multi use building case study

Case Study: Designing a Multi-Use Community Recreation Center

• June 25, 2020

Community recreation centers have evolved from a building comprised of a simple gym and sporting area into mixed-use facilities for the entire community. Municipalities are envisioning these community rec centers as places for people of all ages to connect, exercise, unwind, educate and learn – all in one space.

With a combined 100 years in the commercial design industry, Bobbitt A&E architects understand what it takes to design a community recreation center that will benefit a wide range of people. In this interview, Josh Boltinhouse, AIA and Principal Architect at Bobbitt A&E, highlights the design process for a rec center and shares insights from  Hardeeville Indoor Recreation Center , a project  currently underway  in Hardeeville, South Carolina.

Q: What are the biggest considerations when designing a community recreation center?

BOLTINHOUSE:  One of the most significant drivers and something we always seek is community feedback. In the case of Hardeeville, the town decided to put together a task force to gather input for their new indoor rec center. They held internal meetings and conducted surveys of community members.

Often, community members have a long wish list for their building, but that list will usually need to be prioritized to stay within budget. Before starting the design process for a community center, it’s important to listen to what the members are trying to accomplish with the new space. What they want to  DO  with the space doesn’t always match up with what they want to  PUT  in the space. As a designer walking them through the design process, it is essential to make those distinctions. Once it’s clear how the space will be used, we can convert that into a design. We use our expertise to design the building to meet as many needs as possible. Through good communication, we are able to design a solution for how they want to operate.

For example, initially, one of the key requirements for Hardeeville was to have a rec center that is big enough to host large basketball tournaments. To meet this need and stay on budget, we designed a full-size court that can be easily divided into two courts for multiple games. While this space was ultimately pared down from the original vision, it still meets the town’s goals and the needs of the community.

Q: What are some of the design elements you deploy for community recreation centers?

BOLTINHOUSE:  For the design of a community center, you can go with what you would expect to see in that specific community, or go with something totally different and unexpected. You want a design that will create energy and movement, because it’s a place that will be full of activity.

And for Hardeeville Indoor Recreation Center, we landed on a contemporary design. The lobby features tall ceilings with the structure at a 10-degree slant, so it leans a little bit. This adds movement and flow on the inside, creating an atmosphere fitting for a rec center. Also, since much of the interior space does not allow for windows – like inside the racquetball courts – there’s a risk of the outside appearing dull. We countered this issue by adding angles in the brick design and utilizing a combination of white cast stone and a common red brick for interest. We also used materials found in other local buildings as well as more dynamic materials to break up the facade.

Q: What are communities looking to include in their recreation centers?

BOLTINHOUSE:  Many communities are requesting multi-purpose rooms to host different forms of activities. They want flexible spaces that can be used for a variety of reasons. Ideally, you want people to have many reasons to visit the community center so a larger percentage of the population benefits from the facility. Communities are looking to build spaces that are inviting to all age groups and demographics.

Some of these flexible spaces include basketball courts that convert to pickleball courts, satisfying multiple generations. We are seeing municipalities that are adding weight rooms in addition to traditional cardio centers to appeal to a younger population.

Nutritional offerings, such as a smoothie bar or dietician services, are becoming increasingly popular to promote overall well-being. Rec centers are also being used by community groups looking to rent large spaces for meetings and events. In Hardeeville, we provided for this need by adding vertical partitions that fold up into the ceiling to give added flexibility when expanding or contracting to accommodate various sized groups.

Q: What is Bobbitt A&E doing differently when designing community recreation centers?

BOLTINHOUSE:  Bobbitt A&E strives to provide our clients with the smoothest design process possible. Bobbitt A&E offers  design-build services  that come with many benefits. One of the key advantages of using design-build when building a new community rec center is that it allows us to give our clients multiple options. The architect and construction teams work together by asking the right questions in the beginning to make sure the design corresponds to the budget. Finding an efficient solution that meets multiple needs, instead of designing a singular space for each one, is a core competence for Bobbitt A&E. Our clients won’t have to go through a long design process just to realize they can’t afford it.

Another thing Bobbitt A&E does well is thinking long term and planning for growth when working on community buildings. We ask questions and provide valuable input, because we understand that the community’s needs won’t be the same 10 years after the building is designed and built.

We always try to plan for increased population growth and evolving community programs because we know it is cheaper to accommodate for the future and build correctly now than to have to modify down the road.

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Original research article, differences in experiences with the development of mixed-use projects from 2004 and 2017.

• Indiana State University, Construction Management, Terre Haute, IN, United States

Mixed-use developments, having three or more uses within one development, have several benefits for communities, however due to the complexity of these developments, several challenges arise in the planning and development phases. The main challenges are local regulations, neighborhood opposition, financing, and insufficient market interest. A 2004 survey of these challenges was repeated in 2017 and the differences between the two are compared in this paper. Significant differences were found in the frequencies of the challenges, mainly that the proportion has dropped in 2017. However, local regulations remained the most significant challenge encountered. The decrease in frequencies is conceivably a sign that regulators, financers, and members of the community are becoming more familiar with mixed-use developments.

Introduction

Mixed-use development, multiple uses within a project, although not a new concept, is continuing to grow in popularity. Mixed-use development has several benefits for communities and is a key strategy in achieving sustainable environments ( Woo and Cho, 2018 ). It has been utilized as a popular method for community revitalization, helping to increase density which helps grow communities with limited land space or empty city centers and create a vibrant space for people to enjoy. Additionally, the developments provide benefits to the environment, retailers, residents, and municipalities. Increasing the walkability of an area can reduce commuting distance and auto mode share ( Lee, 2020 ) and thus reduces pollution. Offices and retailers within a mixed-use development become immersed in potential customers from the diverse residents and other businesses ( Chinburg Properies, n.d ; Slowly, 2016 ). Because amenities are closer to home, mixed-use developments promote walking, which provides health benefits for residents (University of Delaware De). Further, it is estimated that nearly 33% of people would prefer to live in a diverse, walkable community ( Slowly, 2016 ). Municipalities see a tax revenue in-crease from mixed-use versus single use and are able to save on infrastructure construction, such as roads and water supply, because of the shared land use (University of Delaware De; Newcomb, 2015 ; Lamb, 2012 ; Useful Community Developm, 2017 ). Any one of these assets would be a reason to promote mixed-use development, to say nothing of simply overcoming obstacles to its provision. In combination, they form a compelling case for mixed use as an element of a more inclusive and prosperous society.

Levine and Inman used the Urban Land Institute definition of mixed-use developments as having three or more uses in one project ( Urban Land Institute, 2011 ; Levine and Inam, 2004 ) as this very premise makes mixed-use developments popular, it also creates challenges. Zoning, building codes, and appropriate uses are some of the prominent challenges developers face when planning this type of project. Transferring one development’s successful practices to another development rarely result in the same outcomes. For this reason, it has proven difficult to determine best practices for these types of projects.

In 2004, Levine and Inam (2004) from the University of Michigan performed a nation-wide survey of developers to determine the highest impact challenges to mixed-use developments. The present study has recreated the survey to determine if there are significant changes in challenges to the use of mixed-use developments in 2017. Further, the current survey also collected the opinions of planners, architects and construction managers as they are the stakeholders most involved with the upfront planning processes involved for mixed-use development and represent their own aspects, opinions, and goals for the success of the project. This study aims to answer the following questions:

• What are the current factors affecting mixed-use development as perceived by developers, planners, architects, and construction managers?

• What are the differences in the factors of local regulation, market interest, financing, local opposition, in a survey of developers in 2004 ( Levine and Inam, 2004 ) and 2017?

Methods and Materials

Literature review.

Mixed use development has become a popular tool to revitalize communities, increase sustainability, and develop a stronger sense of community. The exact definition of mixed-use development is relative from country to country ( Lau et al., 2005 ). In the United States, the Urban Land Institute ( Urban Land Institute, 2011 ) defines mixed-use as “three or more significant revenue-producing uses (that have a) functional and physical integration of project components” (p. 2). Additionally Lau et al. (2005) suggest that no single-use should utilize more than two-thirds of the usable floor plan of the project. The potential uses for the project include “real estate with retail, office, residential, hotel, recreation, or other functions that are pedestrian-oriented” ( Rabianski et al., 2009 ) (p. 206). These uses encompass the popular live-work-play environment for people where everything needed is comparatively close. However, despite these definitions, one mixed-use development approach and plan rarely results in the same success amongst various projects; this is due to the various ways in which mixing uses may be applied.

According to Grant (2002) , there are three main ways that a community may apply mixed-use: increasing the intensity of land uses, increasing the diversity of uses, and integrating segregated uses. Intensity of land use is known as the variety of choices of a specific type of use; multiple types of retail or housing choices to accommodate all levels of income ( Niemira, 2007 ). Projects may be as large as entire neighborhoods, an entire street or block, or as small as an individual building; located in inner city or city centers, brownfield or greenfield sites, or city edges such as suburbs ( Rowley, 1996 ). These projects are typically implemented as an attempt to promote mixed use developments through “1) conservation of established mixed-use settings; 2) gradual revitalize and incremental restructure of existing parts of towns, such as infill development and reuse, conversion and refurbishment; and 3) comprehensive development or redevelopment of larger areas and sites” ( Rowley, 1996 ) (p. 87). Table 1 summarizes the variables of these factors.

TABLE 1 . Factors and variables for the application of mixed-use development.

These various factors and their options of mixed-use give more credence to the idea that the same urban form may not be successful in another development; yet can be adaptable as needed, provided the proper planning is performed. This also shows that mixed-use development can occur on several different scales and can intertwine together in various environments; thus, a critical analysis should be performed to determine the best approach to incorporate the proper setting, location, and timing.

As mixed-use developments have evolved, so has their popularity. Rowley (1996 ) points out that due to the diversity of the urban setting, experiences are different than in suburban or rural settings, such as “people, activities, uses, architecture; the amenities, open spaces and other visual stimuli that cities can offer; and a rich public life” (p. 89). Further, many of these services, including retail and public transit, rely on a higher density in or-der to function ( Brewer and Grant, 2015 ). In a survey from four real-estate associations, the top three reasons cited for the popularity in 2006 were: “the live-work-play environment as a single location is convenient; rising land prices are making more density necessary; and the format is being encouraged by local public agencies” ( Niemira, 2007 ) (p. 54). While there are individual benefits to mixed-use development, there are community-wide benefits as well. Hoppenbrouwer and Louw (2005) report that the most significant advantages of mixed-use development are a reduction in travel needs, followed by increased urban diversity, and vitality.

Mixed-use developments generate economic vitality ( MahmoudiFarahani et al., 2018 ) benefits for businesses. Job creation is a strong sign of vitality and a main goal of mixed-use development is mixing residences and offices to provide easy access to employment and clients ( Grant, 2002 ; Hoppenbrouwer and Louw, 2005 ; Grant and Perrott, 2011 ; Kong et al., 2015 ). Businesses actually prefer to be in mixed-use as some of their client-base is already created just by proximity ( Chinburg Properies, n.d ; Slowly, 2016 ); for example when stadiums or arenas are in the community, there are “50,000 people will want to have something to do before and after the game other than hangout in the parking lot” ( Slowly, 2016 ) (para 9). Even on a smaller scale, a community with a theater or playhouse has the same need, employees have a place for lunch, entertainment, and so on ( Efficient Gov, 2015 ). Diverse uses attract more and diverse people, providing an increased potential for the business to be seen rather than with an isolated location ( Chinburg Properies, n.d ; Slowly, 2016 ; University of Delaware De). Further, property managers tend to provide better service as they have more clients within a building, resulting in quicker response to issues, preventative maintenance, and lower costs from sharing the building with other inhabitants ( Chinburg Properies, n.d ; Buildings, 2009 ). If successful, profits for businesses in mixed-use communities can exceed traditional locations by three times, sometimes more ( Leonard and Cumbelich, 2014 ).

Regulations are required for infrastructure maintenance and economic support. Roads, water supply, drainage, etc. are built to a specific capacity and if these capacities are exceeded they can break down faster, require more maintenance, or may not work at all; thus planners are often unable to accommodate all development requests of higher density. Additionally, uses are regulated by zoning in order to not saturate the market, preserve history, or not disturb residents. One jurisdiction may have different objectives and purposes or different views how to reach them in another district. Besides counties, jurisdictions could also be cities. Each jurisdiction has a committee of people from the community that approves regulations, zoning changes, land use, and construction. These planning committees are led by planners who are professionals that are employed by the city or county in order guide the committee that make decisions on these regulations ( City planning, 2016 ).

