Working closely with Exeter Hospital since 1995, Jones & Beach Engineers, Inc. (JBE) has designed and implemented eight major facility improvement and expansion efforts on the campus. Including four parking lots, a four-story parking garage, and more than 250,000 S.F. of new building space, this multi-phase undertaking demanded a masterwork of advance planning and construction sequencing. With the hospital in operation through the duration of the project, complex utility relocation and refurbishment had to be coordinated so as to maintain uninterrupted service. Adequate parking and access also needed to be preserved, requiring that work be carefully staged so as to not interfere with the day-to-day functions of the facility. An integrated pedestrian circulation plan was also included in the design to encourage safe walking passage throughout the campus. With the completion of this vast scope of improvements, including the new Center for Ambulatory Care shown here, JBE has diligently worked to provide this regional medical center with the tools it needs to meet the challenges and opportunities of 21st century medicine.