Church Health at Crosstown Concourse in Memphis is the largest private faith-based health clinic in the U.S. The innovative design successfully co-locates multiple healthcare-related program and functions to offer patients a full-service clinic, wellness center, and community gathering place – all under one roof.

The facility is a testament to founder Dr. Scott Morris’s lifelong vision to provide quality, affordable healthcare for working, uninsured people and their families. A family practice physician and ordained United Methodist minister, Dr. Morris founded Church Health in 1987 and understood that consolidating Church Health’s 13 different locations and services at a single location would allow them to double the number of patients and families they could serve.

In 2012, Dr. Morris signed on as the largest founding tenant and helped jumpstart the unique transformation of a 1.5 million-square-foot abandoned concrete Sears, Roebuck and Company distribution and retail center into a health/wellness, arts, and education “vertical urban village.” The charge for the design team was to take the vision Dr. Morris had nurtured for Church Health from inception through its 30-year history and create a new state-of-the-art-facility where patients could “see wellness happening.”

Built in 1927, the 10-story Art Deco Sears warehouse structure had roughly the same square footage as New York’s Chrysler Building. The large footprint coupled with the sheer volume of space presented multiple challenges to the design team. A key design driver was to create a space that was accessible, comfortable and appealing to patients while optimizing functionality in order to utilize the space to its fullest potential.

Embracing Existing Conditions. The team started by embracing the qualities of the existing facility and deliberately focused on not changing or masking them in any way. The existing building structure was fixed column grid, so the team chose to let the existing layout drive design decisions from the outset, rather than challenge it. To that end, they left as much of the column surface exposed as possible, so that it became an integral part of the design—a visual as well as a physical/structural necessity. The team sealed the aggregate in the concrete and painted the columns to give them a fresh and crisp appearance while preserving the texture, which had an appealing tactile quality. Texture made other appearances throughout the space through exposed plywood that was visually intriguing, as well as textured acrylic panels. Designers looked to celebrate these existing materials as beautiful design elements rather than simply a substrate.

Where infrastructure was added, the team chose materials with qualities similar to the current materials.

Leveraging Existing Window Sizes. The building’s Art Deco design featured extensive fenestration, definitely ahead of its time for a warehouse facility. Existing window openings were very large and allowed natural light to penetrate far into the interior space. The design team was very careful to place full-height walls deep into the interior to avoid blocking natural light wherever possible. Light is used in the space to illuminate and highlight items of interest, color gradients, and characteristic elements throughout the space. In other areas, adjustable lighting gave occupants control over the space, which eases stress and enhances the user experience.

Optimizing Operations by Design. While the structure of the building influenced interior spatial organization, operational flow affected the layout of interior spaces where designers could take advantage of more flexibility. To create a logical flow, the team looked at day-to-day activities within the space. As patients and providers moved through their day, areas that were used more frequently needed to be immediately accessible. There were “back of house” areas for storage and other low-traffic applications to keep the daylight focused in the most heavily trafficked areas. This approach created zones of hierarchy and use of space so that the brightest and largest spaces are where people are most concentrated, moving inward to the least used spaces. The most public, extroverted spaces—waiting areas, congregating spaces—were the ones with the highest visibility. These were also the most transitional and democratic, with the highest traffic and most exposure. Individual patient areas were immediately accessible with less daylight but still enough that staff who spent their days in these areas could get some light exposure. Restrooms, triage, and storage were located deep into the interior of the spaces where full height walls would not block the natural light.

Overcoming Spatial Challenges. There were some challenges to laying out the building this way. The clinic and dental areas were large, and the building footprint was more rectangular than square, which meant the potential for long travel times walking from one end of the building to the other. To alleviate this, the design team created centralized, independent nodes along the linear pathway to make adjacencies and paths of travel more logical. One example of these nodes was the nursing pods that supported clinic areas. In addition to logical placement along the path, the nodes were identically outfitted with duplication built in so that they could function independently. The duplicate pods also gave Church Health the option to open different functional clinics at different times without opening the entire facility.

