28 ISE Magazine | www.iise.org/ISEmagazine
Sustainable Lean design
transforms retail space
for patient care
UF Health facility converts big-box store into innovative medical center
By Du Meyer
Photo by Flad Architects
February 2024 | ISE Magazine 29
Industrial engineers working along with design team experts can redefine existing retail
spaces for optimum clinical use by designing ecient layouts to support Lean processes. ...
A Lean design that optimizes use of existing space and supports ecient clinical processes
results from involving sta and physicians throughout the design process.
30 ISE Magazine | www.iise.org/ISEmagazine
Sustainable Lean design transforms retail space for patient care
In 2020, UF Health The Oaks opened in a
139,000-square-foot former big-box retail mall
anchor department store space in Gainesville,
Florida. Today, the clinical space has become a
model for innovative transformation of former
retail space into patient care space. The renovated
space now consists of outpatient clinics, lab, radiology
and surgical center for ophthalmology, otolaryngology
(ear, nose and throat, including allergy) and audiology
services provided by University of Florida (UF)
Health. The opening of the new facility revitalized the
community and provides convenient state of the art
healthcare for patients.
Project background
In December 2018, a big-box department anchor store
announced multiple closures nationally, including its
location in Gainesville. The 139,000-square-foot space
provided UF Health with the opportunity to relocate
and expand high-demand services. These outpatient
services were once dispersed throughout the city in
multiple locations. The new location consolidated
services into one convenient one-stop site for patients.
The benets of the location include closer proximity
to the interstate; accessible open parking; more visibility;
and easy access to adjacent shopping and dining. The
project occurred in two phases. Phase 1 included the
design and buildout of the outpatient clinic and lab
spaces, in which construction took 14 months. Phase
2 included the design and buildout of the outpatient
radiology and surgical center, and took approximately
six months to construct. The total project budget was
$34.9 million.
See Figure 1 for an illustration of the disperse
locations of services prior to the new site and Figure
2 for the location of the mall and UF Health The Oaks.
Figure 3 shows the former department store prior to
renovations.
Design objectives
The design of the facility maximizes clinical capacity
using existing space. Levels 1 and 2 of the former
department store were optimized for maximum
functional use. Applying a standard exam room,
procedure room and operating room layout was integral
to the design to support standardized work processes.
The layout design incorporated exibility for future
changes. The buildings electrical and mechanical
systems were designed to perform eciently and
meet the capacity needs of the facility into the future.
The heating and cooling of the spaces uses a variable
refrigerant ow system designed to save up to 50% more
I
Figure 1
Original sites
The previous dispersed locations of outpatient services for eye, ENT and allergy services.
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February 2024 | ISE Magazine 31
energy consumption compared
to traditional systems. Interior
design elements, including
artwork, improve the patient, sta
and visitors’ overall experience.
Consolidating services for a one-
stop shop provides convenience
and ecient patient ow. Figure 4
shows the areas of development.
Phase 1: OP ENT, audiology
and eye clinics
The rst phase of the project
completed in February 2020
renovated 114,000 square feet
on the rst and second oor of
former retail space. There are
87 exam rooms, 15 procedure
rooms including laser rooms, eight
treatment rooms and 10 sound
booths across the three practices.
The rst oor consists of new outpatient clinics. The
second oor consists of clinic administrative and sta
support spaces, including oces, sta lounge and
meeting rooms. Shell space was reserved for surgery
support spaces and future interior buildout.
POD clinic design. On the rst oor, each of the
main services – ophthalmology, otolaryngology (ear,
nose and throat, including allergy) and audiology – are
laid out in a pod design where subspecialties of each
service can eciently service their patient population.
A pod consists of six to eight exam rooms surrounding
centralized support spaces including a nurses’ station,
collaboration area, clean storage rooms, soiled holding
rooms and medication prep area. The collaboration
space at the heart of each pod is where physicians and
sta can complete documentation and consult with
Figure 2
New location
The new location at the Oaks Mall is conveniently
located near the interstate.
Figure 3
The inside of a big-box retail store before renovations
that converted the space into outpatient clinics.
Photo by Du Meyer, UF Health
Figure 4
The areas of development shown by level.
32 ISE Magazine | www.iise.org/ISEmagazine
Sustainable Lean design transforms retail space for patient care
each other regarding care plans, while still
maintaining visibility of the patient exam rooms.
