Medical

What kinds of medical buildings do we design?

"Medical" covers a wide range of buildings, and they don't share a rulebook. A dental suite and a surgery center may sit in the same retail strip under different code provisions, different state oversight and very different mechanical systems. So we name the facility type precisely first.

Medical office buildings versus medical suites

A medical office building, or MOB, is a building type; a clinic is a tenant. We design both. On an MOB the questions are about the shell: structural capacity for imaging equipment, shaft space for exhaust and gas risers, roof area for a larger mechanical load, and a parking count that reflects patient turnover rather than office headcount. On a clinic suite the questions are about the program inside that shell.

Physical therapy and behavioral health

Physical therapy is closer to fitness space than to a clinic: open gym floors, treatment bays and equipment loads. Outpatient behavioral health leans on acoustic privacy, staff sightlines, and fixtures chosen to limit risk where the program calls for it. Neither is an office with a new sign on the door, a point we make often to owners converting office space.

Business occupancy or ambulatory health care: why does the line matter?

Occupancy classification is how the building code sorts buildings by the risk to the people inside. Most clinics, dental offices and medical office buildings are classified as business occupancy, the same broad group as an office. That works because a patient in an exam room can get up and walk out in an emergency.

The line moves when patients cannot. When a facility provides care that leaves patients incapable of self-preservation, meaning general anesthesia, deep sedation or emergency treatment that leaves someone unable to evacuate without help, the building code adds requirements for ambulatory care, and the Life Safety Code (NFPA 101) treats the space as a separate ambulatory health care occupancy once a set number of such patients are present at once. Those rules can bring smoke compartments, stricter sprinkler and fire alarm scope, emergency power, and corridors and doors sized for moving a patient on a stretcher.

Why the classification has to be decided early

The trouble is that the answer depends on clinical decisions, not architectural ones. A practice that plans to add sedation dentistry, or a specialist who wants to perform procedures in-office, may push a suite across the line without anyone noticing until plan review asks. By then the walls, the ceiling and the fire alarm design are drawn for the wrong occupancy.

Which approvals does a medical project need in Texas?

Every commercial building in Texas goes through local plan review and, above the cost threshold, state accessibility review. Medical space can add two or three more tracks, and each has its own reviewers, forms and timeline. Missing one doesn't just delay a step; it can hold the certificate of occupancy after construction is finished.

City and fire marshal review

Houston has no conventional zoning, but it has development rules, parking requirements, stormwater detention and enforceable deed restrictions, and medical use can trip parking ratios office use would not. Sugar Land, Katy, Pearland, The Woodlands and unincorporated Harris and Fort Bend counties each run their own review, and many of those cities zone. Fire marshal review covers sprinklers and fire alarm.

State licensing, where it applies

Some facility types must be licensed by the state, and in Texas that runs through the Health and Human Services Commission. Surgical and emergency facilities are the usual examples, and licensed facilities may face design standards and inspections beyond the building code. Which rules apply depends on the facility type and the services offered, so we confirm the licensing path with the operator before design starts rather than inferring it from the floor plan.

Accessibility review

The Texas Department of Licensing and Regulation (TDLR) requires projects with an estimated construction cost of $50,000 or more to be registered, reviewed and inspected by a Registered Accessibility Specialist under the Texas Accessibility Standards (TAS). Almost every medical suite clears that threshold. We cover how that review works in TDLR accessibility review for commercial projects.

How should a clinic floor plan work?

A good clinic plan runs two circulation systems on one floor plate. Patients move from the front door to check-in, to waiting, to an exam room and back out. Staff, supplies and soiled materials move through a separate back corridor that patients never see. The two meet in exactly one place: the exam room, where each has its own door or its own side of the room.

The zoning plan below shows that logic in three bands. The Public zone holds the entry, waiting room and check-in. The Clinical zone holds exam rooms, procedure rooms and imaging. The Staff and support zone holds the workroom, clean and soiled utility and the break room. The patient path and the staff path are drawn as two separate routes, and they only meet inside the exam rooms.

Exam room modules

Exam rooms work best as a repeated module: same size, same casework, same sink location, often mirrored in pairs to share plumbing walls. Roughly 100 to 120 square feet suits most general practice, with larger rooms where specialties bring in equipment. Identical rooms let any provider use any room, which keeps a schedule moving.

Nurse stations, utility rooms and sterilization

Nurse stations belong where staff can see the exam room doors, not tucked behind them. Clean utility and soiled utility are separate rooms with separate purposes: one stores supplies, the other holds used linen, waste and instruments waiting for processing. Sterilization, whether a compact dental sterilization center or a larger processing room, should flow one way from dirty to clean. A small lab or specimen drop sits near the exam rooms with a sink and dedicated counter space.

