read the article - Radelet McCarthy Polletta

APRIL 2013 • VOL. 13, NO. 3 • A VENDOME PUBLICATION
WWW.HEALTHCAREDESIGNMAGAZINE.COM
Hope spreads
Trends in cancer center design
The Mario Lemieux Center for
Blood Cancers
An Environment Designed for
Hope and Comfort
102204_wmas.indd 42
7/29/13 1:51 PM
healing
HOPEFUL
Modern cancer treatment centers require spaces that support a multidisciplinary,
technology-driven approach to keeping survivorship rates on the rise
the story of cancer treatment in the United
States is one of hope, with survival rates today
presenting a stark contrast to those of just a few
decades ago. In fact, the American Cancer Society
(ACS) reports that the five-year survival rate for
cancers diagnosed between 2002 and 2008 is
68 percent, up from the 49 percent found between
1975 and 1977.
But the organization’s Cancer Facts & Figures
2013 report is also tempered by the realities of
what’s yet to come. While incidence rates are declining for most types of cancer, others are on the rise,
such as melanoma, thyroid, and pancreas. And in
2013 alone, about 1.7 million new cancer cases are
expected to be diagnosed.
The treatment landscape is about to see some
new challenges, too. Cancer is a disease of aging,
and more than 70 million baby boomers are heading
into the over-60 population. Add to that healthcare
reform’s call for accountable care, influence on
physician integration, and coverage of the currently
uninsured. Pushing the care environment forward
102204_wmas.indd 36
are new approaches to delivery, including a focus
on outpatient care enhanced through a teambased approach, technology playing an ever-more
critical role, and an overhaul of treatment spaces to
provide control—as well as a sense of optimism—to
patients during a time when they may not be feeling
it otherwise.
“In designing these facilities, it’s about creating a space that not only reflects the cutting-edge
technology and the extraordinary knowledge that’s
at work to solve the problems of cancer, but it’s
also to create an environment that’s about life, and
about thriving, growing, and recovering quickly
from this dreaded disease,” says Rick Kobus,
senior principal, Tsoi/Kobus & Associates (TK&A;
Cambridge, Mass.).
Above: The infusion treatment areas at the Duke
Medicine Cancer Center in Durham, N.C., are grouped into
neighborhoods, and each bay has the ability to function as
either a private or social space.
©ROBERT BENSON PHOTOGRAPHY
By Jennifer Kovacs Silvis
7/29/13 1:51 PM
102204_wmas.indd 38
have limited mobility, that the treatment is exhausting,
and that it’s really important to provide these diagnostic tools and place them at convenient locations
for the patient,” Kobus says.
Adjusting the placement of services also prevents
bottlenecks that often occur in cancer treatment
facilities and improves throughput of patients, especially for pieces like registration, insurance co-pays,
lab results, pharmacy pick-ups, etc. Another example
of streamlining can be found in moving departments
traditionally maintained in the acute care setting, such
as imaging, and instead operating them right from
the outpatient cancer center. “I think folks know that
they have to manage care delivery at a better cost,
in a more effective way, especially with accountable
care. Lean process planning has been a real addition
to the design, construction, and planning of these
facilities in past years,” says Kelley Simpson, senior
partner, Oncology Solutions.
Top: At the Integris Cancer
Institute of Oklahoma, a teaming
area surrounded by private, semiprivate, and open infusion areas
supports staff collaboration and
gives patients a choice in their
treatment space. Middle: As part
of the Lancaster Health Center’s
radiation oncology renovation,
a light panel provides nature
views to reduce the harshness
of technology and enhance the
patient experience. Above: The
MD Anderson Cancer Center Alkek
Hospital provides family-friendly
amenities, including extra TVs
in patient rooms as well as an
observation deck, movie room,
and business office suites.
BLAKE MARVIN/HKS INC. (INTEGRIS AND LANCASTER HEALTH CENTER); LACASSE PHOTOGRAPHY (MD ANDERSON); DENMARSH PHOTOGRAPHY INC. (MARIO LEMIEUX)
Streamlining care
Like the shift seen in survival rates, cancer care environments have also changed drastically from what
they were 30 years ago, with 85 to 90 percent of care
now delivered in the community through outpatient
centers. With that trend has come a push toward a
team-based approach that involves multidisciplinary
groups of caregivers, from surgeon to radiologist to
pathologist. “When those physicians are located in
different facilities, it’s a challenge for patients to get
the big picture of their whole care plan. What providers are realizing is if we can facilitate a place where
our caregivers can be together and consult patients
through team care, not only are the outcomes better
but the patients are finding they’re getting better and
higher quality care,” says Jason Schroer, associate
principal/senior vice president, HKS Inc. (Dallas).
However, reintegrating once-private-practice
physicians into a hospital-run program as well as
bringing surgeons into the outpatient setting isn’t
always easy, says Jake Jones, vice president, facilities design and development, Oncology Solutions
(Decatur, Ga.). “For oncology specifically, the integration of the surgical piece and the multidisciplinary
care aspect takes a lot of operational change and a
lot of re-educating the physicians as to the value to
them and to the patients. In terms of facilities, there’s
a complement of clinical space that needs to be
included and designed around that model,” he says.
