Let the Sunshine In
Client: The University of Texas M.D. Anderson Cancer Center
Architecture: KMD Architects (structural shell and core); FKP Architects, Inc. (programming, medical planning, interior design, equipment and space planning)
Photography: Hedrich Blessing, Geoffrey Lyon
Opened: March 2005
Total Project Area: 780,000 sq. ft. (includes 590 examination rooms, 75 chemotherapy beds)
Total Cost: $366.4 million
Cost/Sq. Ft.: $470
What do you do when you're one of the world's premier cancer centers and people start showing up at your door in unprecedented numbers? You build, and you build fast. That was the situation that faced the University of Texas M.D. Anderson Cancer Center in the late 1990s, when a projected 30% downturn in inpatient activity turned out to be a 30% upturn in overall demands. “We fast-tracked what we anticipated would be a 600,000+-square-foot outpatient building and decided on specific occupancy later,” says M.D. Anderson Facilities Project Director Janet Sisolak. Because Anderson physicians have a tradition of carrying out treatment and research simultaneously, the new 780,000-square-foot, eight-story building was located adjacent to the existing campus, across a new, purpose-built 1,500-foot bridge. It soon became clear, for clinical and economic reasons, that the preferred services to offer would be for gynecologic, breast, and genitourinary patients. Moreover, beyond serving as a traditional cancer care clinic, the building mainly would be given over to the latest advances in diagnostic and interventional radiology.
But it was in how these services were to be housed that the real design challenges arose. The result is a uniquely open and flexible building that, in basic concept, can be described as “turned inside out.” The following are comments by Sisolak; Susan Lipka, M.D. Anderson's executive director of Capital Planning and Management Services; Alexander Wu, director of strategic planning at KMD Architects, the San Francisco firm that designed the structure and provided master planning for this portion of the M.D. Anderson campus; and John Crane, AIA, ACHA, president and CEO of FKP Architects, Inc. They provide the details of a high-tech ambulatory cancer treatment center that lets the sunshine in.
Lipka: “We've seen many swings in clinical trends in recent years, from an emphasis on inpatient beds to more outpatient services and back, in some areas, to more inpatient beds. We really can't see into the crystal ball beyond three years anymore. I wanted a design solution that would accommodate any need for flexibility and adaptability, hold down the costs of future renovation, and allow existing clinics to grow contiguously. All the permanent impediments to this-the elevators, the stairwells, the plumbing, and electrical chases-were therefore pushed outward, with the interior featuring movable walls to allow for ready reconfiguration of examination rooms, procedure rooms, and office space, as needed. In the end, this design realized everything I've ever wanted to do with a building.”
Wu: “I'm still a bit in awe of how all this was worked out. In planning this building, we had to do research on the future of cancer treatment, and M.D. Anderson's combination of research and treatment resources is unique, in my experience. Technology, drugs, delivery systems, and patient demographics are changing constantly. We know, in general, that cancer is becoming more treatable and, at the same time, more chronic, with a growing need for a variety of ambulatory services. But more than that, the departments were planned both vertically and contiguously to share services more efficiently. For example, departments needing mammography scans were located close to mammography and shared the same floor.”
Crane: “The focus of FKP's work was instituting the integrity of the interior design of a building on this scale. The Ambulatory Clinical Building design emphasizes efficient layouts supporting patient dignity, as well as aesthetics that value humans, not just technology. There is also an emphasis on designing an uncluttered environment, encouraging patient mobility and a sense of safe shelter.”
Sisolak: “Organizational management and the designers worked closely with clinical division heads to identify programs and technologic developments that might change patient volumes and space needs in this facility over the next five to ten years. As one might expect, this was difficult. One example is breast imaging, which was projected to transition from diagnostic mammography to magnetic resonance imaging (MRI). Also, during the planning process, three of the imaging modalities under consideration were in research and development. Vendors were a bit hesitant to share trade secrets, making the design process extremely challenging. Another example was the transition of diagnostic imaging from analog to digital modalities; given the pace of these changes, we had to design for both.
“Still another interesting example was an approach to radiation oncology pairing linear accelerators with computed tomography (CT) to better target treatment. We initially designed spaces to accommodate this, but then our main campus reported that patient access to the linear accelerators had been slowed because the room turnaround time was compromised, so the CT was abandoned. As it turned out, Varian Medical Systems developed an onboard imaging system that interfaces CT and linear accelerators using minimally sized equipment, taking up much less space and speeding the procedure time, and so it was integrated into the plans. Our radiation oncologists and other specialists are constantly pushing the industry for improvements, and now we, as designers and design managers, are being kept in the loop.”
Lipka: “Another result of these collaborative investigations is that we have oversized a number of procedure rooms-for example, to accommodate the migration from PET to PET-CT. Physicians are always interested in obtaining the latest and greatest, no matter how much planning has gone on beforehand but, as a general matter, M.D. Anderson is trying to stay on the cutting edge rather than the bleeding edge of technologic change.”
Lipka: “All patient waiting areas and staff corridors, as well as break areas, are located on the outside curtain
wall, with views provided to various rooftop gardens.”
Sisolak: “This was one of the best decisions we made. Along the 450-foot floor plate are some natural breakout areas within the fenestration for lounges and dining areas. There also is dedicated space at the end of this floor plate for staff, who have access to this lounge area through their own corridor. We've received a lot of positive feedback from staff on having this exposure to natural light and views, and we've heard that staff on the main campus, who work in closed interiors and don't see much daylight, want something like this, too. Also, on Level 8, the curtainwall has been stepped back to allow space for a rooftop garden, where patients receiving infusion therapy can relax and enjoy the views during their procedures and families and other visitors can join them.”
Wu: “This design approach reflects one of our firm's specialties called ‘Double-Green Design.’ We emphasize providing lots of natural light and access to gardens and water features so a person passing through the building experiences a series of healing environments. Frankly, I had my doubts about how opening patient and visitor access to the outdoors might work in the heat of Houston. But on my last visit, I couldn't even find a seat because they were all taken. Patients obviously enjoy the outdoors; during periods of despair or fear, just being able to step outside seems to provide a feeling of hope.”
Planning for the Future
Wu: “This is the first of a series of four buildings we have planned on the M.D. Anderson campus for what we're calling an ‘urban health village.’ The idea is based on the concept of the European hilltop village, with lots of green space, buildings of varying
heights, and gathering spaces both inside and out. The patient drop-off area looks like a hotel reception area. The buildings will be designed as ‘thin’ structures, making them relatively transparent and easy to negotiate through wayfinding. Because of the sheer size of the building structure, we provided glass walls to enhance visibility to the outdoor courtyard, the cafeteria and outdoor eating areas, the connecting bridge, etc., so patients will feel at ease finding their way about.” HD