The Ultimate Recycling Project – Vanderbilt Health One Hundred Oaks Outpatient Clinic Mall (Healthcare Design Magazine)

NASHVILLE – One Hundred Oaks was the first closed indoor shopping mall in Nashville, originally built in 1968. Featuring 880,000 square feet of retail space on a 56-acre site and 4,000 parking spaces, One Hundred Oaks was a “retail wonderland,” well known in the Nashville area. However, by 2005, the mall was dead in the water, another casualty of suburban flight. There were attempts to revive the mall in the 1990s, but despite viable exterior tenants, the interior upper concourse was all but abandoned.

At the same time, just four miles away, Vanderbilt Health’s flagship facility, Vanderbilt University Medical Center (VUMC) was growing and quickly running out of space to expand services on its 21st Street campus. Because of growth on the university campus and the dense urban environment, VUMC was basically landlocked.

Vanderbilt leadership made the decision to create a new health and wellness campus away from the crowded main campus, enabling Vanderbilt Health to deliver care to the community with convenience, as well as to accelerate market share growth that would simply be impossible at the current site. As far as location and accessibility factors are concerned, there was no better spot than One Hundred Oaks. But could Vanderbilt Health really put all its future plans in the middle of a failed shopping mall?

Despite the unconventional nature of the location, One Hundred Oaks actually had a lot going for it. It was located close to the 21st Street campus-just four miles away-as well as downtown Nashville, and was easily accessible, scalable, and, perhaps most importantly, available. As the old adage goes, it was so crazy, it just might work.

Vanderbilt Health, developers ATR & Associates Inc. and Corinth Properties, and architecture firm Gresham, Smith and Partners repurposed the 880,000-square-foot mall into a 450,000-square-foot medical center (only 300,000 feet of which is currently being used), home to 22 specialty clinics (as well as pharmacy, imaging, and a lab) housed in a LEED-certified-no mean feat considering that the infrastructure was built 40 years ago as a retail space. There would also be a 47,500-square-foot, five-story office tower. And it was all delivered on time and on budget.

With a 12-year lease in hand, the team set about on executing the master plan in mid-2007-no mean feat given the space and timeline. As Katherine Kennon with Vanderbilt Space and Facilities Planning explains, “We partnered with Gresham, Smith and Partners’s planning group and scheduled a crazy number of meetings-something like 100 meetings in a month and a half. There were three groups a day meeting for a roughly eight-week period with the users to develop their individual programs and space plans.”

Roughly 35 groups were programmed; ultimately only 22 were chosen to move into the new space via a decision matrix created by the Vanderbilt team.

In addition to the structure itself, there were many site enhancements made, including major changes to traffic circulation. “While Vanderbilt was going through its design work internally,” explains Tony Ruggeri of developer ATR & Associates, “the developers were working with Gresham, Smith and Partners on the site. We wanted to ensure that there was better traffic flow, because we knew there were some serious traffic issues both on the property and in entering and exiting the property. We also worked with Metro Nashville to realign some of the traffic lights nearby. We also worked on the external façade.”

Other additions include a walking trail, new landscaping (including 100 oak trees, of course), improvement and expansion of the existing retail, and the establishment of enhanced security provided by Vanderbilt Police.

The interior conversion was not without significant challenges. More than 25,000 linear feet of walls and 1,000 doors were installed, for example. Because the construction timeframe was so tight (it was completed in a mere 10 months), more than 250 on-site workers were used during peak construction. “There were definitely coordination issues,” Ruggeri says. “You had half the structure stripped down; we were also redoing the exterior of the building and all the site work, and at the same time, there was an active retail business going on with the established tenants. It was very challenging from a logistical standpoint.”

Architecturally, the space still shares many characteristics with a traditional shopping mall: strolling along its 800-foot circulation spine, one passes clinics just as if they were mall shops. “The funny thing is that the entire inside of the mall was demolished and removed,” says Architect of Record Steve Johnson of Gresham, Smith and Partners, “and we could have reassembled the interior space in many different ways. But after we took a step back and looked at it logically, we decided to keep the entrances where they were and to really replicate the general structure of the mall. As we started to lay in the clinic modules, we found that the idea of a mall-like circulation actually worked pretty well. It all just made sense, and it became obvious fairly quickly.”

Following that same mall-like mentality, One Hundred Oaks features kiosks that allow for self check-in, and patients can grab a pager and go next door to shop while waiting for their appointments. And, of course, it isn’t often you see a medical center where the main corridor has 20-foot ceilings.

“There was a definite need to create a space that would live up to Vanderbilt’s high standards of medical delivery,” Johnson explains, “but it was not a typical space, certainly not for a healthcare facility. This was an entirely new situation for Vanderbilt, for the developers, and for the established retail in the space. It was apparent that the MEP systems in the mall were antiquated and were not going to be suitable for healthcare, so those had to be replaced. There were issues with other utilities, as well-where would the power come from? We wound up having to move where the power entered the building. What about the sanitary and sewer lines? A lot of this unfolded during the design process, and some of it after construction had already begun. There was a lot of trial and error.”

Finishes and furnishings were kept as simple as possible, but the effect is a unified look rather than cheapness. “We struggled for a bit trying to understand the identity of the space,” Johnson says. “Was it very hospital-like, or more hotel-like? In the end, it is somewhere in between. There is a definite hotel check-in feel, added to by the random patterns of seating in the waiting areas.”

Skylights were replaced to increase the amount of natural light in the space, and valet parking is now offered, further enhancing the hospitality element of One Hundred Oaks.

Completed in late 2008 (the pediatric clinic opened early, in February 2008, while the other clinics opened in early 2009), the project has been embraced by the community, which was thrilled to have the dead retail space upgraded to a secure and thriving medical facility (“There was virtually unanimous support for the project,”Ruggeri says).

No doubt this positive reception was enhanced by the pre-opening steps taken to reach out to the community, including neighborhood meetings to address concerns, a vigorous marketing/outreach campaign, and $25,000 in neighborhood improvement grants from Vanderbilt.

Is this type of retail-recycling the tip of the iceberg? Will we see more and more creative repurposing of space to be used for healthcare in the wake of reform and the need for expanded services to handle the aging baby boomer population? Only time will tell, but for Vanderbilt Health and the city of Nashville, the solution couldn’t have worked out any better.

Vanderbilt Health’s Cyril Stewart summarizes this complex project perhaps about as well as it can be: “One of the lines we used on a promotional billboard for the project said, ‘We’re not just transforming a mall, we’re transforming healthcare.’ We challenged every group involved with this project to innovate and come up with better ways to provide healthcare to this community. I’d say they all succeeded.”