August 25, 2005

Creative site selection opens doors

Sometimes, the best place for a clinic is where you least expect

By PHIL GIUNTOLI
CollinsWoerman

Guintoli

Medical and dental practices, in growing numbers, are opting to own their operating spaces instead of lease them.

This can make solid business sense by helping the owners diversify their investments, build a real estate portfolio and ensure that all tenant improvements are owned both for depreciation advantages and if relocation becomes necessary.

However, this trend also presents a challenge for organizations during the search for the "right" place.

If a medical practice intends to locate outside the greater Seattle area or to a suburb, there are potentially more options available for this type of use.

However, when an organization's real estate needs are in-city, particularly in Seattle, it becomes challenging to locate appropriate, affordable, cost-effective space.

Photos by Keith Megay Photography

An abandoned warehouse in Wallingford turned out to be just the place for a new orthopedic clinic, shown here before and after construction. Nontraditional spaces offer their share of headaches, but can prove economical in the long run.

High land values and construction costs can make it difficult for small practices to afford to purchase raw land or existing space, and then to develop and redesign or update it, whether it is traditional medical space or vacant commercial property.

It is therefore essential for such businesses to plan and be creative when they select their real estate. The clients that have the most success involve their entire consulting team, including the architect, from the beginning of the site-selection process. This is especially important when evaluating nontraditional spaces, or spaces that are not currently used for medical purposes.

By working with the architect up front, clients can ensure the building they are considering not only meets their financial and location requirements, but can be designed or renovated to serve staff and patients efficiently and effectively.

Creative site selection

The recently completed Seattle Orthopedic Clinic in Wallingford provides a good example of this process.

The owner group, Ballard Orthopedic Surgeons, a division of Proliance Surgeons, was looking to expand its local practice. It currently has clinics in First Hill and Ballard, but the need for expanded services required a third in-city location to offer magnetic resonance imaging, physical therapy and an ambulatory surgery center.

Because of the importance of proximity to its other clinics and its existing patient population, the group preferred the new office to be located in or near North Seattle.

After establishing its conceptual program, Proliance Surgeons contacted CollinsWoerman architects to help with the site-selection process and design work. Together with the architect, the organization reviewed six or seven potential clinic sites in First Hill, Ballard and Wallingford. None of them met all of the requirements for the new clinic and surgery center.

After the initial search turned up few appropriate sites, the group decided to be more creative about the types of spaces it reviewed. To that end, an abandoned warehouse on North 45th Street, once used by a bank as a car-repossession lot, became a promising option.

The site had its share of challenges. The top floor was originally exposed to the outside, and because it was designed as a parking garage, it had a 7-inch drainage slope across approximately 150 feet.

The building also straddled a zoning change, with 80 percent of the property zoned commercial and 20 percent zoned residential. The owner would have to work with the city and the neighborhood to change the zoning to 100 percent commercial.

Lastly, the walls were located directly on the property line, greatly limiting the ability to make changes to the building exterior.

Despite these challenges, a feasibility study determined the site could accommodate the clinic's desired program, and improvements could be completed within budget.

An advantage was that each floor had on-grade access due to a sloping site. One floor could be used for parking and the other for clinical functions.

The structure was also sound and the column spacing generous, aiding in medical-tenant planning. With this information, the Proliance Surgeons relied on creativity to tackle the challenges.

Getting to work

The final renovation had three goals.

First, develop a state-of-the-art medical facility. Second, enhance the street appeal of the building with its prominent location. Third, reach the first two goals in a cost-effective manner.

To achieve these goals, the architect used as much of the existing building as possible. While a new roof structure was eventually put in place, the building's bones were effectively retained, dramatically cutting the cost of materials.

Large new window openings were cut into the existing precast walls. Exterior cladding options were limited due to the building's location on the lot line, however the city granted four additional inches for a cladding material to be applied to the concrete facade.

An exterior "skin" product faced with natural wood was hung outside the weather barrier envelope. This was the most cost-effective way to change the image of the once-drab facade while minimizing the impact on the existing envelope.

The shape of the footprint enabled an efficient medical layout.

The interior was divided into four distinct spaces, including the clinic, ambulatory surgery, physical therapy and MRI, which all share a common waiting room.

All spaces use warm colors and textures to minimize the institutional feel of a traditional medical space. The waiting room, for example, is wrapped in wood panels and includes a fireplace and concrete hearth. The large exterior windows open onto the lobby, providing natural light into the building entry.

Eyesore transformed

The final result speaks for itself. An abandoned eyesore has been transformed into a medical clinic that provides state-of-the-art facilities and enhances the neighborhood while meeting the goals of its ownership group.

"Almost any site not originally intended for a medical use will have its fair share of challenges, but can wind up being the best solution to an organization's real estate needs," said David Fitzgerald, CEO of Proliance Surgeons.

"We believe that keeping an open mind during the site-selection process and involving the architect from the very beginning resulted in an office in our ideal location, redesigned into a beautiful space that meets our needs."

Phil Giuntoli is a principal with CollinsWoerman, a Seattle-based architecture and planning firm.

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