Waiting, check-in and privacy

Check-in desks need to let a patient give a name and date of birth without the whole waiting room hearing it. We plan for that with desk depth, partial screening, a separate private area for insurance and payment conversations, and screen orientation that keeps records out of view. Walls around exam and consult rooms get sound-rated construction carried to the structure above, or sound-attenuated at the ceiling, because a standard office partition carries conversation straight through. That is privacy-conscious planning in plain terms: design the building so patient information stays in the room it was spoken in.

“A clinic is two buildings on one floor plate.
One for patients, one for everyone else.”

Accessibility is a daily reality here

Clinics serve more patients who use wheelchairs, walkers and canes than most building types. TAS sets the minimum: accessible routes, door clearances, restrooms, exam room turning space and reachable counters. We go past it where it costs little, with covered drop-off and at least one exam room planned for a patient transfer.

Medical gas, imaging and infection control

These three systems are where medical space departs furthest from office space. Each touches the walls, ceiling and structure, and each has its own standards.

Medical gas and vacuum

Clinics and dental practices commonly use oxygen, medical vacuum, nitrous oxide and medical or dental air. The governing standard is NFPA 99, which sets how systems are piped, zoned, alarmed and tested. Gas is supplied from cylinders, a manifold or a compressor and vacuum pump, runs through cleaned copper piping, is split into zones with shutoff valves staff can reach, and is monitored by area and master alarms.

Before the system serves a patient, an independent verifier tests it for cross-connections, purity, pressure and alarm function. It is separate from the building inspection and has to be scheduled, so we build it into the construction phase from the start.

Imaging: X-ray, CT and MRI

Any room with X-ray or CT equipment needs a radiation shielding design prepared by a qualified medical physicist. The physicist's report sets how much shielding goes into walls, doors, windows and sometimes floors and ceilings, based on equipment, workload and what sits on the other side of each wall. We draw to that report; we don't guess at it, and we don't finalize the imaging room walls until it exists.

MRI is a different problem. The magnet's field extends past the room, so the suite is planned in zones of controlled access, with screening before a patient reaches the scanner. The room needs radio-frequency shielding, the magnet is heavy enough to govern structural design, and superconducting magnets need a vent path to the exterior. The scanner also has to be delivered and one day replaced, which affects where the suite goes.

Infection control and air

Infection control starts with finishes that can be cleaned hard and often: seamless or welded flooring in clinical rooms, cleanable ceilings in procedure spaces, and casework without open seams. Hand-wash sinks go where care is given, not just in restrooms. The FGI Guidelines for outpatient facilities are the common reference for these requirements, and many licensed facilities are required to follow them.

Air matters as much as surfaces. Certain rooms need defined pressure relationships, with soiled utility and some procedure spaces held negative so air flows in rather than out, and clean supply rooms held positive, along with minimum air change rates. In Houston, humidity control is part of the same conversation, because damp ductwork and ceiling cavities are an infection-control problem as well as a comfort one.

Why do medical projects cost more and take longer?

Medical space costs more per square foot than office space because more of the money goes into systems: more plumbing fixtures, more electrical circuits, med gas, more exhaust, finer HVAC zoning, shielding and heavier casework. We walk through the specific drivers in medical office build-out cost drivers, and every medical project gets its own number because the drivers vary so much between a dermatology suite and an imaging center.

More reviews also mean more sequencing, and some can't start until others finish. The timeline below is a planning range for a typical clinic or medical suite; ranges vary by project, facility type and jurisdiction.

Planning ranges, not a project quote. Timing varies with owner decisions, project complexity, and jurisdiction workload.

Under one contract, the engineers who design the gas, air and power are coordinated with the architecture before the set goes out, which is where medical schedules are usually won or lost. Our full scope is on the architecture services page.

How does medical tenant improvement work in a multi-tenant building?

Much of the medical work in Houston happens inside existing buildings: a suite in a medical office building, a former retail space in a strip center, or a floor in an office building converting to medical use. The shell was designed for someone else, and the first job is finding out what it can actually support.

What to check before signing a medical lease

Plumbing is the most common surprise. Exam room sinks need drains, so a ground-floor suite may need slab trenching and an upper-floor suite needs a path through the tenant below. Electrical service, roof space and landlord rules on exhaust and gas cylinders belong in the test fit too. Our tenant improvement process puts that check before the lease, and our feasibility work does the same for owners buying a building to lease to medical tenants.

Frequently asked questions

Planning a clinic or medical office building?

Send us the address, the facility type, the services you plan to offer and the approximate square footage through the contact page. We'll tell you which approval tracks apply and what the schedule realistically looks like. If the design team is already in place and you need someone licensed reviewing their work, see owner's representation, or browse the other sectors we serve.