Planning staffs and commissions do not always support the mixed-use concept. In interviews performed by Grant (2002) , the researcher found that planners of smaller communities hesitate to utilize mixed-use as they doubt the benefits. Instead, they believe that existing neighborhoods need support and that people choose the suburbs for, among other benefits, the separation from other uses. Rowley (1996) suggests that some planners make uninformed assumptions about the community’s wants and needs. Further, they underestimate the implications of these assumptions. On the other hand, Brewer and Grant (2015) suggest some planners promote density as a way to increase services within the community; however, their execution is lacking. The thought is that increased density leads to lower housing costs and better support of mixed-use; however, actual the actual populations do not meet expectations. Therefore, services do not have the expected support, resulting in the loss of the anticipated benefits associated with mixed-use development.

Another hurdle in successful mixed-use is identifying proper compatibility of uses. This includes compatibility for community and other uses in the area; Rabianski et al. 2009 describes this as creating a synergy in the community. For proper integration and increased vitality, a market analysis for each use is needed to ensure relevant uses, scale, and location ( Anders, 2004 ; Rabianski et al., 2009 ). Taleai et al. (2007) found that uses and land types can actually “repel” other uses. For example, although highways provide accessibility, they also create noise which can be problematic for residences ( Taleai et al., 2007 ). Similarly, other competing or over-saturated businesses and uses should be avoided, instead uses should be complementary. Rowley (1996) describes other factors that affect people using mixed-use developments such as having accommodations for the disabled and elderly, various levels of income, and convenience of use. In order to maximize infrastructure savings, space should be designed to be used as often as possible, including outside of normal business hours ( Rabianski et al., 2009 ). In a diverse area, individual schedules can vary greatly resulting in varying times of usage needs. Rowley (1996) suggests sharing spaces, especially for uses that may not otherwise be able to afford the space on their own; for example a building room may host an aerobics class in the morning, a book club in the afternoon, and a card club in the evening. This type of space sharing helps to further maximize available uses and amenities for the community.

Although many people prefer mixed-use city life, there are as many others who do not wish to live in the city. And, while people enjoy the conveniences that mixed-use development offer, some are very cautious about what uses should be mixed. For example, uses such as “group homes, day care centers, waste management facilities, high-density housing, halfway houses, or prisons typically encounter resistance from residents. Even parks and playgrounds sometimes met opposition” ( Grant, 2002 ) (p.73). Brewer and Grant (2015) point out that attempts to increase population densities and mix are affected by household dynamics. For instance, families prefer homes with gardens, that allow privacy for peace and quiet, offer some separation, and provide community-focused amenities ( Rowley, 1996 ). For a long time, the American dream included a home in the suburbs with a white picket fence and living among people who are nearly the exact same, which goes against urban mixed-used development. However, even in 1996, Rowley notes that social networks are only partly shaped by the home locality, mostly dependent on personal mobility, “convenience, choice, and price” are the main factors of determining shopping. Technology since then, such as the internet, hand-held devices, and social media, has developed strong social networks that are not even in the same state. At the same time, mobile applications such as Uber rideshares have made it easier to live without a car, making urban living even more accessible. These cultural variables can differ in intensity from area to area, making research even more indispensable for planning. Determining the best use of space to attract the most people is integral to mixed-use development.

In addition to the comprehensive pre-construction planning process and challenges, there are challenges during design phases as well. All construction must comply with local building codes, however with mixed-use development, each use may be subject to a different code which can slow production and add cost. Additionally, each use requires its own support system; for example, it is necessary for a restaurant to have an isolated exhaust system from the rest of the building, and retailers do not want apartment plumbing pipes visible in their space ( Koch, 2004 ). For each use, building codes require different fire suppression methods, and in a mixed-use these can become even more stringent ( Rowley, 1996 ) due to the mixture and higher density. Furthermore, structural safety can become challenging as well. Retail space is more open and expansive than residential or office spaces. Typically retail is on the ground floor for easy access to shoppers, thus the ceiling of this space must be designed to support the above load. As retailers prefer to have minimal columns in or-der to maximize space and have unobstructed views, a support beam must be utilized. This is very expensive as is requires engineered support beams and more material for construction ( Koch, 2004 ).

Although mixed-use development can help to diffuse economic risk across the variation of uses, there are several economic risks which can detract developers from attempting innovative mixed-use projects ( Grant, 2002 ). As Grant and Perrott (2011 ) point out, construction costs for these projects are higher than single-use construction, however they do not always generate a sales premium ( Rowley, 1996 ; Koch, 2004 ; Niemira, 2007 ). Unfortunately, people outside of the construction process do not always understand what adds costs to projects and therefore do not prefer the premium sales price. During an interview, a principal from Elkus/Manfredi Architects, LTD. stated that mixed-use projects can cost as much as 70% more than in an average suburb ( Koch, 2004 ) where most uses are separated by building. Furthermore, a survey by Niemira (2007 ) revealed that almost 2/3 of respondents agreed that mixed-use projects have a longer construction time than that of separate components. The longer a construction project lasts, the more expensive it becomes as day to day overhead expenses accrue and cannot be re-covered. Furthermore, investors see mixed-use projects as less prosperous than single-use ones that consequently have a lower exchange value ( Rowley, 1996 ).

However, there are variables which, when present, further increase the chance of success, specifically economic success. Financial returns have the capability to be higher in more dense neighborhoods as they provide more opportunities to accept a mixed-use project. However, smaller cities can lack these drivers of change created from high levels of population influx. Thus, in these cities, more research should be performed to determine the proper economic, market, and political conditions to accept a mixed-use development ( Brewer and Grant, 2015 ). Niemira (2007 ) survey results, suggests that there are three major factors for financial success: “1) having a major draw–employers, an academic institution, an entertainment facility; 2) developing the project as part of a master-planned site; and 3) having an urban location” (pp. 55–56). Being aware of the unique economic environment in which the project will be constructed will only help to increase the chances of making the development more profitable and attract more investors.

Although there is a consensus on various factors that affect success, previous attempts to utilize explicitly defined best practices have regularly not resulted in the same levels of success from project to project. Further adding to the difficulty of administering best practices, it is difficult to quantify them for a specific area until perceived differences are identified ( Hoppenbrouwer and Louw, 2005 ). Rowley (1996 ) states that mixed-use development “cannot be divorced from cultural priorities and lifestyles” (p. 85). Moore ( Koch, 2004 ) explains that, especially with mixed-use development, implementation depends on culture, context, etc., therefore best practices are not necessarily transferrable. According to Kong et al. (2015 ), this means that “different urban forms generally lead to different urban performance” (p. 95). Each project should be guided by the community’s social make-up and not assumed that it will revitalize the community as it did in another community ( Anders, 2004 ) nor that all residents within the community will benefit from the project ( Grant, 2002 ).

Although significant challenges in planning and completing mixed-use developments exist, there are several instances of successful projects. Taleai et al. (2007 ) state the im-portance of planning, which includes analyzing the current market and defining any potential problems. Extensively engaging the community as early as possible ( Anders, 2004 ) also helps to determine market conditions and overcome problems more efficiently. Market analysis includes identifying both successful and competing uses ( Taleai et al., 2007 ). Many agree that location is important as mixed-use performs better when there is more traffic ( Grant and Perrott, 2011 ) and public transportation is within walking distance ( Niemira, 2007 ). Timing is also important as there needs to be enough people to support retail, yet enough businesses to attract people; thus phasing based on community needs is vital to success ( Grant and Perrott, 2011 ).

In an interview by Koch (2004 ), a president and managing partner of a real estate developer in North Carolina said that to draw people towards the development, he reserves the most visible, ground level portion of buildings for most attractive retailers. Similarly, Niemira (2007 ) survey showed that including a major draw, such as employers, an academic institution, entertainment, etc., is the number one factor in achieving financial success. The second and third results from the same survey were being part of a master plan and being in an urban location, respectively. Niemira (2007 ) also found that “almost 60% of industry players and observers who participated in the survey felt that having public-sector involvement in a mixed-use project would help to make it more financially viable” (p. 55).

Levine and Inam 2004 Results

In Levine and Inam (2004) mailed 2,000 surveys to members of the Urban Land Institute. Of the 2,000 surveys, 706 were returned completed and 693 were qualified providing a 36.5% response rate.

The next four tables summarize the main results obtained by Levine and Inam (2004) , related to the use of mixed-use development in 2004. Table 2 summarizes the challenges encountered by the respondents in 2004 and respondents were able to select more than one challenge and write in a challenge that was not listed. The next table, Table 3 summarizes the designation of “Other” written in. Instead of asking to rank all challenges, the 2004 survey asked two separate questions, the first asking to provide the single most significant challenge, the next question asking to provide the second most significant challenge ( Tables 4, 5 ). Local regulations was the most significant challenge with the highest frequency, followed by neighborhood opposition, “other”, insufficient market interest, and secure financing. Neighborhood opposition was the second most significant challenge with the highest frequency, followed by local regulations, secure financing, in-sufficient market interest, and “other”.

TABLE 2 . Challenges encountered to mixed-use development 2004 ( Levine and Inam, 2004 ).

TABLE 3 . Challenges encountered described as “other” ( Levine and Inam, 2004 ).

TABLE 4 . Frequency of most significant challenge 2004 ( Levine and Inam, 2004 ).

TABLE 5 . Frequency of second most significant challenge 2004 ( Levine and Inam, 2004 ).

This research used a quantitative approach through the use of a survey instrument. The population for this study was United States organizations involved in the preplanning process of mixed-use projects, these include architects, city planners, developers, and construction managers.

The survey instrument developed for this survey is greatly inspired by Levine and Inam (2004) instrument. Demographic questions were added to the current survey:

• Please tell us about the industry function you are involved with.

• A map was added to determine geographic region.

• How many years of experience does your organization have dealing with mixed-use projects?

The main questions that remained the same between the two surveys:

• What, if anything, do you think are significant barriers to the further development of these alternatives?

• Which of the barriers above what is the most significant and second most significant single obstacle to further development of these alternatives.

Questions were then added about the change of the challenge, if its significance had increased, decreased, or remained the same.

The survey questions were included in an online surveying platform (Qualtrics) and distributed to U.S. based organizations. Organizations were asked to send the survey out to their members, including American Institute of Contractors, American Planning Association, Association for the Advancement of Cost Engineering, Next City, United States Green Building Council; the members of the Purdue University School of Construction Management contact list were emailed directly. Additionally, in the invitation email, participants were asked if they could forward the invitation to other stakeholders, there-fore snowball sampling was also used. Additionally, the survey was also publicly posted in LinkedIn via personal profiles.

The research questions to be answered by the survey are:

• What are the current factors affecting mixed-use development as described by developers, planners, architects, and construction managers?

• What are the differences in the factors of local regulation, market interest, financing, local opposition, in a survey of developers in 2004 (Levine and Inam) and 2017?

Responses to the encounters and significance of the challenges were coded either yes or no. If the respondents had encountered the challenge, yes was coded, or no if not. Chi square tests were completed to test the proportional frequencies from the 2004 answers compared to the 2017 answers. However, the ranking of first and second most significant challenge was not tested individually, but as the overall ranking of all challenges.

Descriptive Statistics

Table 6 shows the distribution of the roles of the 107 respondents. Both Construction Managers ( n = 64) and Architects ( n = 34) had a higher response rate than other stakeholders. Unfortunately, the reach to Developers ( n = 6) and Planners ( n = 3) was lower than expected. Because it is unknown which organizations actually distributed the email, it is impossible to know the response rate, however, based on responses, it is assumed low.

TABLE 6 . Frequency of role of respondents.

The initial question regarding challenges to mixed-use development asked for all challenges and barriers encountered, Table 7 summarizes the responses. For this question, respondents could select more than one answer and write in a response not provided. Local regulations is the most frequently selected challenge with 54 selections, followed by financing and neighborhood opposition, each selected 40 times. Insufficient market interest is the least frequently chosen with only 14 selections. The “other” option was selected 18 times with challenges written by respondents, Table 8 provides the designation for these selections.

