PacMed Lacey

Lacey Clinic | Providence Medical Group Lacey, WA

The South Puget Sound region is growing rapidly, and the need for primary care facilities is an urgent issue.  Two regional primary care organizations engaged TGB Architects convert an aging surplus inpatient clinic into a primary care facility to deliver a facility at a lower cost than new construction and deliver the project in a compressed time frame.The Lacey Clinic is designed to operationally integrate these two entities by providing improved medical access to an underserved community.  The surplus building, a former chemical dependency inpatient facility, was re-purposed to provide primary care and outpatient imaging services.  The final design layout is combination of existing reconfigured space and an expanded new entry sequence, patient lobby, and registration area.  The design process included several group design events working with stakeholders and front-line staff from both organizations to define a new operational and teaming model.   The building expansion required the removal of several large Douglas Fir trees from the site.  However, those trees did not go far- the trees were harvested and repurposed as structural supports in the entry and lobby.

Project Size: 25,320 sf

Construction Cost: $5.4 M

Status: completed 2017

Project Team:

TGB Architects

Civil – SCJ Alliance

Landscape – RW Droll, Landscape Architect PS

Structural –PSC Structural Solutions

MECH – Wood Harbinger

ELEC – Cross Engineers

Contractor – Andy Johnson Construction

Tags: #Facility Analysis, #Operational Analysis, #Space Planning, #Program Management, #Adaptive Reuse, #Live Timber, #Architecture

“It was so neat to hear people talking about some of the original design meetings and mock-ups you facilitated.  It is important that you fully grasp what was inspired from those meetings, that being pride, ownership and a healthy introduction to the PacMed/Providence teamwork what will be necessary for success.”

Quote from Dan Johnson - Chief Operating Office, Providence Medical Group

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First Hill ASC

First Hill Ambulatory Surgery Center Seattle, WA

The First Hill Ambulatory Surgery Center is a free-standing Ambulatory Surgery Center (ASC), representing a joint venture between Swedish Health System and PolyClinic, and is not affiliated with any Hospital system.  TGB facilitated a design work-session between stakeholders which allowed the two organizations to develop new operational models utilizing Lean methodologies.  A full-scale mock-up was built inside a vacated 38,000 SF medical office building floor plate to provide the design team with interactive and immediate process improvement environment.  Surgical light and boom vendors, and sterile processing equipment vendors were invited to bring equipment to the mock up space for the operating team to evaluate and determine final equipment purchase decisions.  Surgical teams, sterile processing staff and DOH were invited into the mock-up to provide insight and comment on flow, visibility, and innovation to the design.  The project includes 12 O.R.s, 24 Pre-Op/Recovery Bays, 12 PACU bays, and 4 private PACU rooms.  Sterile processing includes pass thru cart wash, 4 sterilizers, and 4 decontamination multi-compartment sinks.  The project also includes administrative areas, patient consult rooms, reception and family waiting area along with new City Light transformer power service, new Generator, and new Medical Gases storage room.  The project was delivered through a Design-Build agreement.


PROJECT COST: $13 Million

STATUS:  Completed 2016


TGB Architects

Sellen Construction


H&M Electric

BRN Engineering

Tags: #ASC, #Design Build, #Lean, #Mock-Up, #Process improvement, #Medical Planning, #Facility and Operational Analysis, #Architectural Design Services, #Space Planning

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Cascade Valley Hospital

Cascade Valley Hospital Arlington, WA

Cascade Valley Hospital was formerly comprised of a 1956 single story masonry block structure, a 1986 4 story nursing tower, and a free-standing MRI building.  The Hospital engaged TGB Architects to do Facility Master Planning, Design and Construction.  Through the process, a new 2 story building was developed that included a new front entry, new Emergency Department, a short-stay observation unit, laboratory, outpatient Infusion unit, kitchen, servery, and dining room, along with a new main lobby with admitting services and gift shop.  The new entry food service/ dining room became an iconic focal point of the design and serves as a day and night beacon to the whole community.  The existing MRI building was also relocated to improve workflow and provide an optimal location for the new building.Additionally, TGB Architects assisted Cascade Valley Hospital in Public Hearings for a bond campaign for funding as well as helping to orchestrate a GCCM project delivery method.  The project was completed on time and under budget in 2010. The project has proven to be a showcase for other small community hospitals.  TGB continues to provide additional design services for Cascade Valley.

