Tuality Hospital commissioned studies to address the needs of its growing market – one in which larger competitors were making substantial inroads. The study called for the development of an outpatient services program to consolidate disparate practices under the greater Tuality umbrella. The PMB team worked with Tuality management and medical staff in programming the 115,000 SF project attached to the hospital by a pedestrian bridge. The project required lengthy negotiations with the local community and the State Department of Transportation on entitlement issues. The project blended hospital outpatient departments, private physicians’ offices, and Portland State University’s medical school in combined programs that redefined Tuality’s delivery model; it has become the hub of local healthcare delivery in the western Washington county area.