TABLE 7 . Challenges encountered to mixed-use development.

TABLE 8 . Challenges encountered described as “other”.

When asked to rank the challenges in Table 7 from one to five with one being the most significant and five being the least significant, 64 of the respondents participated. The frequency of the ranking of each challenge can be seen in Table 9 .

TABLE 9 . Current frequencies of challenges rankings.

Analytical Statistics

It is important to note that not only is there potential for change over time, but between the two populations. In 2004, Levine and Inam ( Levine and Inam, 2004 ) were able to reach developers, however in 2017 the same population was not able to be reached and resulted in mostly construction managers and architects.

The survey asked respondents to rank their first and second most frequent challenge; these responses can be seen in ( Tables 10 , 11 ). The survey question asking which challenges were encountered by respondents ( Table 7 ) was compared to the similar question from the survey in 2004 ( Table 12 ) to answer the second research question “What are the differences in the factors of local regulation, market interest, financing, local opposition, and possibly others to a survey of developers in 2004 and 2017?” Table 12 summarizes the data. Local regulations remains the most frequently encountered. However, results indicate that all challenges except financing were significantly different between 2004 and 2017 results. Interestingly, the four (local regulations, neighborhood opposition, insufficient market and other) are perceived as challenges by less respondents in 2017 than in 2004.

TABLE 10 . Current Frequency of most significant Challenge.

TABLE 11 . Frequency of second most significant Challenge.

TABLE 12 . Changes of percent of challenges encountered from 2004 to 2017.

Based on the survey question asking respondents to rank challenges, the first and second most significant challenge rankings were compared to the 2004 survey questions asking for respondents to select the most and second most significant challenge. Table 13 summarizes the responses of the most significant challenge from 2004 to 2017. Local regulations are the most frequently selected as the most significant challenge. Comparing the overall rankings from each year results in a X2 of 11.212 and a p value of 0.024 suggesting that the ranking of 2004 most significant challenge is significantly different than that of 2017. Again, respondents ranked local regulations the most significant, but less by less people in 2017. More people in 2017 perceived financing and insufficient market interest as the most significant challenge.

TABLE 13 . Changes of percent of most significant challenges encountered from 2004 to 2017.

Table 14 summarizes the responses of the second most significant challenge from 2004 to 2017. Again, regulations are still the most frequently selected as the second most significant challenge. Comparing the overall rankings from each year results in a X2 of 2.738 and a p value of 0.603 suggesting that the results from 2004 are not significantly different from 2017.

TABLE 14 . Changes of percent of second most significant challenges encountered from 2004 to 2017.

Although the intent was to compare the same population over time, due to access by the different researchers, the two time period’s populations were different: developers and planners versus construction managers and architects. Depending on the type of project contract, construction managers and architects can become involved in the project at different times. Typically, architects are engaged by developers before construction managers, but not always. Construction managers have been engaged earlier in planning phases resulting in more successful completion of projects ( Moore, 2013 ). These variations in project involvement could potentially affect the challenges that each population encounters. How-ever, it is still important to understand the frequency of these challenges, regardless of population, as they are still experienced around the same type of projects–mixed-use developments.

The initial research question regarding current challenges to mixed-use development asked for all challenges and barriers encountered, which was summarized in Table 7 .

The four provided challenges (insufficient market interest, local regulations, securing financing, and neighborhood opposition) were primarily selected as expected, however the most interesting findings came from respondent’s written submission for the “other” se-lection. While there are several challenges written in, three new challenges were discovered compared to the 2004 survey:

• keep up with demand and growth

• lack of implementation knowledge and development modeling

• these projects are becoming harder for smaller firms

Other challenges were also written in, but are expected from the literature review and 2004 survey; included financial risk is too high, market saturation, complexity of construction and design, no retail involvement, lack of land and land costs, insufficient developer interest, and these projects are not the norm in their NW market.

Local regulations is ranked the most significant and second most significant challenge. In order after regulations, the ranking of the most significant challenge are financing, in-sufficient market interest, neighborhood opposition, and the other category. In order after regulations, the ranking of the second most significant challenges are neighborhood op-position, financing, insufficient market interest, and the other category.

Difference From 2004 and 2017

In analyzing the differences from 2004 to 2017, the percent of the frequencies encountered for each of the years were compared, these are summarized in Table 12 . As mentioned above, there are three new challenges not mentioned in 2004. All of the challenges saw a significant decrease ( p ≤ 0.05) in the proportion of people who encountered these as challenges, except for the financing challenge. This may be for a few reasons: regulators and people in the local community are becoming more familiar with mixed-use developments. Regulators are understanding how to better accommodate these types of construction and are better prepared to handle them. The local community has changed their wants and enjoy the ease and convenience of a live-work-play environment. However, the other explanation for the significant change in encounters is simply the populations that were reached. The 2017 population was compromised of mainly general contractors and architects who may not be as involved in the early planning stages of mixed-use development and therefore may not encounter as many challenges.

When looking at the ranking of the challenges, both in 2004 and 2017 each year the first and second most significant rankings slightly change, Table 13 and 14 shows the differ-ences in percentage of ranking. However, only the most significant ranking saw a significant change with the overall p value under 0.05.

The analysis of the data from this research has provided several interesting results. First, the new challenges identified through the “other” designation provides insight into the current market within the last few years. Not being able to keep up with demand for construction can occur from a few possibilities. Lack of labor force is reasonably the most significant cause, both in manual and office labor. ( Baiden et al., 2006 ). The average labor participation rate in the United States for January through June of 2017 is 62.8%, a 5.4% decrease in the past 10 years, part of an ongoing trend of the past several decades. However, the construction industry perhaps has been hit the hardest; according to several news organizations such as Forbes ( Beyer, 2017 ), Fox Business ( Grant, 2017 ), CNBC ( Olick, 2017 ), Slate ( Gross, 2017 ), and the like have reported on the ongoing shortage of construction labor. This shortage has continued to decline, especially in the last year ( Valenti, 2021 ).

The difficulty of securing financing can also cause issue with supplying demand as does limited land availability. Requesting a development model solidifies one of the main is-sues with mixed-use development in that project planning best practices, unfortunately, do not always work with these projects ( City planning, 2016 ). Constructing an exact replica of a successful project in a different area can result in a drastically different outcome. The community and economic wants and needs must be identified in order to plan for the most successful uses within the development. The last new challenge identified was that it is harder for smaller firms to participate in these types of projects, which can be explained by the other new challenges. A smaller firm cannot always compete with larger firms ( Valenti, 2021 ). High hourly wages and complete benefits can be more arduous for a smaller firm to offer, especially in comparison to larger firms. Further, financing, insurance, and bonds for construction is based on firm experience and size, thus it is more difficult for a smaller firm to actively complete with a larger firm on these projects. While it may be easy for a small firm to complete a single use project, the combination and size of a mixed-use development can make it too difficult for these firms.

Local regulations have remained the most significant challenge, but its frequency has significantly decreased. Neighborhood opposition has also changed since 2004, decreasing in ranking as a challenge. The old fashion idea of the “American Dream” has changed from a suburban house with a white picket fence ( Govindarajan et al., 2016 ). This change could be driven by younger generations who either do not want or cannot afford their own transportation, more sustainable communities, be more mobile (not owning a house), have less maintenance association with a suburban home, and/or wish to support smaller, more local businesses. The appeal of a “live-work-play” community also attracts older generations whose children are now out of the house and may have the same wants that younger people have, as listed above. Also, those whose health may prevent them being able to drive and wish to avoid isolation are also attracted to mixed-use neighborhoods where amenities are more easily accessible. A 2020 survey by the National Association of Realtors ( National Association of Realtors, 2020 ) shows that all age groups, including older generations, show more interest in walkability near their home and less focused on access to highways. However, the survey does show that 60% of people surveyed want a larger yard with more outdoor space and less people around ( National Association of Realtors, 2020 ).

Recommendations

While this research identified new and changes of significance in challenges, there is further data that should be collected. First, more planners and developers need to be reached to survey so that there is sufficient data in order to statistically determine any differences in the view and experience of challenges. Further, interviews should be completed in order to better understand these challenges and what has been done to overcome them, specifically related to local regulations and securing financing as these are the top two most significant challenges.

More data is also needed to discover why demand cannot be met, if this is actually an emerging challenge that is widespread, and if this is an issue specifically related to mixed-use developments or all construction projects in general. The cause of this challenge, whether it is being able to secure financing, having proposals rejected, lack of labor force, or something completely different, will drastically affect the way in which it is over-come.

Local regulations have been an ongoing issue for mixed-use development. Two main actions should occur to help combat this issue: policy change and education. All roles should be provided more resources in order to better understand mixed-use development, their benefits, and how they can help streamline the implementation process, particularly where mixed-use is a new concept to a community. Educating each role of all perspectives and challenges is important for any interdisciplinary team, especially in this these types of projects. When all parties can understand each other better, issues can be more easily and quickly solved. With education, policy change should be encouraged as well. As presented in the literature review, other countrie’s zoning are much more mixed-use friendly, have less strict definitions of zoning/classes to allow for mixed-use without amendments or need for rezoning approval and there are often public/private partner-ships to aid in starting and completing a project. This type of partnership aids in the is-sue of securing financing for a project. Financial regulations have caused the approval process for all types of loans to be more difficult. Changes in financial regulations are more difficult to achieve, but public/private partnerships can help to alleviate some of the financial strain for these projects. Providing more educational information will also help banks make more educated decisions on lending and overall polices. However, before being able to provide a rich context-based resource to those participating in mixed-use development, more research must be completed, as described above.

Further, research should be conducted on the interconnectedness of the challenges. For example, the inability to secure financing, delays due to regulations, and lack of labor force may contribute to not being able to meet demand. Neighborhood opposition may affect the opinion of the city planners and how they enforce the local regulations. Local regulations may impact the availability to secure financing through a bank. Other relationships may exist such as these that are unknown. Understanding these connections will further lend itself to the understanding of the cause and more importantly, the solution of these challenges.

Data Availability Statement

The raw data supporting the conclusion of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by Purdue University. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

JM researched and wrote the entire paper.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: mixed-use development, regulations, neighborhood opposition, market interest, financing

Citation: Metzinger J (2021) Differences in Experiences With the Development of Mixed-Use Projects From 2004 and 2017. Front. Built Environ. 7:734149. doi: 10.3389/fbuil.2021.734149

Received: 30 June 2021; Accepted: 06 September 2021; Published: 23 September 2021.

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Copyright © 2021 Metzinger. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Jamie Metzinger, [email protected]

This article is part of the Research Topic

Doctoral Research in Construction Management

• Public spaces
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The Third Place

Analyzing the future of mixed-use development in montgomery county.

Posted: 1:32 pm August 25, 2021 by the third place & filed under Planning , Research .-->

A mixed-use development in Pike & Rose with residences located above restaurants on the ground floor.

A conversation with Research Planner Nicholas Holdzkom on the Montgomery County Mixed-use Development Study

By Nicholas Holdzkom and Karen Blyton

You may have noticed new apartment buildings in your area that are being built on top of grocery stores, restaurants, or other retailers.  Montgomery County has allowed mixed-use development in buildings around activity centers for many years with the goal of creating interactive streets, providing meaningful public spaces, and creating communities where people can live, work, shop, and play within a given neighborhood.  Numerous studies show that mixed-use districts generate higher real estate value, reduced vehicle miles traveled, and higher transit ridership. These mixed-use properties, which are common in downtown Silver Spring and Bethesda, have accounted for nearly 50 percent of Montgomery County’s new commercial and multifamily developments over the last decade. That number is rising, and mixed-use buildings are continuing to expand in Montgomery County.

A new study by Montgomery Planning’s Research and Strategic Projects (RSP) Division has found that mixed-use development projects are likely to become even more common than single-use projects both locally and nationally. Considering there is only about 15 percent of “unconstrained” land available for development or re-development in the county, mixed-use properties are needed to support our future economic and population growth.

To learn more, we sat down with the project manager of the Montgomery County Mixed-use Development Study , Research Planner Nicholas Holdzkom. He covers the study’s key findings, what makes mixed-use development successful, and the future of mixed-use development in the county.

