How a McKinney clinic merges lessons from Texas – and Rwanda
If you’ve been through the Medical District recently, you may have noticed that UT Southwestern has expanded Clements Hospital with a new wing. This is a seamless addition to the 2014 installation, so the zigzag hospital now looks like a huge W lying on its side. Like the original to which it is attached, this is a scalpel composition of concrete and glass planes designed by the Dallas office of CallisonRTKL. The new space brings the number of hospital beds to 750 and increases the capacity of its emergency room by 50%.
I’m not here to tell you about Clements, despite his virtues. This column, on the contrary, concerns a project which, in the unfortunate slang of our time, would “disrupt” large hospitals like Clements, and would serve as an antidote to the American institutionalized health system.
But you might not know it by looking at it, and you’ll have to drive about 30 miles north of Clements, all the way to McKinney, to even get the chance. There, a few blocks from I-75 on a strip leading to historic downtown, is the Family Health Center in Virginia, a staggered jumble of beige brick boxes topped with a gable which manages to appear both traditional and modern, domestic and institutional.
This assembly is a Federally Qualified Health Center, or FQHC, a non-profit clinic for primary, dental and behavioral health care for the under and uninsured.
“This space conveys a sense of dignity for those who don’t always have a choice,” says Kate Perry, who leads community health initiatives for McKinney-based Independent Bank. Bank chairman David R. Brooks started the project in 2012 with the intention of improving health outcomes in poorer minority communities on McKinney’s east coast. With in-kind contributions, the 25,000 square foot facility, estimated at $ 10 million, was completed for approximately $ 6 million.
The design was carried out by Boston-based nonprofit architectural firm MASS Design Group, which has a long history of studying and building medical facilities, in the United States and abroad. The company is best known for the National Memorial for Peace and Justice (colloquially, the Lynching Memorial) which opened in 2018 in Montgomery, Ala. An exhibit of the company’s work is on display at the National Building Museum in Washington, DC, through September 2022. (Disclosure: I wrote an essay on the firm’s 2019 monograph, Justice is beauty.)
In its human size and vernacular shapes and materials, the clinic is an alternative to both the cool gigantism of the contemporary hospital and the coarseness of the suburban doc-in-a-box mall. The architectural inspiration is the traditional Texas “dogtrot” house, in which a series of independent structures (represented here by the gable boxes) are connected by shaded walkways.
“The foundational design program was really a place that is super accessible and deinstitutionalized and feels like part of the neighborhood,” says Michael Murphy, founding director of MASS Design Group. “It’s a community center as well as a health care center.”
The approach begins with the literal approach, on a stretch of Virginia where commercial development gives way to residential architecture. McKinney’s First Baptist Church is across the street, which turned out to be a significant advantage: the clinic was able to share an existing church parking lot in a median between the two institutions, reducing to the both the financial and environmental costs of the project. .
The parking lot the clinic added has been moved to the back, so the building can be pushed to the street, giving priority to pedestrian access. “We wanted to resist this inclination of a car-based urban area and make it a more walkable place,” says Murphy.
The entrance is clearly non-institutional in character, located behind a lattice-covered path and adjacent to a small courtyard with native plantations. Inside, visitors are greeted in a bright double-height space with blond wood furniture.
“The main thing that we really wanted to change when you walk into this facility is the experience of waiting, so that you don’t walk into a single closed room where you are crushed against other people,” says David Saladik, a senior director of MASS based in the company’s office in Kigali, Rwanda. To this end, waiting areas run the length of the building in a chain of house-wide interior spaces.
The waiting areas also open onto the courtyard in front of the building, a design inspired by Saladik’s experience in Africa, where patients at MASS-designed clinics wait in shaded outdoor spaces.
The arrangement is more humane, and it’s also healthier, especially during a pandemic. “The most infectious place is really the waiting area, because that’s where you have an indefinite transfer of disease that cannot be isolated,” says Murphy.
The building is essentially divided in two (in plan, it looks like an H, with the wings connected by the central spine of the waiting areas), with the community, educational and administrative spaces on one side and the medical spaces of the other. The layout has the advantage of allowing the clinical side to be fully air-conditioned – as required by the code for medical spaces – while the more public spaces are open to natural ventilation.
The clinical section is organized into four pods, two each on the first and second floor, with a total of 19 examination rooms and nine dental “operative” rooms, arranged in a U-shape around shared nursing stations. Behavioral health rooms are interspersed with physical examination rooms, to reduce stigma and encourage cross-referrals. The furniture is modular for flexibility and of the highest level of design, supplied at cost price by modern furniture company Herman Miller.
“I love how open it is. The bedrooms are large. It will be a one-stop-shop where patients will get everything they are looking for, ”explains Vanessa Garcia, a nurse enjoying a few moments in a work room adjacent to the modules.
The nicest room in the property is the community room, which has large windows that both face the street and open onto the planted front yard. Above, the gable ceiling is a grid of warm wood acoustic bands.
The opening of the room is both literal and metaphorical. “We want to demystify the medical practice inside, in a time of deep skepticism,” says Perry.
This is a laudable goal and could be extended to all of North Texas. “If we could build five in each county, we would have a distributed health care system that wouldn’t overload centralized institutions and serve the whole community more consistently,” says Saladik.
Great ideas can come from anywhere. For better health outcomes, Texas could learn a thing or two from Rwanda.