PROJECT SIZE:  40,000 SF New/ 48,000 SF Renovation. 1,500 SF MRI Relocation

PROJECT COST:  $40 Million

STATUS:  Completed 2010



Hargis Mechanical & Electrical

Degenkolb Structural

KPFF Civil

Brumbaugh Landscape

DK Design Kitchen/Food Services design

Ritter Aalhus Construction Management

Tags: #Master Planning, #Medical Planning, #Architecture, #GCCM, #Community Outreach, #Collaborative Design,

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Free Standing Emergency Department (FSED)

Free Standing Emergency Department (FSED) | Kadlec Kennewick, WA

Kadlec Regional Medical Center’s Emergency Department was reaching its maximum capacity.  The prospect of expanding the existing ER, enclosed within the existing hospital, was a painful prospect.  Demographic analysis showed that 40% of ER patient visits were from the adjacent city across the Columbia River.  ER volume analysis also indicated that 80% of all visits ended with the patient returning home.  Based on this, a decision was made to open a new Free Stand Emergency Department across the river, 12 miles from the hospital.Using Lean design principals, the ER staff worked with the TGB design team in a 5-day design event.  The three-fold goal of this event was to reduce the ER visit time from an average of 263 minutes to 90 minutes with no waiting, with no more than10 minutes from door to doctor.  Furthermore, the building must be designed to a base capacity of 20,000 visits per year with expansion capacity to 40,000.  The team redesigned their processes and protocols, then designed the building to support this goal.Using a daily management system, the first 3 goals are achieved and maintained in the first year.  40,000 visits were achieved by the 3rd year of operation with no significant changes in the building or protocols.



STATUS:  Completed 2013


TGB Architects

Mechanical & Electrical- Coffman Engineers

Structural- PSM

Civil- JUB Engineers

Landscape- Heritage Professional Landscaping and Maintenance

Bouten Construction Company

Tags:#Masterplanning, #Medical Planning, #Architecture, #Emergency Room, #Collaborative Design, #Process Improvement

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Healthplex | Kadlec Richland, WA

Kadlec Regional Medical Center (KRMC) had 30 separate outpatient clinics, service lines and departments serving a wide range of patients with chronic conditions, all located throughout the Tri-Cities community.   This presented access challenges for patients accessing multiple services in addition to an inefficient use of available space.  An 80,000 SF existing “big box” retail store was purchased to house all services in one location, but two previous design attempts did not provide the needed integration. TGB Architects joined the project at this phase, leading the stakeholder team in a process of discovery to find effective ways to integrate service lines and orchestrated a design process to develop a new setting for integrated services.   TGB then facilitated a Lean 3P process that engaged front line staff from all 30 services lines.  By looking to non-traditional methods of healthcare, TGB discovered a model of that provided healthcare to the family community of the patient. This changed the project strategic intent to: “How might we together create a community of providers to care for a community of clients?” The group event produced a new model of care with improved operations, integrated staff work areas and standardized patient care areas to allow maximum flexibility. A guiding metaphor that had direct architectural and operational implications: a cornfield.  A cornfield will not produce corn unless two conditions are present:  there must be many stalks and they must be planted closely together. This “cornfield” became an open office concept for 90 staff members, with seating is arranged for collaborative consultation. The “Cornfield” anchors the center of the facility, with clinical encounter and treatment areas are located around the outside.  In the front is a patient community gathering space are with comfortable seating, education areas, and food service.The Healthplex is now three years old and has surpassed all growth projections.