What was the purpose of the Montgomery County Mixed-use Development Study?

The Research and Strategic Projects (RSP) Division wanted to understand the characteristics of mixed-use properties in different parts of Montgomery County, as well as national trends in mixed-use, relative to trends in the county. The study focused on what is called “vertical” mixed-use, which is usually in the form of residential-over-retail in a single building and on a single parcel, though there are some exceptions. It looked specifically at mixed-use projects delivered since 2010 as well as what is in the Development Pipeline.

We wanted to understand what aspects of mixed-use are doing well, what aren’t working as well, and why. We also wanted to explore recommendations for improvements to Montgomery County policies to enhance mixed-use development. And finally, we hoped the study would help us improve Montgomery Planning’s data collection on mixed-use properties.

An important component of mixed-use is the activation of the ground floor space, which is usually retail, so we did a ground floor retail analysis. There is a section that creates typologies based on project size and geography, a section on success factors, and finally there are comparisons of county polices that pertain to mixed-use development with other jurisdictions.

We didn’t have the expertise in-house, so we solicited proposals from consultants and hired HR&A Advisors, a national real estate and economic development consulting firm.

A mixed-use property in downtown Bethesda with apartments located above retail space.

Why did you decide to do this study now?

Well, it’s been pretty noticeable for a while now that, besides a few areas in the county that still have open land, and are generally developing pretty large single-family communities, that most new development has been of the mixed-use, in-fill, variety.

This trend started generating a lot of questions: What do these mixed-use projects look like in different parts of the county? How do the projects we’re seeing come to fruition, entirely or in phases, compare with those of our neighbors, both regionally and nationally? What factors can help mixed-use projects be more successful or less successful? Finally, what can we, as a Planning Department, learn from a planning and regulatory policy perspective about supporting these types of products to be the most strategic, complementary, equitable, and successful projects they can be?

A mixed-use property in downtown Wheaton with apartments located above a Safeway grocery store.

What were some of the study’s key findings?

Mixed-use development is steadily growing as a share of total development in Montgomery County, with projects in the Development Pipeline even more weighted toward mixed-use than recent development. Between 2010 and 2020, mixed-use development made up nearly 50 percent of new commercial and multifamily developments delivered. Consistent with national trends, mixed-use projects are becoming more common than single-use—the Pipeline shows that split increasing to 60 percent.

The mixed-use development projects we’ve seen in Montgomery County are predominantly anchored by residential uses with ground floor retail as the secondary use. They are primarily located Downcounty and along the I-270 corridor. The scale is generally mid-rise in form, with high-rise buildings occurring most frequently in Bethesda and Silver Spring. In fact, Rockville, Bethesda, Silver Spring, Gaithersburg, and North Bethesda make up 88 percent of total mixed-use square footage.

The study concludes with recommendations based on the data analysis, policy analysis, and a review of case studies from comparable jurisdictions. It demonstrates that mixed-use development is most successful in more urbanized places and, thus, provides recommendations prioritizing densification and increased flexibility for ground floor uses and activation strategies. Additionally, it recommends maintaining and increasing affordable housing.

Regarding the development process, the study recommends exploring the streamlining of the development approval process outside of the need for plan updates. This could be achieved through adjusting policies to balance flexibility with minimum requirements, exploring tweaks in the bonus density point system, and establishing policy and workflows focused on flexibility, in general.

Map of Montgomery County’s mixed-use vs. single-use development between 2010-2020. Image credit: HR&A Advisors

What did you find that makes a mixed-use development successful?

Mixed-use developments near, or within, already vibrant areas succeed better than those situated in more remote locations or on back-streets, especially when combined with proximity to transit. These areas tend to be walkable and more easily accessible to residents, workers, and shoppers of diverse incomes. Having a variety of retail, restaurants, and other amenities activate ground floor space. Connectivity and customer attraction are more difficult when buildings are near large, vacant areas or parking lots. Similarly, the vacancy of ground floor retail is considered a “negative amenity,” behaving similarly to vacant areas and parking lots.

Another successful strategy for mixed-use development is the inclusion of elements authentic to a neighborhood. In smaller developments, this characteristic can come by adding to the existing fabric of an area and aiming to lease ground floor space to local retailers as opposed to national brand names. And, other ways successful projects maintain authenticity include supporting and displaying local art or hosting community and neighborhood events. In larger mixed-use districts, the authenticity of the project can be strengthened through the engagement of the local community throughout the planning process, ensuring the community’s vision and voices help to drive project design.

There’s also an environmental component to mixed-use. Putting spaces to multiple uses, by definition, maximizes a site more than single-use. Additionally, mixed-use projects can include traditional methods of sustainability, such as LEED certification, as well as less traditional methods like green roofs, storm water collection and recycling, or solar panel integration, creating amenities that can often return premium rents and provide interest.

One final thing I can say about making mixed-use successful is for developers to make sure their projects are inclusive–designed for all people, both community members as well as visitors, as well as people of all abilities.

A mixed-use property in downtown Bethesda with two fast-casual restaurants located on the ground floor of an apartment building.

What do you see for the future of mixed-use development in Montgomery County?

Given what I mentioned earlier about increasing expectations for the delivery of new mixed-use projects in Montgomery County, based on both existing projects since 2010 as well as the Development Pipeline, I would say that mixed-use development is crucial to the county continuing to develop and re-develop and mixed-use projects will continue to increase. Through our zoning, particularly the Commercial/Residential (CR) family of zones, our goal has been to create a regulatory scheme that encourages properties to develop, or re-develop, as mixed-use sites. Right now, mixed-use projects generally occur Downcounty, especially in Silver Spring and Bethesda, with other projects along the I-270 corridor, but there are many other sites throughout the county where mixed-use is allowed, per the zoning. Thus, mixed-use can continue to develop and evolve throughout the county. It will be interesting how new forms of mixed-use developments could look in other parts of the county, should opportunities arise.

What is next for this research?

The Research and Strategic Projects Division sees this study as part of a series, begun several years ago with examinations of commercial space in the county, specifically the office, industrial, and retail market sectors, done either as standalone products or in support of master planning initiatives.

I’ll give you three places this research can go. One is that this research, as I mentioned previously, just looked at “vertical” mixed-use but we know we have many examples of the “horizontal” type of mixed-use as well. Those are mixed-use districts, like Pike and Rose or King Farm, for example.

Another place this research can go is, as I also mentioned earlier, it dovetails nicely with a lot of Planning Department efforts over the last few years, especially the update to the General Plan, Thrive Montgomery 2050 , which is currently being reviewed by the Planning, Housing, and Economic Development (PHED) Committee of the Montgomery County Council, as well as both the Silver Spring Downtown  and Adjacent Communities Plan , and the Fairland and Briggs Chaney Master Plan , which is very much a corridor plan.

Finally, as we show in the study, it’s good to know more about the development type that is becoming more and more the majority of projects that are getting built, both in form and function but also geographically.

Things can change quickly and as these studies age, we’re trying to think of ways to stay up on these market trends and other issues in the county. With that in mind, we’re always interested in hearing what good ideas for studies that the public are curious about that we could incorporate into future work plans.

4 Responses to “Analyzing the future of mixed-use development in Montgomery County”

Paul Mortensen

This is a great study to understand what is currently being developed in the county. However, the creation of mixed use developments and more importantly, mixed use communities is inevitable if we are to ever truly attempt to combat climate change, extreme weather and social and economic isolation. Past zoning that isolated uses and promoted the easy use of automobiles to get from one location to another is not sustainable! We have to create communities with centers that offer work, live, play, shop, learn and pray all within walking and biking distances that one day will be linked by transit options to each other. Ideally, the 18% of undeveloped land within our county should never, ever be developed! It should be protected, enhanced and even expanded through the mix of uses within existing centers, neighborhoods and larger communities. Electric or autonomous cars will not save our world from human generated destruction. Maximizing mixed uses throughout our existing communities will help significantly because it will get people out of cars, it will promote walking and it will dramatically reduce energy consumption and climate change. So bring on the corner store! Bring on a senior residential building over a school. Bring on a library at the base of an office tower. Bring on Missing Middle housing as part of our residential neighborhoods. Bring on a community pool and gym under dense residential uses. Bring on all types of mixed uses that promote walkability, social interaction and economic gain!

Max Bronstein

Seems that years back land/area available for development was a smaller percentage than what’s currently being mentioned. How did it grow? There is mention of the need for more affordable housing along with mention of generating housing that commands a premium in price/rent. Is that an unavoidable fact of economic life? You probably realize that current housing is the largest reservoir of affordable housing so efforts are called for to preserve those existing homes & a long range plan to support preserving them as needed in the future & as affordable housing. In regard to the Planning Department’s long-time subtle war on automobiles, we offer a few observations. There was the negative mention of parking lots – a needed item until the Jetson age car arrives that folds into an attache case. The transit system does not exist in MoCo that will enable people to travel the county to wherever in order to go where they need or wish to go. Also, not all are able or desire to walk, bike, scooter, etc. to a destination. Get realistic as to our aging population (the Perrennials) who will drive or be driven in regard to health & other unique needs. I suggest you reach out to those who have a bit of gray hair for counsel. Realize that peoples needed destinations do not locate natuarlly within a block or mile etc. of their residence. Presently & pehaps futurely many jobs & activities will be performed remotely so that will be a help. Good luck.

Robert Smythe

Both previous comments make excellent points! Common to them is a failure of the planner-speak jargon from the County to acknowledge that their favorite tool — “mixed-use development”— means adding both commercial and residential vehicles, both day and night, to a traffic situation that has not been designed to accommodate it!! The simplistic belief that people will somehow be able to adjust painlessly to this problem is why downtown Bethesda is approaching traffic gridlock with no way to resolve the situation. We can’t all just become happy pedestrians just because the “planners” can’t resist granting developers the right to build every high-density structure they wish for. They get the profits and we —the resident citizens — get the headaches!

Sylke Knuppel

I completely agree that mixed-use is a critical piece of future MoCo development. But one question that has been difficult to get a clear answer to is exactly how much development does the 50% represent? Montgomery County, being a County with over a million residents needs a minimum amount of new housing to support jobs and economic development. Do you have an idea of how much housing the County needs to be mixed-use to meet its housing goals?

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An interdisciplinary debate on project perspectives

• Research article
• Open access
• Published: 14 October 2022

Extremes of mixed-use architecture: a spatial analysis of vertical functional mix in Dhaka

• Fatema Meher Khan   ORCID: orcid.org/0000-0003-4761-7836 1 ,
• Elek Pafka 2 &
• Kim Dovey 2  

City, Territory and Architecture volume  9 , Article number:  31 ( 2022 ) Cite this article

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The concept of mixed-use is now well-established as an urban design and planning principle that adds to the vitality, walkability and productivity of the city at neighbourhood scale. There is much less research on the dense and complex vertical mix of functions within buildings. This paper investigates the extremes of informal vertical mixing of functions within buildings in Dhaka, where commercial and retail functions often penetrate to upper floors and where access routes are often mixed with residential functions. A modified form of space syntax analysis is used to analyse and critique the mix of circulation patterns and functions in 15 complex mixed-use buildings. The plans and relational diagrams reveal how different functions are mixed or separated, and the relative spatial depth they penetrate from the street. Five primary circulation diagrams emerge with different degrees of informality in different districts of the city. Under conditions of informal adaptation, vertical functional mix produces benefits in the form of synergies but also problems of privacy and security. To engage effectively planners need a complex understanding of the interrelated spatial, social and economic logics involved.

Introduction

It is now sixty years since Jacobs ( 1961 ) transformed our conceptions of functional mix, suggesting that an understanding of co-functioning was a key to understanding how cities work. She railed against the modernist segregation of the city into mono-functional zones that prevented close connections of home to work, school, shopping and recreation. Functional mix was the antithesis of modernist development that stressed the spatial segregation of urban functions to avoid an undesirable juxtaposition of uses. For Jacobs mixed-use was necessary to the social and economic vitality and intensity of the city; this work has been increasingly embraced in urban planning and functional mix has become a key ingredient of walkability (Grant 2002 ; Hoppenbrouwer and Louw 2005 ; Rabianski et al. 2009 ; Frank et al. 2006 ; Dovey and Pafka 2020 ). While most of this research has focused on the neighbourhood scale, it has been understood that functional mix also operates at the building scale. Most notable here is the widespread historic type of shop-house with residential located above retail functions; this building type has long been a staple in South and Southeast Asian cities (Davis 2012 ; Han and Beisi 2016 ).

