• The new University Health System’s outpatient care facility sits in a prominent location west of downtown and serves as a gateway to San Antonio’s west side. Photo by Dror Baldinger, AIA.

No one looks forward to going to the hospital or to a health clinic, whether for a routine exam or an unusual ailment. Worse is the experience of having to shuttle yourself from a doctor’s office for an exam, to a clinic for blood work, to a pharmacy for medication, and then back again to the doctor’s office. To ease the anxieties of their patients and customers, the University Health System of San Antonio redesigned their 100-year-old Robert B. Green campus in downtown San Antonio. To accomplish this goal, and at the same time to create a world-class facility on a limited budget, they assembled a team of architects, artists, and craftspeople to develop a project that would do more with less. With a few straightforward ideas about public art, hospitality, and site, they hoped to provide a building that would represent UHS as an institution.

The design team, led by CallisonRTKL Associates and Overland Partners, met with demolition, renovation, and new construction that resulted in the reorganization of the campus around a central space that will one day become a public park for the underserved west side. The campus now includes an urgent care center, a surgery suite, a medical clinic, medical offices, a pharmacy, dining facilities, and parking. It is a one-stop facility with everything but an emergency room and inpatient services. The majority of these services are housed in 235,000 sf of space in a LEED Gold-certified clinic building.

The design team and client immediately recognized the power of art to inspire visitors and ease patients’ anxieties. Wanting to advance the healing process, UHS drew on a growing body of research connecting art in the healthcare environment to an improved quality of care for patients and better workplace satisfaction for staff. An art selection committee — led by consultant Allison Hays Lane and composed of representatives from UHS, the City of San Antonio, academia, the art world, the design team, and staff — prioritized the selection of local artists. Much of the artwork is site-specific and has a meaning relating to medicine or the human body. Mark Webb, CEO of Pediatric Services and primary representative on the client side, noted that even the selection process proved therapeutic for staff and committee members.

UHS and the design team focused on artwork as a way of attracting and retaining customers and the best doctors and nurses. One installation celebrates those staff: Local artist Chuck Ramirez conceived a wall of photographs of UHS staff and patients that serves as a privacy screen between a waiting area and clinic spaces. In the lobby, a shimmering 48-ft-long sculpture by Cathy Cunningham Little reminds us of what connects us as humans: 4,000 tiny suspended square tiles take the shape of a DNA double helix. Artwork also acts as a wayfinding tool at the urban scale: Bill FitzGibbons’s “Colorline” uses color-changing LEDs to illuminate the building facades, attracting the attention of cars passing on the adjacent highway.

Most of the artwork is well-integrated into the architecture of the building. One of the best examples of this is a sculpture experienced from both the exterior and the interior. The new building had to take a North-South orientation, due to site constraints; this resulted in a long elevation facing west that is vulnerable to the harsh afternoon sun. The architecture team engaged artist Ned Kahn to develop a kinetic sculpture for this facade that could allow for light and views yet mitigate heat gain. The result is a mezmerizing series of approximately 5,000 steel louvers that gently turn with the wind. 

The design team drew inspiration from the hospitality industry to enhance the patient’s experience by minimizing wait times and creating thoughtful, respectful, welcoming spaces to reduce anxiety. UHS wanted the arrival, parking, and movement through the building to be intuitive, and the architects responded by designing simplicity and consistency into the architecture from one floor to the next. The lobby reception desk is similar to a hotel reception where a customer is greeted by friendly staff. Throughout the structure, one finds gracious spaces for waiting, grabbing a snack, or for quiet reflection. The building is welcoming and comforting.

The design team, with CallisonRTKL leading the charge on interiors, successfully separated the front- and back-of-house spaces on this tight site. They went to great effort to right-size clinic spaces by designing each clinic to share exam rooms and other support spaces with adjacent clinics. To determine the scale of this space-sharing, at the beginning of the design process, the architecture team employed sensors to measure and track the flow of people through a typical UHS clinic over a period of two weeks. They analyzed the data to determine how big to make each clinic, and they developed plan diagrams to demonstrate to the client how the spaces would function. The result is that, when one operator is busy, it can grab space from its neighbor.

This efficiency of space is another example of the design team doing more with less. The entire site assumes this challenge — from the development of the massing of the buildings to create open space at the center of the campus, to the formal simplicity of the new building, to the economy of materials inside and out. The result is a building that doesn’t distinguish itself as groundbreaking architecture or as a design award winner, but instead as a welcoming, comforting space for an underserved neighboring community. It is a firm commitment from UHS and the design team to the west side of San Antonio to say, “You are important to us.”

Overland Partners architect Tim Blonkvist, FAIA, described one of his most satisfying moments: A customer who goes to the clinic frequently for her son’s treatments told him that, despite the stress that brings her there, she feels comfortable; it is a space where she belongs and is welcome. This kind of ownership is what UHS hopes will set its Robert B. Green campus apart from other institutions and give its patients the ability to move through the healing process with dignity.

Margaret Sledge, AIA, is an architect with Lake|Flato in San Antonio.

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