On Sept. 30, 1994, Fort Ord was decommissioned. It was one of the largest U.S. military bases ever shut down. Located near Monterey Bay on the California coast, some of the services provided by the base needed to continue, and one of the most prominent was serving the needs of the local military veterans. Jammed into a 35,000-square-foot medical building, the U.S. Veterans Administration (VA) operated an outpatient clinic that served more than 10,000 patients a year, employing about 125 staff members.
A prototypical clinic delivers evidence-based care in a sustainable building
But the building was old and outdated, hampering the staff’s ability to deliver the quality care that veterans, active duty military and their families deserved.
A Prototypical Health Care Model
Michael O’Connor is a principal and director of health care for Nichols, Melburg & Rossetto Architects + Engineers (NMR) in Redding, Calif., and his firm won a national competition to deliver a new building that matched the needs of the veterans community: the Major General William H. Gourley Outpatient Clinic, Marina, Calif., a three-story, 150,000-square-foot facility.
“I found the project interesting for a variety of reasons,” O’Connor says. “One of them is the site selected was on the decommissioned fort list, Fort Ord base. It was kind of intriguing and a premium site close to the ocean in Monterey. The upper part of the building has the fabulous blue water views.”
Another aspect was the changing ideas of health care, moving to a model of Patient Aligned Care Teams (PACT). NMR worked with the VA, touring prominent national systems in the private sector, and took the best ideas that would work with the VA population. For example, this unique population requires a more robust physical therapy environment than typical clinics. From that effort, the design team developed a prototype building that sets a standard for the VA to emulate in other clinics.
“The VA was going through a very interesting moment in time,” he says, “and changing the clinical protocol in health care clinical delivery methods. They reconfigured how they had been doing clinics in the past, and this project hit at just the right time.”
In the PACT model, patients are assigned to a team of caregivers, and, instead of the patient moving from one office or exam room to another, the team comes to the patient. That had significant impacts on the design of the building that transcended everything from floor plan to daylighting and even individual room layouts.
“We separated the patients and the providers,” says O’Connor. “It’s kind of a front of house, back of house arrangement, almost like the Disneyland model. The supply routes run through the back of the building, which allowed us to create areas of respite in the front of the building. It’s sort of a dual circulation system that really makes the environment hospitable.”
That change is probably most notable in the exam room design, which has two entry doors, one from the front of the house for the patient and the other from the back for the care providers. “It lets the staff talk without worrying about HIPA rules and allows them a free flow of information. Teams can really collaborate on the patient. The big drive is to bring the services to the patient rather than go room to room.”
A Green Challenge
Not only was NMR faced with the difficulty of delivering a prototypical building on a design schedule that was driven by tight review dates, it also faced the daunting task of making a health care building meet sustainable building guidelines. Hospitals and other health care facilities are not regulated by energy requirements since they need to have redundant energy supplies and operate 24 hours a day, 365 days a year. A grade school, for example, can more easily meet net zero energy standards because it is essentially off-line for three months a year.
The competition required that the building meet LEED Silver status, but the developer upped the ante and asked that the building achieve LEED Gold. To accomplish that, NMR delivered a highly efficient façade that features insulated metal panels from CENTRIA, Moon Township, Pa. The Formawall Series helped deliver advanced thermal efficiency and moisture control as well as featuring a halogen-free foam core.
Aluminum panels by Quality Metalcrafts LLC/ Americlad, Rogers, Minn., wrap the window perimeters, creating a pop-out feature. The choice to use metal panels for the exterior was, in part, driven by the location of the building. “We were definitely being very respectful of the Monterey coastal region,” says O’Connor. While beautiful and delicate, that salt-water environment can also offer harsh treatment of building materials, and the durability of metal was a major factor in its selection.
One of the major trends in health care these days is connecting patients with nature. It’s been recognized through a number of studies that patient recovery can be accelerated by exposing them to the natural environment, and for military veterans, who face their own unique challenges, the quiet and peacefulness of a natural setting has extensive benefits. The clinic features physical therapy areas that are outdoors, and includes extensive daylighting that breaks down the barrier between the indoors and outdoors, flooding the patient areas with natural light.
NMR’s interior designer Tamara Sunderman integrated glass patterned dividing walls that facilitate the movement of natural light. The designs she selected also include natural elements such as blades of grass embedded on glass.
Sustainability and resilience go beyond daylighting and energy efficiency. “One of the things on the sensitive side of the green issue,” says O’Connor, “is something we ran into because the building is so close to the ocean. We had to use low-pressure sodium lights in the parking area.” Artificial lighting disorients sea turtles who have recently hatched and causes them to move toward the light rather than toward the ocean. It is one of the major causes of sea turtle deaths and is considered a significant marine turtle conservation problem.
A Nod to History
Tradition is a watchword of the military, and Fort Ord, which was founded in 1917, had an extensive, vibrant and notable history. Just the siting of the clinic on the 14 acres of Fort Ord, surrounded by the dunes and cypress trees and coastal vegetation, evokes that history. But a unique aspect of the history was integrated into the design of the clinic.
Several artworks from the enlisted men’s club at the base were relocated to the clinic. Much of the work had been completed in the early 1940s as part of the Federal Art Project under the direction of the Works Progress Administration. The most notable of the pieces is an 87-foot-long mural executed by Carleton Lehman and depicts a fantastical sea story with references to Moby Dick and the story of Jonah. The mural is 6 feet 9 inches high and in its original placement wrapped around several windows.
During the mural’s restoration, the design team measured out the mural and aligned key elements of the architecture to match the existing window pattern of the mural. After its restoration, it was installed in the new clinic, offering yet another historical reference and unique opportunity for respite for the patients.