Modernist zoning was invented to solve real problems that can emerge from an unregulated mix of uses. In 2010 and again in 2019 fires have broken out in mixed-use buildings in Old Dhaka, killing a total of 205 people (Imam 2010 ; Molla 2019 ). Both fires involved flammable industrial materials stored on lower floors with housing and production work above. These fires were variously blamed on electrical transformers, gas cylinders, chemical storage, building regulators and owners, but also on a more general lack of urban planning controls (Tishi and Islam 2019 ). In Dhaka, functional mix is widely considered problematic; beyond issues of fire safety, there are perceived problems of visual disorder, privacy and social insecurity (Tishi and Islam 2019 ; Nahrin 2008 ). This paper analyses a range of mixed-use buildings in Dhaka to better understand the morphologies of informal mix.

While there is considerable scholarly work on the shop-houses of South and Southeast Asia (Imamuddin et al. 1989 ; Chun et al. 2005 ; Phuong and Groves 2010 ; Su-Jan et al. 2012 ; Davis 2012 ) the buildings under discussion here encompass a much denser range of building types. No survey or analysis has been conducted to understand the operation of dense informally mixed buildings such as these. This study explores four principal questions: How are different functions mixed and/or separated within circulation systems of mixed-use buildings? To what relative spatial depth do different functions penetrate from public space and to what height above street level? How are buildings adapted informally to multiple uses and what are the synergies and challenges of such mixing? This paper analyses the functional mix of some of the most extreme of vertically mixed buildings in Dhaka—those that test the limits of functional mixing. These analyses reveal typical circulation patterns and the spatial logic of interrelations between functions, based in the economic and social logic of the city. The paper concludes with a critique of the benefits and challenges of vertical functional mix.

Mixed-use buildings are common in cities of the global South, particularly South and Southeast Asia. The prevalence of functional mix has been noted in Indonesia (Susantono 1998 ), India (Verma 1993 ), Vietnam (Phuong and Groves 2010 ) and Pakistan (Haque 2015 , p. 7) where they generally feature high-levels of informal or unregulated mix. More contemporary mixed-use buildings demonstrate new forms of mix, spatial organisation and building morphology in high-density buildings with vertical stacking of wholesale, retail, restaurants, offices, storage, micro-industries and housing (Ujang and Shamsuddin 2008 ; Tipple et al. 1996 ).

While Dhaka was always mixed, as the urban density has intensified the mixed-use buildings have grown informally in both extent and functional complexity to meet local demand. Incremental conversion of residential buildings to accommodate workshops, storage, commercial and retail functions are common (Khan 2020 , 2021 ). Access routes into and through mixed-use buildings are adapted where it is possible to separate entrance and circulation for separate uses. However, a singular entrance for residential and non-residential functions is common and can result in privacy, security and safety issues.

Study area and methodology

Dhaka is dominated by informal economic activities and the current land-use of most districts is shown in planning documents as mixed-use (Rajdhani Unnayan Kartripakkha [RAJUK] 2015 :38). However, there are also marked differences between the old city, those districts that have developed with a mix of formal and informal planning, and the modernist planned city. These three settlement patterns—historic core, semi-planned and planned—represent key historical phases of urban growth in Dhaka (Fig.  1 ) and are the most evident morphological patterns in contemporary Dhaka (Nilufar 2011 ). Figure  2 shows typical streetscapes from mainstreets of each of these three areas. While each is informalised they also represent increasing levels of formalisation. For this study, five mixed-use buildings have been chosen from each of these districts in order to show the range across the city, but also to better understand the extremes of mix within each district.

Dhaka and the three sample districts (Map based on Nilufar 2011 ; Google Earth)

Typical streetscapes from each district (Photos: Fatema Meher Khan & Kim Dovey)

Islampur in the Historic Core is located at the southern edge of Dhaka. This area has long been the centre for a wide range of wholesale and retail markets with different professional groups who used to live in the shop-houses (Mohsin 1991 ). A rich mix of uses has been embedded within the fabric of this area since its inception in 1600 and has increased and intensified over time informally into a mix of housing, retail, wholesale, offices, workshops, go-downs (warehouse/shop) and light industries. There were attempts to impose formal land-use planning codes in this district but the state lacked the power to enforce them (Jahan 2011 ). This zone is seen as most problematic and is the scene of the fires mentioned earlier. The second area, known as Green Road, is a semi-planned neighbourhood near the spatial centre of Dhaka that has developed since the 1960s with a combination of formal and informal street networks. While initially, it was a middle-income residential area, other uses such as shops, workshops and offices have spontaneously developed over time. After 2000, a part of this area was declared commercial, this effectively formalised the mix of functions in those areas, however, non-residential functions in residential areas remain informal. The third area, Uttara, is a planned neighbourhood located on the northern periphery of Dhaka, developed since the 1980s with a regular grid and plot size. Although initially planned as a residential neighbourhood, it has informally developed other functions including shops, cafes, restaurants, and offices over time. Again, mixed functions on the main roads have become authorised over time, while non-residential functions on other streets remain unauthorised. The 5 buildings selected from each of these sites represent a range of mixed-use buildings in each case, but with a focus on denser buildings which test the extremes of mixed-use, avoiding simple low-rise shop-houses.

The method of categorizing building functions deployed here has been adapted from the work of van Hoek ( 2008 ) who suggests that urban functions be divided into three primary categories that we call ‘live’, ‘work’, and ‘visit’, plus the various forms of mix that emerge between them (Fig.  3 ). This live/work/visit model (Dovey and Pafka 2017 ) is based primarily on the argument that the population in a building, street, or neighbourhood at any particular time can be understood as a mix of those who live there, work there, or visit the place. Most previous studies have considered urban functions in categories such as residential, industrial, commercial, retail, education, entertainment, recreation, health, transport, government, community, parking, vacant, hospitality, etc., which is a modernist way to segregate the city into different categories. Such categorisations are problematic for two major reasons. Firstly, with so many categories/sub-categories, it is difficult to measure and map complex cities with any coherence. Secondly, there is a problem of consistency since the boundaries of any of these categories overlap and can become subsets of another.

The live/work/visit triangle (based on Dovey and Pafka 2017 )

This approach is based on a live/work/visit triangle utilizing the points of the triangle for living (red), working (blue) and visiting (green) with the interstitial colours to indicate the different forms of mix between them (Fig.  3 ). ‘Live’ incorporates places people sleep overnight. ‘Work’ denotes offices, factories and educational spaces. ‘Visit’ is an umbrella concept for places that are primarily used by visitors such as shops, restaurants, libraries, theatres, museums, parks and recreation (Dovey and Pafka 2017 ). A live/visit mix is represented as yellow; a live/work mix as magenta and a work/visit mix as cyan; a mix of all three will be white. Figure  3 also shows how this method of analysis can be used to show the vertical layering of primary functions of buildings in section and the ways this produces mixed colours when viewed in the plan.

In order to conduct a comparative analysis of the interrelations between functions within each building, we have conducted an adaptation of gamma analysis derived from space syntax analysis. A ‘justified gamma diagram’ is one of the analytical methods developed by Hillier and Hanson ( 1984 ) to study the ‘social logic’ of the relationships between spaces within buildings and the depth of those spaces from the street. In this process, architectural plans are translated into diagrams of topological segments (Ostwald 2011 : 445; Dovey 2008 ). Thus the circulation pattern of the building can be identified along with the ways in which the building plan produces separations and intersections between access routes. In the process of the structuring of gamma diagrams, every space in a building is allocated a depth value, according to the minimum number of spatial segments that one must pass through to arrive in that space from the street. These diagrams reduce the plan to a set of spatial segments represented by circles with permeable connections represented by lines. This method produces diagrams of spatial permeability with all spaces of the same depth lined up horizontally at each level away from the street (Hillier and Hanson 1984 : 147–149). Because they rely on passing trade, shops are typically one level deep from the street. A stairway between floors is diagrammed as one segment.

Syntactic analysis

This section presents the syntactic analyses of selected buildings from each from the Planned (PL), Semi-Planned (SP) and Historic Core (HC) districts - a sequence of increasing informality and complexity of functional mix. In each case, we show both gamma diagrams and floor plans, colour coded according to the live/work/visit triangle described above. The circles outlined with thick lines represent the main circulation routes of each building; these are also colour coded by the functions to which they give access. In order to make these diagrams readable, clusters of segments with similar functions are represented with elongated boxes to indicate a number of segments in a cluster. The circulation lines are also colour coded by the various uses to which they provide access. A comparative analysis of these gamma diagrams will follow.

We first consider examples from the more recently Planned areas on the urban periphery (Fig.  4 ) where all buildings were initially designed as mono-functional residential buildings. All 5 examples are 6 storeys high on similar plots; all except the final example have substantial parking at ground level and elevator access to upper floors. The key interest here is in the ways functions have been transformed. PL1 has a central circulation spine that begins with a triple mix (white) of live/work/visit, which gradually becomes live/work (magenta) and then residential (red), as it penetrates deeper into the building. PL2 mixes living, working and visiting on the 4 lower floors; separate shops have emerged on the street frontage of the ground floor which is otherwise devoted to parking. PL3 largely remains mono-functional with just a few shops with separate access at street level. In PL4 and PL5 large portions of ground floor parking have been converted to retail with housing above, but without mixing of entries. This part of Dhaka was planned as mono-functional residential but clearly needs retail to function effectively. Additional visit and work functions that have emerged on upper levels include a dental clinic, school and beauty parlour.

Syntactic analysis of buildings from Planned Areas (PL)

Syntactic analysis of buildings from Semi-Planned Areas (SP)

Considering examples from the Semi-Planned area (Fig.  5 ), SP1 is a 10 storey building that contains two quite separate circulation systems with a complex retail network on the ground floor and housing (with elevator) above. The functional mix is thus confined to the ground floor and basement. SP2 is a 6 storey residential building where office functions have replaced apartments on the 1st and 2nd floors, while retail has separate entries on the street. SP3 is a 4 storey building that is primarily occupied by offices, but mixed with residential on the two middle floors; the main access spine is mostly a live/work mix (magenta). SP4 is a 6 storey building on a street corner with 10 street entries for shops and offices plus a separate entry to the residential floors above. These floors have become mixed with offices up to the 2nd floor. SP5 is a 4 storey building with a mono-functional residential tree-like structure and separate entries for the ground floor shops.

Finally, we consider the more extreme examples from the Historic Core (Fig.  6 ). HC1 is a 5 storey building entered through a shopping arcade with warehouse/shops (go-downs) on the 1st and second floors and residential above. The circulation has a tree-like structure comprising visit, work, and living at progressive depths. The go-downs extend 5 segments deep while residences extend 7 segments deep. Shops are accessed both from the street and arcade. Mixed circulation is confined to the first three floors and becomes progressively less mixed as it penetrates deeper. HC2 is a 6 storey building with a network of shops on the ground floor, multiple street entries and interconnecting corridors that penetrate up to 6 segments deep. Residential apartments on the 3rd to 5th floors are accessed through a separate stair from the street and have an elevator from the 3rd floor. Here there is a notable contrast between the networked access structure for the shops (with 10 street entries) and a tree-like structure for the housing. HC3 is a 5 storey building with primarily work-related functions (printing) on the ground and first floors with residential above. HC4 is a 6 storey building that combines visit, work and living at progressive levels. It has shops and offices on the ground and first floors with residences above. The mixed circulation penetrates 2 segments deep, moving from a triple mix to live/work and then residential. HC5 is a 5 storey building that mixes retail with work on the first two floors and then work with residential on the three floors above. The single white and magenta access spine indicates that shoppers, workers and residents all use the same access route. Some of the shops (book-binding) are located up to 4 segments deep from the street. The work functions on the upper floors (go-downs) share a kitchen with residential functions. Hence, the combination of working (blue) and living (red) on the upper floors is represented by the mix of live/work access (magenta) on the diagram.

