A New Translation
Cancer treatment is evolving. In the era of genomic medicine with new knowledge emerging from research, two trends are paramount in cancer center design—supporting personalized medicine and creating rapid translational research from bench to bedside. The approach of translational research is a two-way street. Basic scientists provide clinicians with new tools for use in patient care and for assessing their impact, and clinical researchers make novel observations about the nature and progression of disease that stimulate basic investigations.
So the new design challenge is how to bring these two types of researchers and their divergent environments together to accelerate new knowledge and help foster development of genetic-specific treatments. This must be done while also creating healing environments that support each patient’s unique psychological and social needs to create a customized experience that aligns with the new personalization of genomic medicine.
Growing needs bring down barriers
In 2005, the cancer center at the University of Arkansas for Medical Sciences (UAMS) found itself at a crossroads. Twenty years of success yielded a program that had doubled in size and no longer fit in its initial 11-story, 180,000-square-foot building, expanding far across the university campus and scattering patient care, practitioners, and scientists.
Realizing that its future success depended upon growth and consolidation to support translational medicine, increase access for patients, and attract and retain top talent, UAMS needed a smarter facility solution to advance cancer care. The prospect was exciting—creating the optimum translational environment to deliver personalized cancer care—but creating institutional support and finding funding would be significant challenges.
Leadership recognized the underserved population and growing needs within Arkansas, plus the potential economic benefits a comprehensive cancer center could provide the state, but they lacked a platform to highlight its need and value. UAMS, home to Arkansas’s only research-based cancer center, saw Arkansans leaving the state because treatment was not available for some diseases. For a great number, traveling for care was not financially possible, leaving many without options.
When Winthrop P. Rockefeller, Arkansas’s former lieutenant governor, was diagnosed with a disorder that can lead to leukemia and had to leave Arkansas for care, the rally cry for improved access and a truly amazing partnership between the university, government, and philanthropic community to raise the funds was born. The state legislature approved a dollar-for-dollar match to philanthropic funds raised, thereby generating the financial support needed to grow programs and recruit top researchers and clinicians. The legislature’s vote was unanimous, a first in Arkansas.
Foresight neutralizes challenges
As UAMS worked with FKP Architects and Cromwell Architects Engineers to plan its facility expansion, it became clear that the existing facilities, while presenting several space limitations, had been built with forethought and held multiple opportunities for positive reuse towards the dual goals. Located on a tight urban site in Little Rock, Arkansas, UAMS’s situation was atypical in that it had immediately adjacent land area to expand. Additionally, the existing building’s internal circulation held pathways toward the adjacent site and had ample floor-to-floor ceiling height, making alignment of an expansion much easier.
Maximizing the original investment, UAMS and the design team uncovered value in the existing facility by reconsolidating research and patient care through expanding the existing tower, consolidating scattered services, and relocating the main entry to a new atrium. The existing building was reoriented, with patient waiting areas moved to the opposite side of the building, adjacent to and accessed through the new atrium and elevators. Floors of both the new and existing buildings were aligned, making the connection seamless. To accommodate the expansion, a vehicular roadway was closed, allowing for the creation of a generous covered patient arrival area and a pedestrian plaza that connected to a visitor parking garage.
To optimize bench-to-bedside care and give UAMS the essential flexibility to adapt to future technology changes and other care evolutions, designing an open loft floor plate and column grid was key. Common planning dimensions were developed to be compatible for clinic, research, and office functionality, and drove the column grid to allow efficient layouts for all three functions. Vertical building organization studies evaluated consolidating research floors separate from clinical floors and ended with integration and an intermixed approach supportive of fostering translational medicine.
Optimizing the patient experience
The new Winthrop P. Rockefeller Cancer Institute expansion consolidates UAMS’s cancer care programs to improve patient convenience and reduce travel to other campus locations by bringing services to the patient wherever possible. Conversely, when patients have to travel, the wayfinding is intuitive, easing one’s stress. A two-story skylight solarium provides an indoor connection to diagnostic imaging services that previously cancer patients had to traverse by going outside and up a steep hill. At the end of the solarium is a new garden, one of the few green oases on the dense urban campus.
