How does one move a high-tech cancer treatment center, complete with linear accelerator, from an overcrowded hospital basement to a classic residential neighborhood without driving the neighbors away? That was the challenge faced by Shore Memorial Hospital in the Atlantic City region of southern New Jersey. The 296-bed facility, affiliated with the University of Pennsylvania Health System, had been providing cancer treatment since 1983 and radiation therapy with a linear accelerator since 1991, in a typical hospital basement setting. But the program was outgrowing the basement, and the linear accelerator was aging. It was obviously time for a move, and the location selected was land the hospital owned across the street that fronted on a colonial/Victorian “Main Street” setting in Somers Point—an area boasting a local historical society very much involved in setting architectural guidelines. Chosen to meet the design challenge of integrating high-tech cancer care into a neighborhood was S.J. Fenwick Associates, a local architectural firm with long ties to the community. Having designed a wide variety of structures, from medical office buildings to private homes, for more than 20 years, the Fenwick firm was taking on its first hospital project. The result, by all accounts, was an aesthetic and technical success: blending in with the community, offering a comforting patient care environment, and accommodating a $1.7 million Varian Medical Systems' Clinac 21EX linear accelerator in its demanding surroundings. Recently, firm owner Stephen J. Fenwick and principal designer Doortje Schipper discussed the experience, and what they learned from it, in an interview with HealthCare Design Editor Richard L. Peck.

Working With the Setting

Fenwick: “This is a 27,800-sq.-ft., three-story building on a long rectangular site, with one short end overlooking a bay and its long end on Shore Road (a main street with quite a few residences) nearby. It was on the residential Shore Road side that we had to install a linear accelerator. This posed a couple of problems: We had to bring in this 10,000-lb piece of equipment on a level grade through the opposite end of the building (figure 1) and make sure that the corridors were designed to accommodate all the turning radii involved and had a floor structure that could handle the load. We also had to design the exterior of the building housing the linear accelerator to appear residential. As a result, what you see from Shore Road appears to be a traditional home, with sloping roofs, correctly proportioned windows, and a ‘faux front door’ (figure 2). But what is really behind it is a linear accelerator buried three-fourths underground, with reinforced concrete walls 7' thick in some places, and a 5,400-lb metal entry door. Additionally, a retaining wall 5' above and 5' below grade houses 40% of the facility's mechanical equipment, with another 40% hidden behind the gabled roof. In short, residing in this ‘traditional neighborhood home’ is a state-of-the-art linear accelerator and all its heavy-duty support systems (figure 3).”

BASED ON AN INTERVIEW WITH STEPHEN J. FENWICK AND DOORTJE SCHIPPER, S.J. FENWICK ASSOCIATES, ARCHITECTS & PLANNERS LLC, LINWOOD, NEW JERSEY

The Interior Design

Schipper: “We've used quiet, soothing colors that look good either in natural light, which we've been able to bring into most of the regularly occupied rooms, or under fluorescent lighting fixtures. The lamps were selected to provide an excellent color-rendering index, so the colors have a warm appearance under the lighting. The downstairs, which includes the lobby, reception, waiting room, and various patient counseling and education rooms, is predominantly a rose color (figure 4).

“The second floor, housing offices, workshop rooms, and a physicians' library (figure 5), is a periwinkle blue. There are cherry wood doors and trim, cut-and-loop carpet, vinyl strip wood flooring, upholstered furniture (with armrests) in the waiting area, sled-runner chairs for easy use in the patient library (figure 6), and a shoulder-height chair rail in the corridors—just a lot of attention to detail beyond simply decorating with artwork. What made it work was that our clients knew exactly what they wanted, and they were quietly tenacious in accomplishing it to provide patient- and family-friendly surroundings.”

The IT Center

Fenwick: “The information technology department is located on the third floor and serves as what the hospital calls its ‘lights-out’ data center—a backup for any problems that might occur at the hospital itself. Fiberoptic cable connects the two data centers. This area required an HVAC unit to be installed that actually manages relative humidity, which is standard for computer equipment of this caliber. The department has secure access and, in general, functions very well on that floor.”

Lessons Learned

Fenwick: “We learned about the value of getting complete information in planning for and installing a piece of equipment like a linear accelerator. This was the latest and best equipment, but we didn't obtain sufficient information from the manufacturer for proper installation until the last minute. Positioning the equipment properly on its mounting plate was not a problem, but we had some delays and difficulty in hooking up the heating, cooling, and electrical connections—especially in areas where contractors had to drill through the concrete walls. The lesson was that a good set of shop drawings from the manufacturer well ahead of time would have been very helpful in installing equipment of this type. The final result, though, did work out well.”

Schipper: “I appreciated how helpful it was to have clients who knew exactly what they wanted and how to convey it. We dealt with two hospital administrators who had been specifically tasked with this, with one having the overall vision of what they wanted to accomplish and the other being skilled in describing the details of this three-dimensionally. They actually took me on visits to a few nearby facilities to point out what they liked and didn't like about their designs. We noted that even newer facilities were cluttered with the necessities of the workplace. Basically, they wanted the result of our project to be a professional-looking environment—no clutter, everything in its proper place (figure 7) rather than just ‘a place to work’—and a place where patients and families would find pleasant and comforting.”

Fenwick: “It was interesting how the hospital allowed us to focus our discussions with only those two administrators and didn't get others involved. It made all the difference in getting a clear message and following through. Which only illustrates what all experienced designers know: It takes a good client to make a good building.” HD