Syntactic analysis of buildings from the Historic Core (HC)

Patterns of Mix

We can see in these examples what may seem a bewildering range of ways in which these buildings mix functions in different ways and to different degrees. While it is not our goal to reduce this field of differences to any kind of essential types, we want to find a way to understand spatial patterns that are evident in this production of vertical mixed-use in buildings. We now take one further step beyond the gamma diagrams to suggest that these mixed-use buildings can be broadly categorised into 5 diagrammatic types with different circulation systems. While the floor areas devoted to different functions are evident on the plans, our primary concern here is to understand the ways mixed-use buildings mix or separate access routes in everyday life. Figure  7 presents a typology of mixed-use buildings representing the typical patterns of vertical mix circulations that are identifiable within the 15 cases. Each of these types is identified first as a relational diagram, followed by a brief description and the examples listed in the final column. In the generic diagrams, the complexities of individual spaces are collapsed in order to reveal spatial clustering by function and connectivity, while also revealing the overall depth or shallowness from the street. In these diagrams, the representation of different functions and their mixes follows the live/work/visit triangular model used earlier in this study. The main circulation spines are represented by thick lines; those with mixed colours (magenta, cyan, white) indicate mixed access spaces.

Figure  7 shows that some types are more common than others, however, this is not a random sample and we are more interested in the range of types. Type A is the vertical mix of live and visit functions often known as ‘shop-top housing’; it is the only type where functions and entries are fully segregated. This is typical in more formal cities and it is not surprising to find it mostly in the Planned Areas. Type B incorporates a complex access network with multiple street entries and arcades giving access to both work and visit functions with separate access to a residential tower above. The mixing of access routes is confined to work/visit which again is typical in more formal cities. Type C is a stack of visiting, working and living functions in a vertical sequence with a single spine of mixed access. Thus all three functions are mixed at street level, but this mix is reduced to live/work and then to residential for the upper floors, as the circulation spine progresses deeper into the building. This type is mostly produced by the informal adaptation of residential buildings. Type D is similar but with retail and some work functions separated at street level - thus there is no mixing of retail and residential access. While there is only one example of type E in our study, this is the most mixed example and the only one without any mono-functional access—mixed access extends throughout the depth of the 5 storey building.

 A typology of mixed-use buildings

These generic syntactic diagrams demonstrate that visiting, working and living functions generally remain in a consistent sequence of progressive depth in buildings. Shops typically remain at the shallowest position, as they depend on accessibility for their business. They often extend deep into ground floor plans and sometimes to the 1st and 2nd floors. Work functions are often mixed with shops on the ground floor but more commonly extend to intermediate floors as in types C and D. Residential functions always occupy the deepest and most private sector of the building. Figure  7 also shows the ways the different types are distributed across the three areas of the city from which examples were chosen. In general terms, the Historic Core has more complex and mixed examples while the Planned areas have more segregated functions. This reflects the fact that the Historic Core has always been mixed while buildings in the Planned and Semi-Planned areas were initially designed as mono-functional and have become informally mixed over time.

In this study, we have mapped and analysed functional mix within selected buildings of an extremely mixed informal city. These examples are not random nor typical, they have been chosen as the most mixed cases in each study area because they embody this extreme and test the limits of functional mixing within buildings. These buildings have been analysed through methods that reveal typical circulation patterns and the mixing of different functions within them. While the building plans and syntactic diagrams are empirically interesting (Figs.  4 , 5 and 6 ), the key findings of the paper lie in the generic diagrams that reveal broader patterns of vertical mix and circulation systems (Fig.  7 ). This work also enables further critique on the benefits and challenges of different forms of vertical functional mix. It is not our purpose here to make judgements about the effectiveness or otherwise of different kinds of functional mix based on this data, however, it is possible to discern a certain spatial logic, linked to the economic and social logic of the city.

While these mixed-use buildings involve challenges at the micro-scale of storage of noxious materials and social encounters, it also has significant benefits at the broader scale. Informal adaptation to a greater mix serves city dwellers by filling the gaps between demand and available services; in this way, the mix contributes to the local economy. The informal conversions are generating a more walkable and lively urban environment by integrating diverse functions, activities and people—a quality that is often missing in the modernist planned areas. While this city clearly needs greater regulation, these neighbourhoods are more walkable and efficient because of the mix and would be quite dysfunctional without it.

When we look at the circulation spaces of the syntactic diagrams we note a considerable amount of mixing of work/visit (cyan) and work/live (magenta), a few spaces that mix all three functions (white), but never live/visit (yellow). In other words, whenever residential access becomes mixed it is always mixed with production functions first and only occasionally with shopping as well. There are clear synergies in the mixing of work and visit functions that are not present when either of these functions is mixed with residential. These are not the kinds of synergy that originally drove the proliferation of the shophouse where one lived over the store and often entered the home through it (Davis 2012 ). Thus the synergy between residential and retail that produces shop-top housing—the form of functional mix that works so well in almost any highly urbanized city—depends on a separation of these functions within each building.

The issues of functional mix cannot be considered separately from the range of morphological factors that frame the ways it emerges; particularly in relation to street interface conditions and density. The capacity to design separate access routes into each building depends to a significant degree on the capacity for multiple street entries—the cases in our sample range from 3 to 11 street entries each with an average of 4–6. This capacity will depend in turn on plot size and block location—a larger plot size and corner location produce more capacity for multiple street entries. Figures  4 , 5 and 6 show that the more informal districts have a much less regular plot size and shape, with a greater average and range of street entries. By contrast, significant parts of the street frontage in the planned area are consumed by carpark entries. In general, the unplanned areas have a greater capacity to produce separated entries.

The issues and challenges that emerge in relation to an extreme functional mix cannot be extricated from questions of density. The buildings we have considered range from 4 to 10 storeys; plot coverage in most cases is close to 100% and net floor area ratios range from 2.8 to 6.0. While these building densities are not uncommon in Dhaka, they are very high by global standards (Dovey and Pafka 2014 ). Population densities are also extremely high, whether in terms of residential populations, jobs or streetlife—the same live/work/visit categories used for the functional analysis. Many of these internal spaces have very high population densities in terms of overcrowded housing, offices, workshops and shops. It is important to understand that a problem that may appear to be caused by the mix, may not be a problem at a lower density; it is not just the fact of mixing different populations within circulation spaces but the intensity of this mix.

Many of these buildings, especially in the Planned district, were originally designed as mono-functional but have been informally adapted to various forms of mixed-use. The key dynamic here has been one of residential space converted to workshops, offices, shops, schools and so on. While shops and offices may be interconvertible, there are no examples of them being converted into apartments. It is clear that economic forces are the key drivers—work and visit functions bring higher rents in those spaces closer to the street. Depending on the ways in which the building was initially designed, it will have varying levels of capacity to adapt. If there is a single circulation spine and no space for additional entries then such entry spaces will be mixed. This will reduce the amenity and security of all remaining residential apartments, also reducing the rental value and increasing affordability. Thus the functional mix within buildings is linked to the socio-economic profile of residents.

The two greatest challenges embodied in the extreme forms of vertical mix we have documented here are the risk of fire and the social difficulties of shared access. The deadly fires that have occurred in Dhaka are often seen as due to an incompatible mix of functions, where noxious or dangerous materials are stored in spaces where any resulting fire is difficult to control or escape from. However, this problem could be addressed through stricter control of storage, workplace safety and fire egress without changing the functional mix. The challenge here is partly local because there is such a strong tradition of the go-down—the small shop that is also a warehouse.

The social issues that mixed-use functions usually cause are privacy and security. The informal transformation of residential buildings from mono-functional to mixed-use often generates shared circulation spaces where public access penetrates deeply into the upper floors, compromising the privacy and security of residences. It is imperative that work and visit functions achieve this public access for their business. The gamma diagrams in Figs.  4 , 5 and 6 show these levels of penetration graphically; they also show that even the most dense and complex buildings can be designed with segregated access.

In as much as mono-functional planning has been damaging to the city, the adaptation of residential buildings to mixed-use functions is a benefit. The planning challenge lies not in micro-managing what the mix should be but in protecting citizens from negative outcomes. The formal controls of the state should focus on proscribing certain outcomes rather than prescribing particular functions. It is important to acknowledge the benefits of informal adaptation within a formal planning framework. It is also necessary to identify and address the key problems related to informal mix in buildings. The control of mixed entries is a complex issue that requires a better understanding of the relations between formal and informal processes in any city. While the separation of residential entries is generally preferable, there may be advantages in blurring the boundaries between home and work - as is happening in more formal cities. Housing that is entered through mixed entry spaces may have difficulties in terms of privacy and security that other housing does not, however, it will also be more affordable and adaptable. It is not the role of the state to enforce the segregation of entries. The broad challenge, both in Dhaka and other highly informalised cities of the global South, is to develop forms of urban planning that can address the challenges of a dysfunctional mix without destroying the vitality and productivity of the mixed-use district.

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Department of Architecture, Bangladesh University of Engineering and Technology (BUET), Dhaka, Bangladesh

Fatema Meher Khan

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Fatema Meher Khan is an Assistant Professor at the Department of Architecture at the Bangladesh University of Engineering and Technology (BUET). Her research interest lies in urban design and planning, morphological aspects, and informal urbanism. Some of her research papers are on mixed-use function, urban morphological transformation, and social equity. Elek Pafka is Senior Lecturer in Urban Planning and Urban Design at the Faculty of Architecture, Building and Planning at the University of Melbourne. His research focuses on the relationship between material density, urban form and the intensity of urban life, as well as methods of mapping the ‘pulse’ of the city. He has participated in research on transit oriented development, functional mix and walkability. He has co-edited the book Mapping Urbanities: Morphologies, Flows, Possibilities . Kim Dovey is Professor of Architecture and Urban Design at the University of Melbourne, where he is also Director of InfUr- the Informal Urbanism Research Hub. He has published and broadcast widely on social issues in architecture, urban design and planning. Books include 'Framing Places', 'Fluid City', ‘Becoming Places’, ‘Urban Design Thinking’ and ‘Mapping Urbanities'.

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Khan, F.M., Pafka, E. & Dovey, K. Extremes of mixed-use architecture: a spatial analysis of vertical functional mix in Dhaka. City Territ Archit 9 , 31 (2022). https://doi.org/10.1186/s40410-022-00177-y

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Clinician and staff experiences with frustrated patients during an electronic health record transition: a qualitative case study

• Sherry L. Ball 1 ,
• Bo Kim 2 , 3 ,
• Sarah L. Cutrona 4 , 5 ,
• Brianne K. Molloy-Paolillo 4 ,
• Ellen Ahlness 6 ,
• Megan Moldestad 6 ,
• George Sayre 6 , 7 &
• Seppo T. Rinne 2 , 8  

BMC Health Services Research volume  24 , Article number:  535 ( 2024 ) Cite this article

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Metrics details

Electronic health record (EHR) transitions are known to be highly disruptive, can drastically impact clinician and staff experiences, and may influence patients’ experiences using the electronic patient portal. Clinicians and staff can gain insights into patient experiences and be influenced by what they see and hear from patients. Through the lens of an emergency preparedness framework, we examined clinician and staff reactions to and perceptions of their patients’ experiences with the portal during an EHR transition at the Department of Veterans Affairs (VA).

This qualitative case study was situated within a larger multi-methods evaluation of the EHR transition. We conducted a total of 122 interviews with 30 clinicians and staff across disciplines at the initial VA EHR transition site before, immediately after, and up to 12 months after go-live (September 2020-November 2021). Interview transcripts were coded using a priori and emergent codes. The coded text segments relevant to patient experience and clinician interactions with patients were extracted and analyzed to identify themes. For each theme, recommendations were defined based on each stage of an emergency preparedness framework (mitigate, prepare, respond, recover).

In post-go-live interviews participants expressed concerns about the reliability of communicating with their patients via secure messaging within the new EHR portal. Participants felt ill-equipped to field patients’ questions and frustrations navigating the new portal. Participants learned that patients experienced difficulties learning to use and accessing the portal; when unsuccessful, some had difficulties obtaining medication refills via the portal and used the call center as an alternative. However, long telephone wait times provoked patients to walk into the clinic for care, often frustrated and without an appointment. Patients needing increased in-person attention heightened participants’ daily workload and their concern for patients’ well-being. Recommendations for each theme fit within a stage of the emergency preparedness framework.