Figure 5 shows the pod design.
Exam and procedure room layout. Elements
in the exam room are standardized and also
designed for exibility. Clinic exam rooms
range from 120-144 square feet. Each room has
a nurse work area, documentation desk and
an exam chair or table. Procedure rooms are
approximately 180 square feet customized to t
the specialty equipment. Specialty procedure
rooms include a laser procedure room,
emergency eye procedure rooms and ENT
procedure rooms. Procedure rooms are larger
to accommodate additional equipment and
provide more circulation space around patient
exam table or chair. Sound booths are also
located in the hearing center.
Figure 6 shows the standard eye exam room;
Figure 7 the procedure room; and Figure 8 the
sound booths used in the hearing center.
Phase 2: Ambulatory Surgery Center
and Imaging Center
The second phase of the project completed
in August 2020 was the renovation of 25,000
square feet of the former anchor store’s
automotive center, converting it into an
outpatient imaging center and surgical center.
The surgery center has ve operating rooms
(Figure 9) and 19 pre- and postpatient holding
bays (Figure 10). The imaging center (Figures
11, 12, Page 34) consists of one X-ray, one
Figure 5
The pod design, with exam rooms surrounding
central sta and physician collaboration space.
Figure 6
The standard eye exam room.
Photo by Flad Architects
Photo by Flad Architects
Figure 7
The procedure room.
Photo by Flad Architects
Figure 8
Sounds booths are located in the hearing center.
Photo by Flad Architects
February 2024 | ISE Magazine 33
CT and one MRI. Locker rooms for the surgery center
are located on the second oor along with other sta
administrative support spaces.
Both imaging and surgery centers share a single
waiting room and check-in desk for eciency. The nurse
call system was designed so that physicians located
in the operating room can be alerted and respond to
code in the imaging center.
Standard OR design. Each operating room was
approximately 380-470 square feet with a standard
equipment layout. In each room, the nurse and
physician desks are located in a standard location
with respect to the OR table. Lights and movable
utility booms are laid out so utilities can be
accessible for all dierent types of cases. Each OR
has video integration that allows a video feed from
surgical equipment in the OR eld to be displayed
on multiple monitors in the room during the case.
Automated med dispensing is available in each
OR for anesthesia meds and is located in standard
location with respect to anesthesia machine.
Each room has two supply cabinets that house
standard supplies used in the majority of cases.
While specialty supplies are stored in adjacent
clean holding rooms where they are picked for
specic case carts. A location for nurse call was also
standardized in each room for consistency.
Operational planning
The hours of operations for the clinic, surgery
center, radiology and lab draw vary. All services are
available Monday through Friday, but service start
times dier. The facility entrance that connects to
the interior of the mall entrance is coordinated with
the mall hours, which vary throughout the year with
adjustments for the holidays. Access to the main
mall from the clinical space is available only when
the mall is open. Access from the main parking lot is
scheduled based on the earliest service hours ready
to receive the rst patient appointments. Doors into
each clinical practice o the main concourse are
scheduled based on when the practice hours. The
door access schedule is maintained by the hospital’s
automated security systems (Figure 13, Page 34).
A waynding directory and signage throughout
the facility helps guide patients and visitors to the
dierent clinics, surgery center, radiology or lab
o a main concourse that runs the length of the
ambulatory space. Within each main clinic practice,
subspecialty pods are color-coded and stop letters
are assigned to support waynding (Figure 14, Page
34).
Lab specimens from both the outpatient draw
station and the surgery center are picked up and
processed at an o-site lab facility. Within the
surgical center, there is a lab storage room designed
specically to hold lab specimens for pickup by the
lab courier.
An existing loading dock of the former retail space
was repurposed as the loading dock for receiving
supplies, linen and case carts for the facility. The path
for clean and dirty is planned for eciency.
Instrument sterilization processing at the new surgical
Figure 9
An outpatient operating room.
Photo by Jesse Jones, UF Health
Figure 10
Outpatient pre- and post-holding bays.
Photo by Jesse Jones, UF Health
Figure 11
X-ray room.