Project Size:  80,000sf

Construction Cost: $10.5M

Status: Completed 2015

Project Team:

TGB Architects

Civil – Meier Architecture | Engineering

Landscape – Heritage

Structural –JUB Engineers

MECH – Rice Group

ELEC – North American Engineers

Contractor - Bouten

Tags: #Facility and Operational Analysis, #Space Planning, #Project and Program Management, #Primary Care, #Adaptive Reuse

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VMMC CCU and Oncology


VMMC had constructed the shell & core several years earlier.  Project included design of pre-fabricated restroom units with toilet, sink & shower, pre-fabricated mechanical frames and piping sections.  28 Critical Care Unit included a Radiology suite with CT Scan & X-ray unit.  The 24 bed Oncology Unit included a Pharmacy included ante-chamber and Infusion mixing hoods.  Full scale mock-ups constructed and simulations conducted on both floors.  Design was successful to segregate the flow of materials and supplies from the movement of patients and families.  Spaces were provided for both families and staff respite areas on each floor.  Pass-thru patient care supply cabinets were installed between the patient room and hallway to minimize the interruptions into the room that materials and EVS staff might otherwise make.   


PROJECT SIZE:  28,000 SF 28 bed Critical Care Unit & Radiology Suite, 24,000 SF 24 bed Oncology Unit and Infusion Pharmacy,

PROJECT COST: $21 Million CCU & Radiology, $19 Million Oncology & Pharmacy

STATUS:  Completed 2014


TGB Architects

Skanska Construction

CPL Structural Engineers

Macdonald Miller

Veca Electric

OTHER: Zero external staging area mandated that much of the work was prefabricated, delivered to street side crane, and lifted into place through an existing window opening on the un-occupied floor. 

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Mason General Hospital


TGB completed a demographic & needs assessment resulting in a campus master plan to address anticipated community healthcare needs.  The plan included consolidation of eight primary and specialty care clinics under a single roof.  The intent of consolidation is to convey an integrated care system.  The new 2 story Clinic will be directly connected to the hospital, will have 2 dedicated X-ray rooms, and outpatient lab draw services, as well as walk-in clinic.  Specialty care clinics include Orthopedics, Podiatry, Women’s OB/GYN, Pediatrics, General Surgery, and Eye Clinic.  The project also combines 3 separate Primary care clinics into a single service line.   The project also includes a new Data Center that will house servers for both the existing hospital and new clinics.  The project is under construction with completion scheduled for December 2019.



PROJECT COST: $25 Million Clinics, $2 Million Data Center

STATUS:  Master Plan – 2015, Design – 2017, Construction – 2018-2019,


TGB Architects

Skanska Construction

PCS Structural Engineers

Notkin Mechanical

Wood-Harbinger Electrical & Technology Engineers

PACE Civil Design

SCL Alliance Landscape Design

OAC Services Project Management

OTHER: Project will be delivered through a GCCM delivery method, where Skanska Construction company engaged the project early during the design process.


Tags:#MOB, #Design Build, #Mock-Up, #Process improvement, Master Planning, #Space Planning, #Medical Planning, #Facility and Operational Readiness, #Architectural Design Services,

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Tulalip Gathering Hall

Tulalip Gathering Hall

“It is important that we return to the tradition of gathering to revitalize our tribal values and integrate them into our emerging present-day culture.  An increasing percentage of our tribal community are youth.   Our gatherings need to help them to know our traditions and customs to help them into the future.   We must balance between the old and the new ….  We must balance between what is meaningful and what is useful.”

The Gathering Hall is a multi-use facility that can accommodate up to 1,500 tribal members for such activities as General Counsel, Pow Wows, meals, funerals and other gatherings.  It is sited on Tulalip bay which is the historic and cultural center of the Tulalip tribes.  The form and materials of the building are simple and traditional.  The ancient wisdom of tribal peoples draws them to gather in a circle.  This allows them to both listen to a speaker, and also see the faces of the other listeners helping them to find the way to consensus and agreement.   The large supporting cedar columns are arranged in a gentle curve to encourage a circling arrangement of gathering.  This enclosing shape also references the shape of a canoe which is an important artifact of travel for the Coast Salish People.