The institute approaches the patient care environment holistically, providing care for the body, mind, and spirit. Small design features make a big impact in patient satisfaction, offering a sense of control that, psychologically, cancer patients need. All positions in the infusion center have access to natural light; an exterior balcony allows patients to enjoy fresh air and a gentle breeze on a nice day. Spacious waiting rooms filled with natural light accommodate patients and families in flexible, private groupings. Varied seating choices include comfortable rocking chairs and high-side paneled chairs, thus supporting varying levels of social needs, from maximum interaction to greater seclusion for quiet respite.
Featuring a grand stairway, a 12-story, light-infused atrium serves as the institute’s origin of primary circulation and orientation. The main public elevator tower sheathed in stone both anchors the atrium and lifts one’s sight upward—simultaneously grounding and inspiring the human spirit. It serves as a primary wayfinding element that can be seen from any area. Additionally, the atrium lobby provides enhanced check-in with easily identifiable information desks and self check-in kiosks. The first floor offers patients a range of hotel-like amenities, including valet parking, concierge, food services, a library, and a
chapel. UAMS created a juried process to incorporate local artists’ original work that showcased regional themes.
The atrium’s grand piano can be heard throughout the building, with volunteers, staff, or patients providing the music. UAMS’s atrium also is the site of a “Seeds of Hope” celebration. Patients receive two seed-shaped tokens when they complete treatment—one to drop in the atrium’s pod-shaped sculpture and one to take home. Through the ritual, patients leave hope behind and take hope back into the community.
Encouraging intellectual “collisions”
To foster new breakthroughs, collaboration must be increased between the internal academic community of scientists, clinicians, and educators. This is accomplished by the building’s universal open floor plate, which allows for the development of open lab concepts. Instead of individual labs, research floors can be open with research “bays” that house multiple investigators. Researchers can share equipment more easily, reducing costs and increasing ideas for collaborative science that could turn into new cancer treatments.
“Intellectual collisions” are not always scheduled; in fact, the chance meeting of a colleague in the atrium or outdoor terrace proves to be just as effective as, and sometimes even more so than, traditional conference rooms. The grand staircase serves as more than just a way to move between floors but as a unifying element that brings clinical faculty into contact with their scientific colleagues, helping support the two-way knowledge transfer demanded by translational medicine.
Even the building’s vertical organization and layout of the traditional conference center was rethought to encourage accidental meetings. Faculty offices were placed on the 10th floor near the research labs on the ninth, 11th, and 12th floors, connected by an interior stairwell that opens into a casual, inviting café area circled by conference rooms with “barn style” doors. Scientists are frequently seen mixing with clinical faculty over cups of coffee either before or after formal meetings.
The ultimate measure of a building’s success is not only based on whether it was completed on time and on budget, and if it achieved the client’s goals, but also on whether it transformed an organization’s business and its culture. The new building is a key component in the Winthrop P. Rockefeller Cancer Institute’s successful five-year recruitment plan of new clinicians and scientists. Arkansas now has a full array of cancer programs, so its citizens no longer must leave their home state to get great cancer care.
At UAMS, as in much of academia, there frequently is an unwritten rule of “no Friday meetings.” With the new expansion’s variety of uplifting gathering spaces, inside and out, the Winthrop P. Rockefeller Cancer Institute no longer has difficulties with attendance at Friday afternoon meetings, and new ideas are sparking all over. HCD
Diane R. K. Osan, FAIA, ACHA, is a Senior Principal and Senior Project Designer at FKP Architects, specializing in healthcare design for 25 years. FKP Architects’ Principal Cynthia Walston, AIA, LEED AP, is a laboratory planner, specializing in health and research design for more than 20 years. For more information about the Winthrop P. Rockefeller Cancer Institute project or to contact the authors, visit www.fkp.com or www.cromwell.com.