Photo by Jesse Jones, UF Health
34 ISE Magazine | www.iise.org/ISEmagazine
Sustainable Lean design transforms retail space for patient care
center is done o-site and transported to the
surgery center. Not having a facility on-site saved
valuable space that could be allocated for clinical
use. A required ash sterilizer room is included
in the design for emergencies. Dirty instruments
are transported to o-site remote sterilization
processing. Clean instruments are transported to
the new surgery center and restocked in clean
holding rooms. To facilitate this process, space is
allocated for holding clean and dirty case carts.
Waste containers for regular trash are located
at the loading dock. Additional secured exterior
location for hazardous (red) waste was added
adjacent and accessible from the loading dock.
Administrative support operations
Sta support spaces are located on the second
oor, allowing for the maximum clinical capacity
to be located on the rst oor. Administrative oce
functions take place on the second oor where
space is restricted only to sta. Also located on
the second oor is the sta lounge, which was
designed to be inviting, supporting sta well-
being during their breaks. Large meeting rooms
for physicians and sta support grand rounds,
education and training. Meeting attendees can
participate in other meetings held on other sites,
using remote meetings from the conference rooms.
Art plays an essential role in the design both
for interior spaces as well as the exterior of the
facility. From the initial point of entry, patients
and visitors are greeted with custom artwork of
colorful landscapes, welcoming them in. The main
concourse that patients and visitors walk through is
lled with art pieces that engage them. Above the
main concourse are mobiles created by local artists
that hang from the ceiling, symbolizing the healing
hands of healthcare workers.
Comfortable seating throughout the concourse
allows patients and visitors to sit outside the main
patient waiting area. Within each clinic, calm and
unique nature photography taken by sta are on
display. In imaging rooms, art is incorporated in the
ceiling to distract patients during their CT. On the
exterior of the facility, custom-lit art panels consist
of nature photography to highlight the building and
provide unit art for all visitors to enjoy (Figures 15, 16).
Outcomes and postoccupancy
statistics
Operational statistics from 2020-2022 show daily
trends for outpatient demand at this facility for
services provided. Eye clinic visits to various
subspecialties average between 174 to 194 visits per
day depending on the day of week. ENT clinic visits
average 86 to 121 clinic visits depending on the
day. Emergency eye procedures done in the clinic
Figure 12
CT scan imaging room. Custom ceiling panels with images
are aimed to put patients at ease during procedures.
Photo by Jesse Jones, UF Health
Figure 13
The interior entrance from the main mall into UF Health
The Oaks.
Photo by Flad Architects
Figure 14
Subspecialty pods are color-coded and identied by
dierent letter stops.
Photo by Flad Architects
February 2024 | ISE Magazine 35
practice average ve on Saturdays.
For outpatient imaging visits, the daily average ranges
from 2.9 to 3.7 for X-ray procedures; 8.7 to 8.9 MRI
procedures; and 14.1 to 15.1 CT procedures. The total
number of surgical cases per day ranged from 4.6 to
12.9 average daily cases for eye surgeries and 2.8 to 9.0
average daily cases for ENT surgeries, depending on
the day of week. The complexity and duration of cases
impact total cases that were scheduled for specialties
on any given day (Figures 17-19).
Industrial engineers working along with design team
experts can redene existing retail spaces for optimum
clinical use by designing ecient layouts to support
Lean processes. Reusing existing spaces saves
capital and time for construction. Investing in building
infrastructure systems during renovations provides
long-term maintenance benets.
A Lean design that optimizes use of existing space
and supports ecient clinical processes results
from involving sta and physicians throughout the
design process. Design standards are applied both
for consistency for current users and exibility for the
future. Planning for the future is key as healthcare
services demand and technology change, and
the building infrastructure and capacity should
accommodate them. Designing for optimum capacity
and patient ow can be achieved with ecient layouts,
while interior design elements such as artwork, materials
and nishes enhance the overall patient experience.
Du Meyer is the Director of Design and Construction for
UF Health in Gainesville Florida. She has more than 20
years of operations, equipment and facilities planning
experience in health care. She holds bachelor’s and
master’s degrees in industrial and systems engineering
and a master’s degree in health administration from the
University of Florida.
Figures 15 & 16
Artwork on display in the lobby at the main entrance and exterior art shown in large lit panels with custom
photography.
Photos by Flad Architects
Figures 17, 18 & 19
Outpatient imaging visits
The average clinic practice visits, radiology procedures and surgical cases by day of week.