Conclusions

Application of an emergency preparedness framework to EHR transitions could help address the concerns raised by the participants, (1) mitigating disruptions by identifying at-risk patients before the transition, (2) preparing end-users by disseminating patient-centered informational resources, (3) responding by building capacity for disrupted services, and (4) recovering by monitoring integrity of the new portal function.

Peer Review reports

Electronic health record (EHR) transitions present significant challenges for healthcare clinicians and staff. These transitions require adjustments in care delivery and may threaten care quality and value. It is critical that healthcare organizations undergoing these changes learn from others who have undergone similar transitions [ 1 , 2 ]. However, the current literature lacks adequate guidance on navigating EHR transitions, especially as they relate to how clinicians and staff interact with patients [ 3 ].

Embedded within EHRs, patient portals facilitate complete, accurate, timely, and unambiguous exchange of information between patients and healthcare workers [ 4 , 5 ]. These portals have become indispensable for completing routine out-of-office-visit tasks, such as medication refills, communicating laboratory results, and addressing patient questions [ 6 ]. In 2003, the VA launched their version of a patient portal, myHealtheVet [ 7 ] and by 2017 69% of Veterans enrolled in healthcare at the VA had registered to access the patient portal [ 8 ]. Similar to other electronic portals, this system allows Veterans to review test results, see upcoming appointments, and communicate privately and securely with their healthcare providers.

EHR transitions can introduce disruptions to patient portal communication that may compromise portal reliability, impacting patient and clinician satisfaction, patients’ active involvement in self-management, and ultimately health outcomes [ 9 ]. During an EHR transition, patients can expect reductions in access to care even when clinician capacity and IT support are increased. Patients will likely need for more assistance navigating the patient portal including and using the portal to communicate with their providers [ 10 ]. Staff must be prepared and understand how the changes in the EHR will affect patients and safeguards must be in place to monitor systems for potential risks to patient safety. Building the capacity to respond to emerging system glitches and identified changes must be included in any transition plan. Although portal disruptions are likely to occur when a new EHR is implemented, we know little about how these disruptions impact healthcare workers’ interactions and care delivery to patients [ 11 , 12 ].

Due to an urgency to raise awareness and promote resolution of these patient portal issues,, we utilized existing data from the first EHR transition site for the Department of Veterans Affairs (VA)’s enterprise-wide transition. We focused on end users’ responses to the question “How Veterans were affected by the transition?”. We used qualitative methods to begin to understand how provider and patient interactions were affected during and by the EHR transition. We explored the impact of the EHR transition on patients through healthcare workers’ vicarious and direct experiences with patients. Due to the high level of disruption in care delivery we draw on insights from an emergency preparedness framework [ 13 ] to generate a set of recommendations to improve healthcare workers’ experiences during EHR transitions. The emergency preparedness framework includes 4 phases of an iterative cycle that include: (1) building capacity to mitigate issues, (2) preparing for the inevitable onset of issues, (3) responding to issues as they emerge, and (4) strategies to recover from any damage incurred.

In early 2020, the VA embarked on an EHR transition from a homegrown, legacy EHR system, developed by VA clinicians and used since the 1990s, to a new commercial system by the Oracle-Cerner Corporation. The primary objectives of this transition were to standardize care and improve interoperability between VA Medical Centers nationwide and the Department of Defense (DoD). Spanning over a decade, this transition plan is scheduled to roll out to all VA medical centers and outpatient clinics.

In this manuscript, we present data from the Mann-Grandstaff VA Medical Center in Spokane, WA, VA’s first EHR transition site. The study uses qualitative methods with clinician and staff interviews as part of a larger multi-method evaluation of the EHR transition. Our overarching goal is to identify and share recommendations to improve VA’s EHR transition efforts; rather than be guided by a theoretical framework our study design including the interview guides [ 14 , 15 ] were based primarily on what was being experienced. An experienced team of ten qualitative methodologists and analysts conducted the study.

This evaluation was designated as non-research/quality improvement work by the VA Bedford Healthcare System Institutional Review Board deeming it exempt from needing an informed consent. Study materials, including interview guides with verbal consent procedures, were reviewed and approved by labor unions and by the VA Bedford Healthcare System Institutional Review Board; all methods were carried out in accordance with local and national VA guidelines and regulations.

Interview guides and an outline of the data collection plans were reviewed and approved by relevant national unions before beginning recruitment.

Recruitment

Recruitment began in July 2020, before the first site implemented the new EHR. Prior to collecting data, we met with site leadership to get buy-in and support for the study, understand local context, determine how the site was approaching the transition, and to obtain the names of clinicians and staff for potential interviews. All potential participants were invited by email to participate in a one-hour voluntary interview conducted on Microsoft Teams® about their experiences with this transition; we used snowball sampling during interviews to expand the pool of interviewees. Verbal permission for audio recording of interviews was obtained immediately prior to the interview. Interview participants were informed that they could skip any questions, pause or stop the recording, and stop the interview at any time and were invited to ask questions before beginning the interview.

Most participants were interviewed at multiple timepoints; these included pre-implementation interviews, brief check-ins, and post-implementation interviews (Table  1 ). At the end of the pre-implementation interview, participants were invited to participate in 3–4 additional, shorter (15–20 min), check-in interviews where information about any changes in the transition process, context, or experience could be discussed. Most initial interviewees, in addition to three new participants, participated in post-implementation interviews (35–60 min; approximately 2–3 months and 10–12 months after the implementation) to reflect on the entire transition process.

Data collection

Experienced qualitative interviewers included PhD trained qualitative methodologist and masters level qualitative analysts (JB, SB, AC, EK, MM, GS) conducted individual interviews with clinicians and staff, aligning to a semi-structured interview guide with follow-up probes using the participant’s words to elicit rich responses grounded in the data [ 16 ]. The guide was designed to inform ongoing efforts to improve the rollout of the new EHR. Six main categories were covered in our interview guides, including (1) attitudes toward the new software, (2) information communicated about the transition, (3) training and education, (4) resources, (5) prior experience with EHRs, and (6) prior experiences with EHR transitions. After piloting the interview guide with a clinician, initial interviews were completed between September and October 2020 and averaged  ∼  45 min in duration. Two-month and one-year post-implementation interview guides included an additional question, “Has the Cerner transition affected Vets?”; data presented here largely draw from responses to this question. Check-ins (October 2020– December 2020) took  ∼  15 min; two-month post-implementation interviews (December 2020– January 2021) and one-year post-implementation interviews (October 2020 - November 2021) took  ∼  45 min. Audio recordings of all interviews were professionally transcribed. To ensure consistency and relationship building, participants were scheduled with the same interviewer for the initial and subsequent interviews whenever feasible (i.e., check-ins and post-implementation interviews). Immediately following each interview, interviewers completed a debrief form where highlights and general reflections were noted.

Throughout the data collection process, interviewers met weekly with the entire qualitative team and the project principal investigators to discuss the recruitment process, interview guide development, and reflections on data collection. To provide timely feedback to leadership within the VA, a matrix analysis [ 17 ] was conducted concurrently with data collection using the following domains: training, roles, barriers, and facilitators. Based on these domains, the team developed categories and subcategories, which formed the foundation of an extensive codebook.

Data analysis

All interviewers also coded the data. We used inductive and deductive content analysis [ 18 ]. Interview transcripts were coded in ATLAS.ti qualitative data analysis software (version 9). A priori codes and categories (based on the overall larger project aims and interview guide questions) and emergent codes and categories were developed to capture concepts that did not fit existing codes or categories [ 18 ]. Codes related to patient experience and clinician interactions with patients were extracted and analyzed using qualitative content analysis to identify themes [ 18 ]. Themes were organized according to their fit within the discrete stages of an emergency preparedness framework to generate recommendations for future rollout. In total, we examined data from 111 interviews with 24 VA clinicians and staff (excluding the initial 11 stakeholder meetings (from the 122 total interviews) that were primarily for stakeholder engagement). We focused on participants’ responses related to their experiences interacting with patients during the EHR transition.

Exemplar quotes primarily came from participants’ responses to the question, “Has the Cerner transition affected Vets?” and addressed issues stemming from use of the patient portal. This included both clinicians’ direct experiences with the portal and indirect experiences when they heard from patients about disruptions when using the portal. We identified four themes related to clinicians’ and staff members’ reported experiences: (1) stress associated with the unreliability of routine portal functions and inaccurate migrated information; (2) concern about patients’ ability to learn to use a new portal (especially older patients and special populations); (3) frustration with apparent inadequate dissemination of patient informational materials along with their own lack of time and resources to educate patients on use of the new portal; and (4) burden of additional tasks on top of their daily workload when patients needed increased in-person attention due to issues with the portal.

Stress associated with the unreliability of routine portal functions and inaccurate migrated information

One participant described the portal changes as, “It’s our biggest stress, it’s the patients’ biggest stress… the vets are definitely frustrated; the clinicians are; so I would hope that would mean that behind the scenes somebody is working on it” (P5, check-in).

Participants expressed significant frustration when they encountered veterans who were suddenly unable to communicate with them using routine secure messaging. These experiences left them wondering whether messages sent to patients were received.

Those that use our secure messaging, which has now changed to My VA Health, or whatever it’s called, [have] difficulty navigating that. Some are able to get in and send the message. When we reply to them, they may or may not get the reply. Which I’ve actually asked one of our patients, ‘Did you get the reply that we took care of this?’ And he was like, ‘No, I did not (P11, 2-months post)

Participants learned that some patients were unable to send secure messages to their care team because the portal contained inaccurate or outdated appointment and primary site information.

I’ve heard people say that the appointments aren’t accurate in there… veterans who have said, ‘yeah, it shows I’m registered,’ and when they go into the new messaging system, it says they are part of a VA that they haven’t gone to in years, and that’s the only area they can message to, they can’t message to the [site] VA, even though that’s where they’ve actively being seen for a while now. (P20, 2-months post)

After the EHR transition, participants noted that obtaining medications through the portal, which was once a routine task, became unreliable. They expressed concern around patients’ ability to obtain their medications through the portal, primarily due to challenges with portal usability and incomplete migration of medication lists from the former to the new EHR.

I think it’s been negative, unfortunately. I try to stay optimistic when I talk to [patients], but they all seem to be all having continued difficulty with their medications, trying to properly reorder and get medications seems to still be a real hassle for them. (P17, one-year post) …the medications, their med list just didn’t transfer over into that list [preventing their ability to refill their medications]. (P13, 2-months post)

Concern about patients’ ability to learn to use a new portal

Clinicians and staff expressed concerns around veterans’ ability to access, learn, and navigate a new portal system. Clinicians noted that even veterans who were adept at using the prior electronic portal or other technologies also faced difficulties using the new portal.

They can’t figure out [the new portal], 99% of them that used to use our [old] portal, the electronic secure messaging or emailing between the team, they just can’t use [the new one]. It’s not functioning. (P13, one-year post) Apparently, there’s a link they have to click on to make the new format work for them, and that’s been confusing for them. But I still am having a lot of them tell me, I had somebody recently, who’s very tech savvy, and he couldn’t figure it out, just how to message us. I know they’re still really struggling with that. (P5, 2-months post) And it does seem like the My Vet [my VA Health, new portal], that used to be MyHealtheVet [prior portal], logging on and getting onto that still remains really challenging for a large number of veterans. Like they’re still just unable to do it. So, I do think that, I mean I want to say that there’s positive things, but really, I struggle (P17, one-year post)

Participants recognized difficulties with the new system and expressed empathy for the veterans struggling to access the portal.

I think that a lot of us, individually, that work here, I think we have more compassion for our veterans, because they’re coming in and they can’t even get onto their portal website. (P24, one-year post)

Participants acknowledged that learning a new system may be especially difficult for older veterans or those with less technology experience.

But, you know, veterans, the general population of them are older, in general. So, their technologic skills are limited, and they got used to a system and now they have to change to a new one. (P13, 2-months post) So, for our more elderly veterans who barely turn on the computer, they’re not getting to this new portal. (P8, check in) And you know, I do keep in mind that this is a group of people who aren’t always technologically advanced, so small things, when it’s not normal to them, stymie them.(P13, one-year post)

Concerns were heightened for veterans who were more dependent on the portal as a key element in their care due to specific challenges. One participant pointed out that there may be populations of patients with special circumstances who depend more heavily on the prior portal, MyHealtheVet.

