When internationally renowned artist Leslie Lerner visited The Wellness Community (TWC) in Sarasota, Florida, after his bladder cancer diagnosis, he found many of the resources and support he sought. But while he appreciated the helpful, caring people he met, he also found that he longed for a facility located in a more natural environment. The current one, while welcoming, was a retrofitted space in a commercial strip mall.

As advances in research and medicine continue to improve cancer survival rates, the influence that psychosocial support and environment have on improving the quality of life becomes more critical than ever. Surroundings that incorporate the natural environment help restore a sense of optimism to cancer survivors and their loved ones—and without a way to effectively provide natural light and access to the outdoors, The Wellness Community realized they needed to take a quantum leap if they were going to more effectively help thousands of individuals and families affected by cancer each year.

Compelling evidence indicates that place matters. Over the past decade, The Center for Health Design, Health Care Without Harm, and The Robert Wood Johnson Foundation have teamed up to investigate studies and projects that document design’s impact on healthcare outcomes. In 2004, one project, The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity, examined more than 600 studies linking patient health and quality of care with the way a hospital is designed. The growing scientific base shows that specific design and architectural elements can improve medical results and user satisfaction, as well as staff retention and financial performance.

The Wellness Community learned from Lerner’s experience. Using the evidence, it is designing a healing campus through the creative combination of innovative partnerships, participatory planning, and evidence-based design techniques. Their new optimal healing environment scheduled for completion in the summer of 2009 will be a model for the 26 other Wellness Communities operating worldwide, illustrating green architecture that combines healing, art, design, and nature.

The organization

Serving 1,600 people a year, TWC of Southwest Florida offers free professionally led support groups, nutrition and exercise programs, educational workshops, and mind-body classes to people affected by cancer. Its programs are effective. Of the support group participants surveyed, 95% found participation helpful; 90% felt less alone; 84% said their attitude improved; and 57% said they felt better physically.

Sarasota’s Wellness Community is a leader among the other Wellness Communities. In 2006, it received the Center of Excellence Award and the highest Quality Assurance rating ever achieved by any Wellness Community from the organization’s national office. Vicki Kennedy, Vice-President for TWC’s national office, noted: “Their dynamic cancer support programs and superb stewardship of resources make them a role model for community-based cancer service everywhere.”

TWC recognizes the values of design and sustainability as the tipping point to effectively attract and help people—and the market opportunity is there. While national data indicate that facilities offering psychosocial oncology could reach about 15% of a region’s population, Sarasota’s TWC reaches only 3.5% of the estimated number of people affected by cancer in Southwest Florida. This data suggests an unrealized potential to serve an additional 4,000 people a year.

Though the quality of TWC programs is unquestionably world-class, its physical surroundings are ready for expansion and upgrade. With this in mind, the Building Hope project was established to:

• serve thousands more cancer patients, survivors, caregivers, and children; and create an optimal healing environment for psychosocial oncology; and

• be a role model for other Wellness Communities worldwide innovatively combining healing, arts, design, and nature in a green facility.

To guide the Building Hope initiative, an integrated design-build team was formed led by Jay Lockaby, TWC’s Executive Director, and the author (Johnette Isham, consultant and Project Director for Building Hope). Design partners include four LEED Accredited Professionals from the offices of Carlson Studio Architecture, Wilson Miller Engineering, Stewart Engineering, and Willis A. Smith Construction, as well as designers from DWY Landscape Architects and TRO|Jung Brannen.

Cancer survivors, volunteers, Sarasota County staff, and TWC staff and board members joined the design team for several charrettes to offer input into the design, construction, and maintenance of the new LEED Gold-registered facility. The charrette participants discussed how to make the five-acre site plan and building systems work harmoniously to produce the best health and client satisfaction outcomes, while conserving natural resources and reducing operating expenses.

TWC also established mutually beneficial relationships with three nationally recognized colleges: New College of Florida’s Professor of Biology and Environmental Studies Dr. Meg Lowman is advising on medicinal gardens and ways to activate the gardens as learning spaces; Dr. Bruce Berg, Campus Dean of Florida State University’s College of Medicine in Sarasota, is assisting with research to evaluate the impact of the new healing environment on patient outcomes and satisfaction; and Ringling College of Art and Design’s Jill Eleazer, a faculty member with 15 years’ experience in healthcare design, and her studio class created the preliminary interior design proposal.