For example, the MemorialCare Todd Cancer
Institute Pavilion at Long Beach Memorial Medical
Center (Long Beach, Calif.), a new 64,000-squarefoot, $32 million facility scheduled to open in July
and designed by C|A Architects, will collocate the
hospital’s outpatient cancer services under one
roof. There, physician office space is designed in a
“timeshare” model, with various specialists sharing
space on a day-to-day basis. In fact, the integrated
approach taken at the facility also includes wellness
pieces, such as a rehab gym, yoga space, demonstration kitchen, therapy session rooms, and space
for acupuncture and massotherapy. “We know that
people seek out these kinds of services and that
we would like to be able to marry all of the Eastern
medicine tools with Western medicine, and have one
integrated program so our doctors will know what
their patients are doing,” says Cathy Kopy, executive
director, Todd Cancer Institute.
At the Duke Medicine Cancer Center in Durham,
N.C., designed by TK&A, collocation principles were
used in the efficient placement of services, as well,
so patients wouldn’t have to traverse the campus to
make regular visits to the lab, radiology, or imaging.
“We have to recognize that very often these patients
7/29/13 1:51 PM
BLAKE MARVIN/HKS INC. (INTEGRIS AND LANCASTER HEALTH CENTER); LACASSE PHOTOGRAPHY (MD ANDERSON); DENMARSH PHOTOGRAPHY INC. (MARIO LEMIEUX)
Above: Open treatment bays at the
Mario Lemieux Center for Blood
Cancers in Pittsburgh are designed
for comfort, with recliners that
offer heat and massage; tables for
laptops, books, and beverages;
a recessed shelf for glasses and
cell phones; and a touch screen
monitor for entertainment. Left:
Patients at the Mario Lemieux
Center are not required to remain
in a treatment bay for the entire
course of a treatment. The
patient family lounge provides a
comfortable alternative for patients
and their family members to spend
time together.
Tech tips
Another way team-based care must be supported
in the physical space is through the installation
of necessary technology to support telemedicine
efforts. “Since a cancer patient often has many different doctors and caregivers as part of a core plan,
[technology] can help break down those barriers and
102204_wmas.indd 39
provide better care,” Schroer says.
Cancer treatment itself is also technologyintensive and requires a great deal of coordination
right from the outset of any project. To start, MRIs
alone advance so quickly that spaces where they’re
housed are often built out last by contractors so the
very latest equipment can be installed, says Mike
Gritters, executive vice president, healthcare servic-
7/29/13 1:51 PM
Giving control back
While the complexity of treatment equipment
continues to escalate and become more high-tech,
requirements for the physical space aren’t necessarily moving in the same direction. “The patients’
desire and need to be in a more relaxed, much less
clinical, and more intimate space when they’re receiving treatment and care—those things are at different
ends of the spectrum. But that’s what the new cancer
treatment facilities really need to be,” says Jim Eaton,
vice president, healthcare division leader, Haskell
(Jacksonville, Fla.).
Dr. Nancy Davidson, director of the University of
Pittsburgh Cancer Institute and UPMC CancerCenter,
says that this personalized treatment approach
102204_wmas.indd 40
was a critical component in planning the new
Mario Lemieux Center for Blood Cancers, a
24,000-square-foot long-term outpatient treatment facility at UPMC’s Hillman Cancer Center in
Pittsburgh.
To start, the center’s must-haves for design
included patient-centered, homelike elements that
support the long periods of time that most patients
normally spend there, often arriving in the morning and not leaving until well into the afternoon.
“That requires a certain attention to the treatment
facility’s ambiance that is especially important
because patients may be there for such long
periods of time,” Davidson says, noting the innate
difference between the design of cancer centers
and traditional outpatient spaces.
“We wanted materials that would be familiar
and that would express a sense of calm,” adds
David Wells, principal, Radelet McCarthy Polletta
(Pittsburgh), the architect on the Mario Lemieux
project. Thankfully, that goal is easier to achieve
today, Wells says, citing advancements that have
been made by manufacturers in offering flooring,
upholstery, and other materials suited for infection
control, without a clinical look and feel.
“We needed to balance and be very cognizant
of those aspects to achieve the level of quality and
soothing appearance of the space,” he says.
Gritters, of McCarthy, notes that plans to create
calming spaces oftentimes call for structural con-
Top: Construction is underway
on the new $31 million Todd
Cancer Institute Pavilion at
Long Beach Memorial Medical
Center. As part of the design
process, focus groups were held
with patients and their families,
which helped determine the
need for flexible space so
patients can have more control
over their environment. Above:
The Todd Cancer Institute
Pavilion features a light-filled,
two-story lobby with warm
stone and wood interior finishes
in the reception spaces and
treatment areas.
