Clinic / Health Unit  

Overview

The Clinic/Health Unit space types are facilities where outpatient ambulatory health services are provided. Support and sub-space types, such as office spaces, private toilets, and filing and storage areas are included.

This space type does not include provisions for invasive surgery, in-patient services, medical diagnostic categories I, II, and III equipment (including exam lights and medical gas systems), radiological diagnostic services (including special structural elements and radiation shielding on ceiling and floor areas), darkroom revolving door systems, or medical laboratory spaces. Clinics where general anesthesia, invasive procedures, or overnight care are provided require Institutional Occupancy construction types and are not included.

See Health Care, Hospital, Nursing Home, Outpatient Clinic, and Psychiatric Facility for more information about inpatient and specialized care facilities.

Space Attributes

The Clinic/Health Unit space type should provide a sanitary and therapeutic environment in which patients can be treated by medical practitioners quickly and effectively. A clinic's size and configuration are determined by its specialization and location. The clinic/health unit space type can be configured into a number of different types of modules to accommodate many approaches to clinic/health unit design. There is however, a trend toward more collaborative health care, which requires nurses' stations and physicians' offices to be close to each other (or eliminate private offices altogether) to provide shared work areas and more opportunities for communication. A clinic/health unit setting is intended to also serve as a healing environment. So there is also a trend to designing less clinical-looking spaces, and introducing more of a personal or homey feeling in individual patient rooms and admitting areas. Access to nature and the colors of nature also support healing. So design the space holistically by incorporating the colors or scenes of nature when views to nature are not available or possible.

Typical features of clinic/health unit space types include the list of applicable design objectives elements as outlined below. For a complete list and definitions of the design objectives within the context of whole building design, click on the titles below.

An efficient clinic design may include medical assistant stations with accessible storage and plenty of workspace. Community Health Care clinic in Lakewood in Washington.
Photo courtesy of Johnson Architecture & Planning

Accessible

• All areas should comply with the minimum requirements of the Americans with Disabilities Act (ADA) and, if federally funded or owned, with the GSA's ABA Accessibility Standards. For more information, see WBDG Accessible Branch and Provide Accessibility for Historic Buildings (historic facilities).

• Clinic/health unit space must be easy to use by patients with temporary or permanent disabilities.

• Consider patients with hearing loss or vision impairments, as well as physical disabilities.

• Use mechanical door openers to assist in entering and leaving the facility.

Aesthetics

Aesthetics are important to the clinic's public image and visibility within the community as well as the connection to healing and the patient experience. Aesthetic considerations include:

• Increased use of natural light, natural materials, and textures.

• Use of artwork, including nature scenes when views or access to nature are unavailable.

• Attention to detail, proportions, color, lighting, and scale.

• Bright, open, generously scaled public spaces.

• Homelike and intimate scale in patient rooms and offices.

• Signage that promotes optimal way-finding, satisfies the orientation needs of the first-time patient, allows easy navigation, and provides highly visible reference points immediately adjacent to each major entrance.

Functional / Operational

• Cleanliness and Sanitation: The cleanliness of a facility is not only related to a patient's medical recovery, but can also affect the perceived level of care. To maintain a sanitary environment, spaces should be easy to clean and maintain. Use durable finishes and sterile/antimicrobial surfaces as necessary. For more information, see WBDG Therapeutic Environments.

• Comfort: Provide space that is comfortable and inviting for family members to congregate and visit without feeling they are in the way.

• Occupancy: The occupancy classification for the Clinic/Health Unit space type is Business Occupancy B2, with sprinklered protected construction and GSA Acoustical Class C2.

• Flexibility: Plan for flexibility and future expansion and/or modifications to the design.

Productive

• Efficiency and Flexibility: The layout of the Clinic/Health Unit should promote prompt and reliable medical attention. Relationship and flow diagrams created at the beginning of the design process will ensure a sensible programming of space. Office support spaces such as workrooms, file rooms, copier areas, coat storage, and lockers typically will be integrated into the clinic environment. Flexibility must also be a basic feature of any health care facility to keep it from rapid obsolescence in the face of changing needs and technologies.

• Acoustic and Visual Privacy: The new HIPAA (Health Insurance Portability and Accessibility Act) regulations address the security and privacy of "protected health information" (PHI). These regulations put new emphasis on acoustic and visual privacy, and may affect location and layout of workstations that handle medical records and other patient information-both paper and electronic-as well as patient accommodations. Flow diagrams created in the beginning of the design process should address controlled access areas.

Secure / Safe

• Emergency Backup Systems: Typically, this space type will require emergency battery backup for 25% of lighting. Refer to individual utility requirements for specific medical equipment.