In fall 2006, Eleazer and six upper-level students chosen from 21 applicants created a design aligned with wellness factors. Combining studies of existing facilities, including focus group research of cancer patients and caregivers, with healthcare design evidence that included developments in psychosocial oncology, the students developed a program that included a space-needs analysis and adjacency matrix with bubble diagrams (figures 1 and 2). Their schematic floor plans involving two- and three-dimensional visualizations (figure 3) conveyed how the interior design addressed the project’s design concept: illustrating the transforming power of connection and choice.

In alignment with TWC’s Patient Active philosophy, the design enables participants to easily choose their own avenues of support, education and hope. Individuals may select from a variety of environments—active, contemplative, uplifting, calming, social and homelike. Connections with the restorative aspects of nature are infused inside and out (figure 4) to capture the views of the surrounding 400-acre nature preserve. Studio, performance, and exhibition spaces are designed to feed the creative spirit and support innovative partnerships with Florida West Coast Symphony, Florida Studio Theatre, Hermitage Artist Retreat, and other cultural organizations. The quality of life for people affected by cancer will be enriched by visiting artists throughout the year.

A college class working with actual design professionals and an actual client was a first for Ringling’s Interior Design program. Department Head Norman Hervieux says, regarding the value of this experience, “The practice of interior design is very competitive. Students need to learn to work collaboratively using current research evidence. As a leading design college, we value our partnership with The Wellness Community because it reinforces the role of designers to improve the quality of people’s lives and the environment.”

Another partner, the nationally known illustrator for the Harry Potter book series Mary GrandPré, created a special pastel entitled Inner Embrace (figure 5) to symbolize the importance of hope and art in healing. Inner Embrace will be prominently displayed in one of the facility’s galleries. GrandPré explains, “Each of us has a connection to someone whose life has been affected by cancer—you realize life is short. I really believe in what TWC is doing to help people find their own inner strength.”

“‘Community’ is perhaps the most important aspect of The Wellness Community model of care that differentiates the program from any other,” according to Kim Thiboldeaux and Mitch Golant in their new book The Total Cancer Wellness Guide: Reclaiming Your Life After Diagnosis.

And, certainly, strengthening community was central to the Wellness Community co-design process. When people see that they are making a meaningful contribution, momentum and empowerment flourish. Recent case studies show that when facility development is coordinated with organizational development, the transformational benefits of change multiply.

To ensure a positive alignment of physical and organizational design, TWC’s strategic planning process used Appreciative Inquiry, a proven organizational development framework that in the last 20 years has demonstrated profound results for building an organization’s capacity, collaborative creativity, profitability, and ongoing sustainability.

Using this strength-based approach, TWC refined its collective vision of a community of exceptional care. Cancer survivors, caregivers, volunteers, staff, and board members were joined by 15 community partners from Sarasota Memorial Hospital, American Cancer Society, TideWell Hospice, Florida State University College of Medicine, and SCOPE (Sarasota County Openly Plans for Excellence), as well as representatives from the arts, design, and business sectors. This dynamic cross section of stakeholders illuminated the key qualities that were sought for TWC’s optimal healing environment, i.e.:

• amplify community and emphasize the whole person: mind/body/spirit

• create a sustainable environment with non-toxic materials

• build on the power of the arts for healing

• increase programs for children and families

• increase technology use—be both high touch and high tech

• lead the nation in new thinking about cancer care and green architecture

The design process further engaged TWC’s most important assets—its clients and staff—in defining specific spaces and features (table).

