Client: University Medical Center, Tucson, Arizona (Steve Brigham, Director, UMC Capital Planning & Projects)

Architecture: CO Architects, Los Angeles, California (Stephen Yundt, AIA, ACHA, Principal-in-Charge; Dennis McFadden, FAIA, Design Principal; James Simeo, AIA, Project Architect; Anthony Moretti, AIA, CSI, Technical Director

Space programming: Kurt Salmon Associates

Structural engineering: John A. Martin & Associates

MEP engineering: Ove Arup & Partners

Landscape Architecture: Ten Eyck Landscape Architects

Contracting: DPR Construction, Inc., Phoenix, Arizona

Design Start: August 2004

Date Completed: January 2007

Photography: © Robert Canfield Photography

Total building area: 82,000 GSF

Total construction cost: $21,435,000

Cost per square foot: $261

A naturally lit refuge of hope, graced by desert gardens, invokes the calm inspiration and rejuvenating power of the Southwestern landscape—that is the Peter and Paula Fasseas Cancer Clinic in Tucson, Arizona (figure 1).

In 2000, University Medical Center (UMC) acquired a 17-acre site along a major thoroughfare in Tucson. On the property rested an abandoned, two-story hospital in visible disrepair. CO Architects' assignment was to design a new, 80,000-square-foot outpatient cancer clinic. As experienced healthcare facility architects, they knew the programmatic goals and metrics, but also knew they could produce an even better project with more insight into the patient and staff needs of the new clinic. They interviewed former and current cancer patients. There was much that they learned, and there were many comments that had an effect on the design and planning of the facility.

Patient needs

As patients revealed their needs and concerns—some quite sensitive about their changing physical appearances—it was clear that a gently embracing and comforting clinic was desired. Many wanted to see the desert light at all times, as the clinic's most common treatment, infusion therapy, can take as long as 8 to 10 hours. Cancer treatment can also require many visits. The design intent was that the clinic be a beacon of hope.

An executive decision was made to retain one of the existing abandoned facilities and to adapt its use to the new clinic. The challenge was to bring natural light into the recesses of the original “deep floor plate” and offer vistas of the rugged landscape.

The solution was to gut the original building and cut three courtyards into the floor plate (figure 2). By surrounding the courtyards with windows on all sides, natural light and the planted desert landscape could extend deep into the new spaces. The entire facility—including every exam room, infusion therapy room, and all public spaces—is brightened as a result. Distant southwestern mountains are visible from many windows (figure 3).

The light-filled courtyards produced a positive transformation (and reduced artificial lighting requirements), yet there were additional patient concerns to be addressed. Patients said that they were sometimes unsure of where to go, or even what to do, upon arriving at medical facilities. Disorientation can be a “side effect” of treatment. It was important that patients feel protected and guided from the moment they are dropped off at the entry point.

The new entry

In response, the original building was extended to the south to create space for a variety of patient and public amenities: a concierge/greeter desk, a public waiting room, a Resource Center, a gift shop, and a café. A large overhanging canopy above the main entry (figure 4) provides shade and acts as a “protective arm.” The entry is also shielded from the sun by a screen wall, creating an “entry porch”.

Upon entering the building, the welcome desk is prominent and faces the door, allowing patients and staff to quickly identify each other and to render assistance if necessary (figure 5). There is a large, open, well-lit waiting room near the welcome desk to accommodate the extended families that often accompany the patients.

The healing garden

The concept of the garden was to return the site to a natural desert landscape. An arroyo (dry creek bed) extends the length of the site. Though a design element, the arroyo also is a catch basin, collecting rain water and condensate from the mechanical equipment, thus augmenting the irrigation of the plants. The regional selection of plants (figure 6) has attracted small wildlife, birds, and butterflies—all supporting the connection to the natural world.

After repeated visits, patients become familiar with the clinic and can choose not to enter through the main door, but rather, walk across the healing gardens and enter directly into a clinic pod (figure 7)—a more discreet entry, as some patients feel insecure about their appearance during treatment. Patients leave the parking lot and cross one of three bridges that span the arroyo within the garden (figure 8). The bridges are symbolic and subtly imply that patients are leaving one world and entering another—transported from the parking lot to a place of hope and inspiration.

Building design

The building's primary cladding of plaster reflects the project's modest budget, but is contextual for Arizona. It is ennobled by the selective use of local Arizona sandstone, which connects the building to the landscape, and is enriched by weathered steel trellises and shade canopies (figure 9). The façade facing Campbell Avenue (figure 10) features an urban response: punched windows deeply set for sun control. The garden façade (figure 11) is rendered in a more residential scale, with plaster in colors that relate the building to the surrounding land. Shade elements give light and shadow to the building but also extend the feeling of the building from the inside towards the outside, thus integrating interior and exterior.

The interior palette (figures 12-15) is made up of neutral earth tones, with generous use of natural materials (cherry wood and stone). Stone flooring was specified as a response to high foot traffic, but also to decrease odor absorption. Special care was taken with the joints between stone tiles to reduce problems for cancer patients walking, often with canes and walkers, and to minimize jolts to the wheelchair-bound. Benches and viewing areas were provided throughout the facility and gardens (figure 16), as it is not uncommon for cancer patients to tire even after a brief walk.

Patients said that they can become extremely sensitive to smells during treatment and recovery; nausea is a frequent reaction to food or strange odors. Even mild or benign fumes can trigger adverse reactions. For that reason, the clinic's cafeteria was relegated to a discrete corner location. The food service area includes an outdoor eating area (figure 17) and is supported with a dedicated air handling system to remove cooking odors efficiently.

Accelerated process

The cancer clinic build-out was a fast-track project due to client pressure to leave the previous facility and to establish the new site as UMC's North Campus.

The design and construction documentation phases were completed in nine months. Separate packages for site/foundation, superstructure and interiors approvals were submitted to the relevant city and state agencies for sequential approval.

Construction began with site-grading work prior to approvals for the later phases of construction. The construction phase lasted 13 months, and the total project was delivered approximately five months ahead of a traditional schedule. The retention and adaptation of the use of the original, existing building realized some savings in cost and time.

Response

The response of staff and patients to the revamped clinic has been positive.

“This is an absolutely gorgeous and serene place for patients and providers,” says Thomas Miller, MD, chief oncologist at the clinic.”

Patient comments include, “The whole setting is relaxing and soothing,” “You come here and it feels like home,” and “I like the overall ‘unhospital’ feeling of it.”

CEO Greg Pivirotto says, “UMC believes that this is not just a new building but a new beginning in the treatment of cancer patients. Our amazing physicians, our caring nurses, the spectacular facilities, the gardens—they make it a healing place full of hope.”

Healthcare Design 2008 November;():8-12