• Fire Protection and Life Safety measures need to be addressed and incorporated into the design as per local or state codes and specific requirements of the clinic/health unit.

• Furniture should be washable and fire-retardant. To prevent falls, choose carpeting that contrasts with the color of the clinic's reception furniture.

• Scale and Separation: When designing clinics for children, incorporate child-sized seating and tables into reception area/check-in room. Allow a separate seating area for children who are ill and contagious to prevent spreading illness.

Sustainable

• Use healthy indoor materials that do not off-gas and that meet no- or Low-VOC requirements while also meeting hygienic and anti-microbial requirements.

• Provide ample natural daylighting and views and access to nature wherever possible.

• Consider the use of renewable energy sources to power the building or spaces and integrate energy efficient equipment into the facility.

• Provide healthy indoor air quality.

• Consider the use of modular construction when renovating or remodeling to reduce construction dust, debris, and waste. Some modular walls can be customized without undermining hygienic requirements. Thoughtfully-designed and aesthetically-pleasing interiors are not only good for patients and their families; they improve the well-being of nursing staff as well.



The interiors of the VA Health Care Center in Butler, Pennsylvania. LEED points were earned for sustainably sourced materials and products as well as thermal comfort and low-emitting materials. The project earned LEED Silver. For more information on this project see the project overview.

Example Program

The following building program is representative of Clinic/Health Unit spaces.

HEALTH UNIT

Description Tenant Occupiable Areas	Qty.	SF Each	Space Req'd.	Sum Actual SF	Tenant Usable Factor	Tenant USF
Entry Lobby				240
Waiting	1	120	120
Reception/Registration	1	60	60
Payee Window	1	60	60
General Patient Care				684
Physician Office/Consult	1	120	120
Exam Room	3	108	324
Nurse Work Area	1	40	40
Patient Toilets	1	60	60
Clean/Supply Room	1	60	60
Medications Storage	1	20	20
Soiled Utility Room	1	60	60
Medical Records				60
Medical Records Files	1	60	60
Staff Support Spaces				216
Staff Toilet (Male)	1	60	60
Staff Toilet (Female)	1	60	60
Staff Break Room	1	60	60
Housekeeping	1	36	36
Tenant Suite			1,200	1,200	1.53	1,840
Tenant Usable Areas						1,840




Example Plans

The following diagram is representative of typical tenant plans.






Example Construction Criteria

For GSA, the unit costs for the Clinic/Health Unit space type are based on the construction quality and design features in the following table . This information is based on GSA's benchmark interpretation and could be different for other owners.

Relevant Codes and Standards

The following agencies and organizations have developed codes and standards affecting the design of health facilities, including clinics. Note that the codes and standards are minimum requirements. Architects, engineers, and consultants should consider exceeding the applicable requirements whenever possible:

• Americans with Disabilities Act
• Guidelines for the Design and Construction of Health Care Facilities by the Facility Guidelines Institute, 2010.
• GSA's ABA Accessibility Standards
• GSA PBS-P100 Facilities Standards for the Public Buildings Service
• ICC IBC International Building Code
• Department of Veterans Affairs (VA): Office of Construction and Facilities Management Technical Information Library contains many guides and standards, including: Design Guides for planning hospital based ambulatory care clinics, community based outpatient clinics, satellite outpatient clinics, and ambulatory surgery clinics. This information library also includes Design Manuals of technical requirements, equipment lists, master specifications, room finishes, space planning criteria, and standard details.

Additional Resources

Others

• Building Research Information Knowledgebase (BRIK) Healthcare Facilities—an interactive portal offering online access to peer-reviewed research projects and case studies in all facets of building, from predesign, design, and construction through occupancy and reuse.
• USGBC Leadership in Energy and Environmental Design (LEED) for Healthcare

Publications

• AIA Academy of Architecture for Health (AAH)—Contains AAH newsletters, reports, and other documents related to health care design
• Architectural Graphic Standards, 12th Edition by The American Institute of Architects, Dennis J. Hall. New York, NY: John Wiley & Sons, Inc., 2016.
• Building Type Basics for Healthcare Facilities, 2nd Edition ed. Stephen A. Kliment. New York: John Wiley & Sons, Inc., 2008.
• Design That Cares: Planning Health Facilities for Patients and Visitors, 3rd Edition by Janet R. Carpman, Myron A. Grant. New York: John Wiley & Sons, Inc., 2016.
• Green Guide for Health Care™—A best practices guide for healthy and sustainable building design, construction, and operations for the healthcare industry.
• Innovations in Healthcare Design: Selected Presentations from the First Five Symposia on Healthcare Design ed. Sara Marberry. New York: John Wiley & Sons, Inc., 1995.