Client and Staff Wish List

A transformational place	Less clutter	Music throughout
An active place	Calming water feature	Restful & inviting colors
A place to laugh	Plants inside & out	Nothing that screams sterile
Spaces to connect	Larger exercise space	No parking lot views
Cocoon-like spaces	Easy-to-breathe indoor air	Outdoor spaces
Calming support rooms	Changeable room lighting	A Zen garden
Art for conversation	Window light	Outdoor Tai Chi
Comfortable chairs	Minimal signage	A real library

New rooms and options were defined from multiple user perspectives:

• a teaching kitchen

• a mind-body studio for exercise and meditation

• an expressive arts studio for children

• an “Ask the Doctor” Living Room for educational seminars

• gallery spaces for patients, children and professional artists

• a library café with computers and materials for learning and connecting

• healing gardens for horticultural therapy, personal reflection and Tai Chi

• a community room for educational programs and performances

• technology for remote program support: podcasts and streaming video

Use of evidence-based design

The use of evidence-based design is helping TWC apply resources wisely to build a better, safer, more efficient place that creates a compelling human experience. In other words, the impact of design decisions will be measured in postoccupancy surveys, focus groups, and data analysis.

Architectural, interior, and garden design solutions addressing seven key areas will frame the post-occupancy assessment:

• Healing elements

• Client outcomes and satisfaction

• Sustainable design

• Operational efficiencies

• Financial performance and philanthropy

• Staff satisfaction and effectiveness

• Key goals from TWC’s strategic plan

From lessons learned, other Wellness Communities worldwide will benefit from the prototypical design features that are evidence-based and co-designed, as described here. For these reasons, the Building Hope project promises to change the face of psychosocial oncology.

Natural healing elements

All rooms will be infused with natural light and will flow from space-to-space with garden views from all windows. Art and natural elements—water, stone, and bamboo—will be used throughout. Gardens will offer multiple locations for privacy, socialization, and therapeutic activity.

Client outcomes and satisfaction

The success of the healing design will be measured against needs expressed in the focus groups using participant surveys. The change in the number of visits per person and the growth of word-of-mouth referrals will be reviewed during the first year of occupancy to measure the impact of the optimal healing environment.

Sustainable design

The LEED certification process will document effectiveness in achieving solutions that protect the environment and the people who occupy it, as well as save money via reduced maintenance, energy conservation, and advanced green technologies, such as daylight harvesting, photo-voltaics, green walls, and solar-powered air conditioning.

Operational efficiencies

Technologies that support improved administrative workflow, cost reduction, and remote access for participants via advanced computing technologies have been included. Design solutions in the administrative offices aimed at positively impacting interpersonal communication, work flow, and productivity will be evaluated in the postoccupancy surveys.

Financial performance

Through the construction of a larger, more attractive facility TWC anticipates that its market share will increase by 8.5%. The architectural design supports alternative sources of revenue through facility rental of the gardens, labyrinth, Teaching Kitchen, and Community Room, and business partnerships for the development of a future 8,000-square-foot building to house services complementary to TWC’s mission.

Staff satisfaction and effectiveness

As noted, design solutions incorporate improved air quality, natural light, restorative gardens, ergonomic workstations, and adjacencies for improved workflow. Assessment by the staff of the benefits of these elements will be collected in postoccupancy surveys.

Strategic plan goals

Strategic planning indicated the opportunity to serve more people with specialized spaces not currently available such as gardens for horticultural therapy and Tai Chi, an Internet Café Library, spaces for family counseling and musical and theatrical performances, an art studio and galleries, as well as creation of a “destination facility” to attract new participants, partners, friends, volunteers, and donors. Additionally, a green facility design that uniquely combines art, design, nature, and technology is reflective of regional values pertaining to quality of life, culture, children, and the natural environment was viewed as a strategy to take TWC to a new level of service, prominence, and philanthropy.

One of the first lessons learned

One important lesson learned from Building Hope so far was best expressed by Daniel Burnham, famed Chicago architect and inspiration for modern skyscrapers: “Aim high in hope and work … Make no little plans. They have no magic to stir men’s blood.” As a small non-profit that is thinking big to change the world and serve more people, The Wellness Community is acting with passion, creativity, and focus, through the combined efforts of its board, staff, cancer patients and their families, volunteers, donors, and community partners, to provide a prototypical optimal healing environment that transforms lives and creates positive psychosocial, ecological, and community benefits. HD

Johnette Isham is President of Johnette Isham & Associates, Inc., a consulting firm dedicated to fusing design with organizational development—learning, leading, and building community.

For more information phone 941.365.8324 or visit http://www.ishamandassociates.com.