STATUS:  Design – 2017, Construction – 2018-2019,


TGB Architects


Structural Engineers


Electrical & Technology Engineers

Civil Design

Landscape Design

Project Management

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Kadlec Nicu

Kadlec Regional Medical Center - NICU

In 2012, TGB with KRMC to renovate and expand their existing Level III NICU.  In 1993, the Mother/Child center was developed with 16 LDRP and 12 NICU in an open bay nursery setting.  Since that time the acuity and level of care, patient family participation, and need for increased privacy warranted an expansion and renovation of the NICU from 12 open bay nursery beds to 28 private family rooms.   The change in care model & practice necessitated extensive pre-planning, operational practice and process changes to be rehearsed, mocked up and simulated.  Additionally, the construction required relocating existing patients & families to another location within the hospital during renovation.  Located on the second floor of the hospital, the expansion extended onto unoccupied roof, added a new rooftop AHU, and was set in a wayfinding theme of animals from various continents.  In additional to the private patient/family care rooms, the scope includes a communal family center for preparing meals, assembling larger families, and respite.  The scope also included bereavement room where families could spend their last few difficult hours with their newborn.  In order to meet the need for natural light, creative measures were negotiated with the Department of Health to accept skylights and borrowed natural light.  Three rooms were designed with demising sliding door so that twins or triplets could be treated within the same family space.    

PROJECT SIZE:  12,000 SF   New 5,600 SF Renovation, 6,500 SF

PROJECT COST:  $14 Million

STATUS:  Completed 2014



M+NLB Mechanical

Sparling- Electrical

DCI Engineers- Structural

Bouten Construction Company

Tags:#Pre-planning, Lean operational process improvement, change management, mock-up & simulation, #Medical Planning, #Architecture, #Collaborative Design,

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Surgical Sterile Processing and Materials Management

Surgical Sterile Processing & Materials Management 

The ART of Surgical Sterile Process and related clean materials storage is all about the understanding of processing volume and flow in an efficient manner to handle the surge and wane of cases.  TGB is experienced in the design of Surgical Sterile Processing for inpatient and ambulatory outpatient surgery facilities, both renovation and new construction. 

First Hill Ambulatory Surgery Center, Seattle, WA (completed 2016):  5,500 SF new free-standing ambulatory sterile processing and clean materials storage facility within a 36,000 SF 12 OR ambulatory surgical facility, private venture not associated with a hospital.  Scope included walk-in/pass-thru cart wash, a series of 3 compartment sinks, 4 sterilizers, case tray assembly tables and storage.  The project was located on the second floor of an existing medical office building in downtown Seattle’s First Hill medical district. The planning process include full size mock-up and simulation of process flow. 

Proliance Spine & Joint Surgery Center, Mountlake Terrace, WA (completed 2017): 3,500 SF free-standing ambulatory sterile processing and clean storage facility within an 8,000 SF 3 OR ambulatory surgical facility.  Scope included medical planning and design within and existing medical office building adjacent to existing MRI services.   

Virginia Mason Medical Center, Seattle, WA (completed 2014): a 14,000 SF multi-phased renovation of existing SPD & highly sensitive equipment while maintaining operations in place of both decontamination, sterile processing, and materials storage.  The project spanned three building expansion joint and included raising floor level of one building so that no future ramps needed to be navigated by staff pushing heavy equipment and surgical instrument carts.  The planning process include full size mock-up and simulation of process flow. 



Lund Opsahl Structural engineers

Wood Harbinger Mechanical & Electrical engineers

Turner Construction Company

First Hill Ambulatory Surgery Center

Lund Opsahl Structural engineers

MacDonald Miller Mechanical

BRS Electrical

Sellen Construction Company

Proliance Surgery Center

Design / Build engineers

Constantine Construction

Tags:#Medical Planning, #Architecture, Lean operational process improvement, #Mock-up & simulation, #Collaborative Design,

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