I have veterans from [specific region], that’s the way they communicate. Hearing impaired people can’t hear on the phone, the robocall thing, it doesn’t work, so they use MyHealtheVet. Well, if that goes away, how is that being communicated to the veteran? Ok? (P18, Check-in)

Frustration with inadequate dissemination of information to veterans about EHR transition and use of new portal

Participants were concerned about poor information dissemination to patients about how to access the new portal. During medical encounters, participants often heard from patients about their frustrations accessing the new portal. Participants noted that they could only give their patients a phone number to call for help using the new system but otherwise lacked the knowledge and the time to help them resolve new portal issues. Some clinicians specifically mentioned feeling ill-equipped to handle their patients’ needs for assistance with the new portal. These experiences exacerbated clinician stress during the transition.

Our veterans were using the MyHealtheVet messaging portal, and when our new system went up, it transitioned to My VA Health, but that wasn’t really communicated to the veterans very well. So, what happened was they would go into their MyHealtheVet like they had been doing for all of these years, to go in and request their medications, and when they pulled it up it’d show that they were assigned to a clinician in [a different state], that they have no active medications. Everything was just messed up. And they didn’t know why because there was no alert or notification that things would be changing. (P8, check in) I field all-day frustration from the veterans. And I love my job, I’m not leaving here even as frustrated as I am, because I’m here for them, not to, I’m here to serve the veterans and I have to advocate for them, and I know it will get better, it can’t stay like this. But I constantly field their frustrations.… So, I give them the 1-800 number to a Cerner help desk that helps with that, and I’ve had multiple [instances of] feedback that it didn’t help. (P13, one-year post) And [the patients are] frequently asking me things about their medication [within the portal], when, you know, I can’t help them with that. So, I have to send them back up to the front desk to try to figure out their medications. (P17, one-year post)

Veteran frustration and the burden of additional tasks due to issues with the portal

Clinicians reported that veterans expressed frustration with alternatives to the portal, including long call center wait times. Some veterans chose to walk into the clinic without an appointment rather than wait on the phone. Clinicians noted an increase in walk-ins by frustrated veterans, which placed added workload on clinics that were not staffed to handle the increase in walk-ins.

It’s been kind of clunky also with trying to get that [new portal] transitioned. And then that’s created more walk-ins here, because one, the vets get frustrated with the phone part of it, and then MyHealtheVet (prior portal) not [working], so they end up walking [into the clinic without an appointment]. (P19, check-in) In terms of messages, they can’t necessarily find the clinician they want to message. We had a veteran who came in recently who wanted to talk to their Rheumatologist, and it’s like, yeah, I typed in their name, and nothing came up. So, they have to try calling or coming in. (P20, 2-months post)

In summary, participants described the new patient portal as a source of stress for both themselves and their patients.

In addition to their own direct experience using a new EHR to communicate with their patients, clinicians and staff can be affected by perceptions of their patients’ experiences during an EHR transition [ 19 ]. At this first VA site to transition to the new EHR, clinicians and staff shared their concerns about their patients’ experiences using the portal. They were particularly troubled by unreliability of the secure messaging system and challenges patients faced learning to use the new system without proper instruction. Moreover, clinicians were alarmed to hear about patients having to make in-person visits– especially unplanned (i.e., walk in) ones– due to challenges with the new portal. Each of these issues needs to be addressed to ensure veteran satisfaction. However, the only solution participants could offer to frustrated patients was the telephone number to the help desk, leaving them with no clear knowledge of a solution strategy or a timeline for resolution of the issues.

We propose applying emergency preparedness actions to future EHR rollouts: mitigate, prepare, respond, and recover (Fig.  1 ) [ 13 ]. By applying these actions, patient portal disruptions may be alleviated and patients’ communication with their clinicians and access to care can be maintained. For example, issues stemming from a disruption in the portal may be mitigated by first identifying and understanding which patients typically use the portal and how they use it. Sites can use this information to prepare for the transition by disseminating instructional materials to staff and patients on how to access the new portal, targeting the most common and critical portal uses. Sites can respond to any expected and emerging portal disruptions by increasing access to alternative mechanisms for tasks disrupted by and typically completed within the portal. After the transition, recovery can begin by testing and demonstrating the accuracy and reliability of functions in the new portal. These actions directly address reported clinician concerns and can help maintain patient-clinician communication, and access to care.

The emergency preparedness framework was applied. This framework includes 4 actions: (1) mitigate, (2) prepare, (3) respond, and (4) recover. These actions can be repeated. Recommendations for how each action (1–4) can be applied to a portal transition are included in each blue quadrant of the circle

Sites could mitigate issues by first understanding which patients will be most affected by the transition, such as those who rely heavily on secure messaging. Reliable use of secure messaging within the VA facilitates positive patient-clinician relationships by providing a mechanism for efficient between-visit communication [ 20 , 21 , 22 , 23 ]. During the EHR transition, clinicians and staff became concerned about the well-being of patients from whom they weren’t receiving messages and those who depended on the portal to complete certain tasks. Since secure messaging is often initiated by patients to clinicians [ 23 ], clinicians will likely be unaware that messages are being missed. Understanding how and which patients currently use the portal and anticipating potential portal needs is a first step toward mitigating potential issues.

Despite efforts to inform Veterans of the EHR transition and patient portal [ 24 ] including information sent to a Veteran by email, direct mail, postings on VA websites, and a town hall, our findings agree with those of Fix and colleagues [ 10 ] and suggest that many Veterans were unprepared for the transition. Our findings suggest that end users heard that more is needed to improve the dissemination of knowledge about the transition and how to navigate the new patient portal to both VA employees and the patients they serve.

Preparations for the transition should prioritize providing VA clinicians and staff with updated information and resources on how to access and use the new portal [ 25 ]. VA clinicians deliver quality care to veterans and many VA employees are proud to serve the nation’s veterans and willing to go the extra mile to support their patients’ needs [ 26 ]. In this study, participants expressed feeling unprepared to assist or even respond to their patients’ questions and concerns about using the new portal. This unpreparedness contributed to increased clinician and staff stress, as they felt ill-equipped to help their patients with portal issues. Such experiences can negatively affect the patient-clinician relationship. Preparing clinicians and patients about an upcoming transition, including technical support for clinicians and patients, may help minimize these potential issues [ 10 , 27 ]. Specialized training about an impending transition, along with detailed instructions on how to gain access to the new system, and a dedicated portal helpline may be necessary to help patients better navigate the transition [ 23 , 28 ].

In addition to a dedicated helpline, our recommendations include responding to potential changes in needed veteran services during the transition. In our study, participants observed more veteran walk-ins due to challenges with the patient portal. Health systems need to anticipate and address this demand by expanding access to in-person services and fortifying other communication channels. For example, sites could use nurses to staff a walk-in clinic to handle increases in walk-in traffic and increase call center capacity to handle increases in telephone calls [ 29 ]. Increased use of walk-in clinics have received heightened attention as a promising strategy for meeting healthcare demands during the COVID-19 pandemic [ 30 ] and can potentially be adapted for meeting care-related needs during an EHR transition. These strategies can fill a gap in communication between clinicians and their patients while patients are learning to access and navigate a new electronic portal.

Finally, there is a need for a recovery mechanism to restore confidence in the reliability of the EHR and the well-being of clinicians and staff. Healthcare workers are experiencing unprecedented levels of stress [ 31 ]. A plan must be in place to improve and monitor the accuracy of data migrated, populated, and processed within the new system [ 2 ]. Knowing that portal function is monitored could help ease clinician and staff concerns and mitigate stress related to the transition.

Limitations

This study has several limitations. First, data collection relied on voluntary participation, which may introduce self-selection response bias. Second, this work was completed at one VA medical center that was the first site in the larger enterprise-wide transition, and experiences at other VAs or healthcare systems might differ substantially. Third, we did not interview veterans and relied entirely on secondhand accounts of patient experiences with the patient portal. Future research should include interviews with veterans during the transition and compare veteran and VA employee experiences.

Despite a current delay in the deployment of the new EHR at additional VA medical centers, findings from this study offer timely lessons that can ensure clinicians and staff are equipped to navigate challenges during the transition. The strategies presented in this paper could help maintain patient-clinician communication and improve veteran experience. Guided by the emergency preparedness framework, recommended strategies to address issues presented here include alerting those patients most affected by the EHR transition, being prepared to address patients’ concerns, increasing staffing for the help desk and walk-in care clinics, and monitoring the accuracy and reliability of the portal to provide assurance to healthcare workers that patients’ needs are being met. These strategies can inform change management at other VA medical centers that will soon undergo EHR transition and may have implications for other healthcare systems undergoing patient portal changes. Further work is needed to directly examine the perspectives of veterans using the portals, as well as the perspectives of both staff and patients in the growing number of healthcare systems beyond VA that are preparing for an EHR-to-EHR transition.

Data availability

Deidentified data analyzed for this study are available from the corresponding author on reasonable request.

Abbreviations

Electronic health record

Department of Veterans Affairs

VA Medical Centers

Department of Defense

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Acknowledgments

We acknowledge and thank members of the EMPIRIC Evaluation qualitative and supporting team for their contributions to this work including Ellen Ahlness, PhD, Julian Brunner, PhD, Adena Cohen-Bearak, MPH, M.Ed, Leah Cubanski, BA, Christine Firestone, Bo Kim, PhD, Megan Moldestad, MS, and Rachel Smith. We greatly appreciate the staff at the Mann-Grandstaff VA Medical Center and associated community-based outpatient clinics for generously sharing of their time and experiences participating in this study during this challenging time.

The “EHRM Partnership Integrating Rapid Cycle Evaluation to Improve Cerner Implementation (EMPIRIC)” (PEC 20–168) work was supported by funding from the US Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Quality Enhancement Research Initiative (QUERI) (PEC 20–168). The findings and conclusions in this article are those of the authors and do not necessarily reflect the views of the Veterans Health Administration, Veterans Affairs, or any participating health agency or funder.

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Sherry L. Ball

Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA

Bo Kim & Seppo T. Rinne

Department of Psychiatry, Harvard Medical School, Boston, MA, USA

Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA

Sarah L. Cutrona & Brianne K. Molloy-Paolillo

Division of Health Informatics & Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA

Sarah L. Cutrona

Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Puget Sound Health Care System, Seattle, WA, USA

Ellen Ahlness, Megan Moldestad & George Sayre

University of Washington School of Public Health, Seattle, WA, USA

George Sayre

Geisel School of Medicine at Dartmouth, Hannover, NH, USA

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Contributions

S.R. designed the larger study. G.S. was the qualitative methodologist who led the qualitative team. S.B., E.A., and M.M. created the interview guides and completed the interviews; Data analysis, data interpretation, and the initial manuscript draft were completed by S.B. and B.K. S.C. and B.M. worked with the qualitative team to finalize the analysis and edit and finalize the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sherry L. Ball .

Ethics declarations

Ethics approval and consent to participate.

This evaluation was designated as non-research/quality improvement by the VA Bedford Healthcare System Institutional Review Board. All methods were carried out in accordance with local and national VA guidelines and regulations for quality improvement activities. This study included virtual interviews with participants via MS Teams. Employees volunteered to participate in interviews and verbal consent was obtained to record interviews. Study materials, including interview guides with verbal consent procedures, were reviewed and approved by labor unions and determined as non-research by the VA Bedford Healthcare System Institutional Review Board.

Consent for publication

Not applicable.

The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Department of Veterans Affairs.

Prior presentations

Ball S, Kim B, Moldestad M, Molloy-Paolillo B, Cubanski L, Cutrona S, Sayre G, and Rinne S. (2022, June). Electronic Health Record Transition: Providers’ Experiences with Frustrated Patients. Poster presentation at the 2022 AcademyHealth Annual Research Meeting. June 2022.

Competing interests

The authors declare no competing interests.

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Ball, S.L., Kim, B., Cutrona, S.L. et al. Clinician and staff experiences with frustrated patients during an electronic health record transition: a qualitative case study. BMC Health Serv Res 24 , 535 (2024). https://doi.org/10.1186/s12913-024-10974-5

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Received : 29 August 2023

Accepted : 09 April 2024

Published : 26 April 2024

DOI : https://doi.org/10.1186/s12913-024-10974-5

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