RENDERINGS BY FOCUS 360, LAGUNA NIGUEL, CALIF. (TODD CANCER INSTITUTE); JONATHAN HILLYER (PROCURE)
es, McCarthy Building Cos. (Newport Beach, Calif.).
Plus, “because MRI machines become outdated every
three to six years, contractors have to design a way
to get the large, heavy equipment out of the building
when it’s time to replace it,” he says.
Also gaining ground on the technology front are
hybrid operating rooms featuring intraoperative MRIs
incorporated into a space to merge the latest imaging
technology of a radiology suite with a traditional OR.
“The technology enables complex cases to undergo
both open and minimally invasive surgery techniques
in the same room,” Gritters says.
On a more extreme end of the cancer technology
spectrum is proton therapy (See “Proton Progress”
at www.healthcaredesignmagazine.com/article/
proton for more details), which requires tremendous
infrastructure support beyond what’s needed for
traditional radiation equipment. But across the board,
Schroer says when it comes to technology and radiation therapies, patients want to know it’s there, but
they don’t want to feel it. “As designers, we’re doing
everything we can to minimize the harshness that may
come with technology. Some ways we’ve done that
is to introduce daylight. Sometimes we can introduce
greenery or plant life. We’ve even looked at using
technology that allows you to project pictures of a
patient’s family on the wall,” he says.
And while care providers have had success in
reducing radiation stints with complements of treatments in pill form, it’s expected that technology will
still be required for some time. With that in mind,
spaces must be designed to support the unknown.
“For instance, we’ll design a building with a higher
floor-to-ceiling height, and that would allow for whatever that technology may become 10 years from
now to be bigger and still be easily plugged into that
space,” Schroer says. “We may overdesign a structure
in certain areas to know it’s flexible to bring in new
technology over time.”
7/29/13 1:51 PM
RENDERINGS BY FOCUS 360, LAGUNA NIGUEL, CALIF. (TODD CANCER INSTITUTE); JONATHAN HILLYER (PROCURE)
siderations, too, such as installation of water features
or natural materials like wood and stone. “In the patient spaces, abundant use of windows and skylights
are also used to bring in natural light,” he says.
Designers must also consider the long amount
of time spent at these facilities from the perspective
of providing services and various space options.
“Patients need to eat, so we need to provide food
service that’s located away from treatment areas
so as not to cause scent issues for those who are
sick. And retail space is definitely a helpful thing to
have in a cancer center,” says Kate Wendt, associate
principal and director of interior design for TK&A, of
everything from on-site pharmacies to wig and prosthetics boutiques that provide one-stop shopping.
Wendt adds that other ideal space options include
education/resource centers and respite spaces like
rooftop gardens and outdoor patios.
Looking forward
With baby boomers promising growth in cancer
care, the industry sector continues to brace for the
full impact of healthcare reform. “The biggest issue
many of our clients face today is physician integration
and how that affects their facilities, because many of
them are integrating what once was a hospital outpatient infusion clinic with the private practice environment. So that’s an issue, and how to expand existing
facilities or build new to accommodate that growth,”
Oncology Solutions’ Simpson says.
And while research and technology advancements
have successfully yielded higher rates of survivorship
for cancer patients, that fact, too, has an effect on
how health systems are planning cancer spaces for
the future. “These patients are living much longer and
the whole survivorship planning aspect of ongoing
testing and intervention is a really big issue, and it’s
how to accommodate that whole cancer population
in their long-term facilities adoption plan,” Simpson
says.
TK&A’s Wendt concurs, noting that the rate of survivorship has “transformed the way cancer centers
are designed. In most all of them, there are spaces
set aside for community outreach and also for training. For survivors, there are club rooms where they
can meet on a regular basis,” she says.
At the new Todd Cancer Institute, preparing for
more survivors translates to planning spaces that
support a lifetime of wellness services. “It’s one thing
to survive your cancer, but you need to survive it and
then thrive,” Kopy says. HCD
Jennifer Kovacs Silvis is managing editor of Healthcare
Design. She can be reached at jsilvis@vendomegrp.
com.
For an in-depth look at proton therapy and
design implications for these challenging
treatment facilities, see “Proton Progress”
at www.healthcaredesignmagazine.com/
article/proton.
Open nurses’ stations are
centrally located within the
ProCure Proton Therapy
Center in Oklahoma City,
Okla., to provide patients with
clear wayfinding cues and
convenient access to staff, as
skylights above offer natural
light.
MORE ONLINE
Hear added insights from the industry professionals interviewed for this article in the webinar
“A Preview of Healthcare Design’s Cancer
Center Trends Report,” part of a recent
Healthcare Design Education Day. To register
and access an archived recording of the event,
please visit www.healthcaredesignmagazine.
com/MarchEdDay.
Reprinted with permission from the April 2013 issue of Healthcare Design ©2013 Vendome Group LLC. All rights reserved.
102204_wmas.indd 41
7/29/13 1:51 PM