Enhancing the Patient Experience. By embracing the building’s inherent structure and materiality and focusing on a patient-centered approach to the design, the team was able to create a space that was welcoming and user-friendly despite its size. Waiting areas were one example of this strategy playing out successfully. There were multiple waiting areas throughout the facility and there was a level of operational and architectural planning to their layout and how people found their way to them. Due to the size of the footprint, navigability and wayfinding was critical, especially for patients with mobility issues. Upon entry, users find immediate visibility to standalone offerings as well as volunteers to meet people at the door and guide them to their destinations. This was especially important as many patients were accustomed to seeing their providers at smaller clinics and could be overwhelmed by the size of the new building.

Paying Attention to Acoustics. Due to the large open spaces and the many hard concrete surfaces, acoustics became a critical element in the design. In exam rooms, acoustics are important for preserving patient privacy while maintaining intelligibility for patients who are hearing impaired. Creating exactly the right acoustical environment requires a calculated balance of wall systems, acoustical ceiling tiles, airflow, and ductwork. The team was tasked with employing acoustical solutions that were effective without overspending. Tectum material was used as full coverage in some areas, and in smaller patterns elsewhere. Designers incorporated it vertically near the nurse’s station to address sound while adding to the aesthetic appeal of the space.

Fine Tuning Design Elements. The project team and client understood that some design elements would need to be fine-tuned once the building had opened and staff and patients became acclimated to the building’s size and its impact on the patient experience. Since the space has been occupied, the team has implemented some refinements to the design based on user experience. Signage locations and sizing required further customization after the space was occupied and traffic flows emerged. Another example of fine turning was reconfiguration of two waiting areas on the second floor that are diagonal to each other and have multiple entry/exit points but were experiencing disparate usage levels. Despite their similarity and proximity, one of the waiting areas tended to be much busier than the other. The team reconfigured furniture and reoriented staffing to help achieve parity and manage how people navigated the space.

Urban Revitalization Success. Because of the attention to detail that was employed every step of the way, the project has been a real success. Today, in addition to Church Health’s clinic, more than 45 businesses and 260 apartments call Crosstown Concourse home. The project has received numerous awards, including a 2019 American Institute for Architects (AIA) Institute Honor Award for Architecture, that recognizes the best in contemporary architecture and highlights the many ways buildings and spaces can improve lives. Recognizing that adaptive re-use is often the most sustainable approach, the Crosstown Concourse project received the Driehaus Foundation National Preservation Award from the National Trust for Historic Preservation and the grand prize in the Congress for New Urbanism Charter Awards. It is the world’s largest historic preservation project to earn LEED Platinum certification. More than just the rebirth of a building, Crosstown Concourse has uplifted an entire neighborhood and given the city a glimpse of its possible future.

Rebecca Courtney, ASID, IIDA, is Principal with LRK and can be reached at rcourtney@lrk.com.

Frank Ricks, FAIA, LEED AP, is Founding Principal with LRK and can be reached at fricks@lrk.com.

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With the help of Dallas-based HKS Inc. as the lead architectural firm, as well as Self-Tucker Architects and Archimania, both of Memphis, the construction of the eight-story tower began in November 2016, and is currently being erected on top of the standing emergency department that Turner construction built in 2014. The notable design features reflect the goal of the medical facility earning its LEED Gold certification as well as attracting top-ranking medical professionals from all over the globe.

According to Kyle Reeves, Turner project executive for the tower, the team selected a unitized curtain wall glass system that will be pre-assembled off site and erected quicker than a stick built system in order to meet the insistent schedule. The curtain wall includes a dynamic glass system, which changes shade in response to sunlight to help with energy efficiency. The construction also includes two green roof areas, which create a calmer healing environment to improve patient outcomes.

“The use of glass, cast stone and metal panels provides a new identity for the campus entrance while also providing a destination that will attract the world’s top medical professionals,” said Reeves. “The use of dynamic glass throughout the entire project adds a level a comfort for patients and family. A new concourse on level three will be the main pedestrian spine that connects the existing hospital to the new expansion. The main public elevator lobby will have glass walls on two sides with enhanced lighting. Its glass walls rise above the roof level, forming a symbolic beacon that reinforces the faith-based focus of Methodist University Hospital.”

The new tower is expected to elevate patient care for Memphis and the Mid-South. The tower will allow for the consolidation of the hospital’s transplant services into a two-floor inpatient/outpatient comprehensive transplant institute. It will also connect the oncology and outpatient care to create a new cancer center. The expansion allows for a 36 percent increase in ICU capacity and a 20 percent increase in the hospital’s operating room capacity.

