A dialysis center with a difference

Over the course of working with Billings Clinic for 20 years, one thing’s been abundantly clear — this client puts patients first. This philosophy can sometimes mean taking the time to rethink how we design healthcare facilities and the patient experience within them.

The new Billings Clinic Dialysis Center in Montana is a good example of knowing when it’s time to change things up. Opened in late July, the center is a partnership between Billings Clinic and Dialysis Clinic, Inc., one of the largest dialysis providers in the United States.

Dialysis centers are highly technical spaces. For people with kidney failure, dialysis machines take the place of a person’s kidneys, removing excess water, waste, and toxins from the blood. This process can take from four to six hours and is done three times a week. And for a patient, I can imagine this feels like a very long time.

Typical dialysis centers can be stark and clinical. They’re most often an open room with chairs lined up around it, all facing each other. Designed more for the efficiency of nurses and caregivers, they’re not always the most relaxing places for patients to be.

For this project, Billings Clinic wanted to try something different with the layout and design. When it comes to planning new facilities, their process is inclusive. Their goal is to understand the different perspectives of the people they serve and the people who work in their facilities. It’s important to ask: What’s the experience like for patients and for caregivers, and how can we do it better?

The “ah ha” moment

Given our team’s long-term relationship with Billings Clinic, we were brought in to lead the design, working in partnership with a trusted DCI consultant to ensure their standards were incorporated and each party was comfortable with the new arrangement. Our plan was to utilize the evidence-based design process we incorporate into all our projects, with the additional challenge to break the mold on the traditional dialysis treatment layout.


“We have stacks of hand sketches we did for this project. You wouldn’t believe all the different ideas. We racked our brains, and it was a lot of fun.”

Fellow designer Corey Stremcha and I worked for two months on different options. None were quite right until we came up with the “pod” concept. This was our “ah ha” moment and ended up being the basis of the final design. The design consists of four areas (the pods), with 8-10 treatment chairs per pod. We designed the building around those pods, filled the entire treatment space with vaulted ceilings, and brought in an abundance of natural light. The pod design provides smaller areas within the space, creating more privacy for patients.

Convenience, comfort, and staff retention

With this model, everything was designed for the convenience and comfort of the patient. Many dialysis patients are wheelchair users, thus when they come into the center, they transfer from wheelchair to treatment chair, so we designed places for wheelchairs to be stored. Other subtle aspects that add to the whole are strategically placed televisions for entertainment and distraction, warm finishes and art integrated throughout to serve as interesting focal points, and plenty of windows with views to the outside greenery and landscaping to enjoy.


To create a less clinical, more welcoming environment, the space is imbued with natural light, and patients can enjoy views to the outside, as well as artwork throughout the space.

The other really cool thing about this project is the attention given to creating efficiencies for caregivers. With the nurse to patient ratio ideally one to eight, we designed the pods around those numbers to ensure caregivers had supportive layouts with plenty of room for each patient, as well as the ability to see each person in their care at all times.

With healthcare professionals in high demand these days, our client wanted a space that people would see as the “best place to work,” so a lot of what we did was to support staff retention. Things were considered such as how they enter the building and come to work, personal lockers where they can store their personal belongings, a treatment floor that is conveniently located adjacent to the employee breakroom — little things that add up and make the facility super convenient.

The key to this project was finding a better treatment layout, and then designing the building around it. There are mechanical rooms, break rooms, offices, and all kinds of other spaces in the facility, but the heart of it is the treatment floor. Once we had that nailed down, everything else fell into place.

Taking a chance on change

There’s no doubt this project cost more than the traditional design, but both patients and caregivers will benefit from our team taking the time to go through a process like this. The facility is unlike any other dialysis clinic around, and it could end up being a game changer more broadly.

In order for us to design projects like this, we need a client who’s willing to go there with us. In this case, Billings Clinic was fully on board and DCI was amazingly open to a different way of designing. True innovation happens when you have a client who’s willing to the push the boundaries and a design team with the ability to show them alternatives. That’s when really cool stuff happens.

A fun side note

During the design process, we used virtual reality walkthroughs to get a real sense of the space. Corey, who’s also an artist, incorporated snippets of his artwork throughout the VR demos to add color and warmth. During one of the walkthroughs, a client representative admired the artwork and as a result, Corey was commissioned to create the painting now hanging above the fireplace in the center’s waiting room. Nice job, Corey!


Thoughtful touches such as local artwork make a difference in the way a place feels for healthcare patients.


Credits to the team:

  • Construction contractor: Fisher Construction, Inc.
  • Civil engineering and landscaping: Sanderson Stewart
  • Interior design: CTA | Cushing Terrell in partnership with Wendy Garrison
  • Architectural, MEP, and structural engineering, AV and technology, lighting: CTA | Cushing Terrell