILLARY SERVICES

DIAGNOSTIC MODULE

COMMONS/

LOBBY

SINGLE PACT

MODULE

(FIRST FLOOR)

SINGLE PACT

MODULE

MENTAL HEALTH

MODULE

(FIRST FLOOR)

COMMONS/

LOBBY

ANCILLARY SERVICE

DIAGNOSTIC MODULE

SINGLE PACT

MODULE

ROOF

COMMONS/

LOBBY

SINGLE PACT

MODULE

SINGLE PACT

MODULE

MENTAL HEALTH

MODULE

MOBILE TECH PAD

ENTRY

VESTIBULE

ANCILLARY SERVICE

DIAGNOSTIC MODULE

Figure 2.24

Th ree-PACT CBOC - Preferred Two-Story

2.46

Three-PACT CBOC Prototype: Modifi ed Two - Story Th e Th ree-PACT Modifi ed Two-Story option illustrated on this page splits the Program for Design unequally between the two fl oors. In addition to the Two-PACT Modules on the fi rst fl oor, the Lobby/Commons Area remains a consistent front bar tieing the modules together and form an identity for the CBOC.

Th e second level includes all of the Ancillary Services Diagnostic Module as well as the Mental Health Component and the third PACT Module. Services that don’t require the fi rst fl oor real estate, such as, Radiology were placed on the fi rst fl oor. Th e mobile technology pad is located in the rear of the clinic unlike the L-shaped option.

A penthouse would be included on the third level.

Refer to Section 5 - Proposed Prototype Layouts for additional information.

PENTHOUSE

COMMONS/

LOBBY

ANCILLARY SERVICE

DIAGNOSTIC MODULE

SINGLE PACT

MODULE

(FIRST FLOOR)

SINGLE PACT

MODULE

(FIRST FLOOR)

ANCILLARY SERVICE

DIAGNOSTIC MODULE

(FIRST FLOOR)

SINGLE PACT

MODULE

MAIN ENTRANCE

MENTAL HEALTH

MODULE

SERVICE

ENTRANCE

COMMONS/

LOBBY

MENTAL HEALTH

MODULE SINGLE PACT

MODULE

ANCILLARY SERVICE

DIAGNOSTIC MODULE

COMMONS/

LOBBY

SINGLE PACT

MODULE SINGLE PACT

MODULE

MOBILE TECH PAD

ANCILLARY SERVICE

DIAGNOSTIC MODULE

ENTRY

VESTIBULE

Figure 2.25

Th ree-PACT CBOC - Alternate Two-Story

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.47

ANCILLARY SERVICE

DIAGNOSTIC MODULE

LOGISTICS

SINGLE PACT

MODULE SINGLE PACT

MODULE

MENTAL HEALTH

MODULE

COMMONS/

LOBBY

ENTRY

VESTIBULE

MAIN

ENTRANCE

SERVICE

ENTRANCE

FUTURE GROWTH

FUTURE

GROWTH

Flare Two-PACT CBOC Prototype Th e Flare option also expands from the Two-PACT CBOC and grows into the Th ree-PACT CBOC. In the diagram illustrated to the right, the Mental Health Component is placed along the exterior edge of the building. By locating the component here, the patients benefi t from natural daylight as well as views of a potential healing garden. Th e Lobby/ Commons Area remains a consistent front bar tieing the modules together and form an identity for the CBOC.

Th e Ancillary Services Diagnostic Module is across from the Commons/Lobby areas creating a wedge between the PACT Modules and ASDM Module. Th is option eliminates a signifi cant portion of circulation space, however, some drawbacks are fl ow issues with primary care and specialist provider communication.

Logistics and some of the mechanical, electrical and plumbing (MEP) requirements are located on the back side of the Flare, away from the Flare, adjacent to clinical functions. Similar to the Linear and L-Shaped options, a penthouse is utilized for the majority of the mechanical system.

Refer to Section 5 - Proposed Prototype Layouts for additional information.

Figure 2.26

Two-PACT CBOC - Flare

COMMONS/

LOBBY

MENTAL HEALTH

MODULE

ENTRY

VESTIBULE

SINGLE PACT

MODULE SINGLE PACT

MODULE

ANCILLARY SERVICE

DIAGNOSTIC MODULE

LOGISTICS

DULLELLEL

HHHHHH

ONE PACT CBOC

PENTHOUSE

ROOF

ROOF

2.48

ANCILLARY SERVICE

DIAGNOSTIC MODULE

LOGISTICS

SINGLE PACT

MODULE SINGLE PACT

MODULE SINGLE PACT

MODULE

MENTAL HEALTH

MODULE

COMMONS/

LOBBY

ENTRY

VESTIBULE

MAIN

ENTRANCE

SERVICE

ENTRANCE

Flare Growth Two-PACT CBOC Prototype to Three-PACT CBOC Prototype:

Th e Two-PACT CBOC Flare Prototype expands into the Th ree-PACT CBOC Prototype. Th e diagram to the right illustrates a single PACT Module added to the Two-PACT option and the Lobby/Commons lengths to support the module addition.

Th e additional ancillary and diagnostic services are added on the other side of the commons, adjacent to the existing

ASDM.

Th e penthouse expands to accommodate additional the utility demand of the added program space.

Figure 2.27

Two-PACT CBOC - Flare Growth

COMMONS/

LOBBY

MENTAL HEALTH

MODULE

ENTRY

VESTIBULE

SINGLE PACT

MODULE SINGLE PACT

MODULE SINGLE PACT

MODULE

ANCILLARY SERVICE

DIAGNOSTIC MODULE

LOGISTICS

TWO PACT CBOC

PENTHOUSE

ROOF

ROOF

Final Submittal May 16, 2014 Project NarrativeOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

2.49

2.7…