“The new facility will be one of the most advanced patient- and family-centered state-of-the-art tertiary care facilities in the Mid-South region,” said Reeves. “This represents a major investment to healthcare in the Midtown Memphis community and innovative spaces that will elevate the care provided to the Mid-South region for generations to come. This new facility will become one of the most advanced patient- and family-centered, state-of-the-art tertiary care facilities in the Mid-South region. This master plan campus improvement will also push MUH further towards its goal of being one of the top academic hospitals in the country.”

The construction of this tower also implements an “integrated project delivery” system (IPD).

“Renovating a space while it remains fully operational can pose a number of challenges. The most frequently cited challenge is that construction often takes longer than it would if the space did not need to remain fully functioning during construction. However, thanks to new collaborative delivery methods like Integrated Project Delivery (IPD), we’re able to mitigate this problem,” said  Reeves.

According to Reeves, IPD focuses on delivering value, eliminating waste and continuously improving. It encourages collaboration, shared risk and accountability between the owner, builder and architect. The IPD team, bound under one contract, often includes the owner, builder and architect, but can also include engineers, large subcontractors and suppliers.

The team establishes a target budget early in the project and outlines clear goals to ensure the project aligns well with the owner’s objectives. With all major parties involved from day one, the system fosters effective communication and decision-making. The architect, builder and sometimes engineer are contractually obligated to work together for the benefit of the project. This level of buy-in means the entire team is focused on adding value to help build a better quality, lower risk and faster project.

The IPD team spends a significant amount of time planning on the front end, so the design and building phases essentially morph into one continuous phase. And because construction can begin before design is completed, we are able to radically improve schedule performance, eliminate costly change orders and therefore reduce the chance of any schedule slips or delays. The collaborative nature of IPD allows us to identify and fix any potential problem areas before they affect the flow of work.

Because of IDP, the market will no longer tolerate mediocrity when it comes to project performance — including cost and schedule overruns, inefficient staffing models and workflow patterns, and facilities that are difficult and expensive to maintain and operate. The Integrated Project Delivery approach ensures that the team maximizes efficiency through all phases, from schematic design through to completion. Ultimately, it guarantees that the builder and designer are focused on adding value, building the project with higher quality, lower risk and at a faster speed.

The facility also includes new technology and electronic systems with linear accelerators, the latest models of MRIs and other state-of-the-art imaging and radiology equipment. This also includes modernized pharmacy, laboratories, dialysis and interventional radiology areas.

According to a statement, Michael Ugwueke, president and CEO of Methodist Le Bonheur Healthcare expressed, “We are committed to the Midtown Medical District, and we are energized by our quest to put patients first in everything we do — from patient access, to patient experience to patient care, MLH is committed to providing high quality care to every patient who enters our doors.”

Project completion is expected for spring of 2019.

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The 50,000-square-foot hospital will have a budget of $25 million, and the architect on the project is Earl Swensson Associates Inc. of Nashville, Tenn. The general contractor for the project will be chosen soon, according to Brian Welton, chief executive officer and administrator of Baptist Memorial Hospital-Crittenden in a statement.

The county is excited about the new hospital, especially after the closing of Crittenden Regional Hospital in 2015. The closure of the hospital was a major blow to the community with regards to healthcare access. Many physicians — specialists and primary care doctors — left town once the old hospital closed, so those physicians who remained were left with an excessive patient load. “More than 400 people lost their jobs,” said Aaron Mitchell, MD, MBA, of Mitchell Family Medicine in nearby Marion in a recent statement.

There is currently almost no equipment available for emergencies in the entire county — not even a CT scanner. Patients have to drive to Memphis for their health care needs. With a population of about 51,000 with about 25,545 of those located in West Memphis, Crittenden County needs this new hospital.

Hospital services at the new facility will include an emergency room, cancer care, a laboratory, imaging and diagnostics. It will not include obstetrics initially, but there is the potential for this later, according to Welton, which many staff are hoping for. While the facility will be smaller than Crittenden Regional, it will be state-of-the-art and easier to find, Welton said.

While the old hospital closed due to financial issues, the new hospital is being funded by the local community. Crittenden County voters approved using a one-cent sales tax for five years to finance construction on the project, according to a statement.

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