A Product of Its Environment
When University Medical Center started to develop the 17-acre site that now houses the Peter and Paula Fasseas Cancer Clinic, the only thought was that they wanted to emulate the aesthetics from the main campus on the new campus. As the project evolved, a vision developed that led to a facility that is not simply cutting-edge in its treatment capabilities, but also in its integration with its surroundings—namely the rugged desert beauty of Tuscon, Arizona. With healing gardens, trees, and mountain views, the clinic strongly relates to both its environment and its community, and thus to patients, family members, and staff. HEALTHCARE DESIGN Managing Editor Todd Hutlock spoke with Principal-in-Charge Stephen Yundt, AIA, ACHA; Project Architect James Simeo, AIA; and Design Principal Dennis McFadden, AIA, of CO Architects about this award-winning project.
Stephen Yundt: The client, University Medical Center (UMC), had purchased 17 acres of property about three miles north of its existing health sciences campus with the intent to relocate the majority of its outpatient programs to the new campus over time, thus freeing space on the health sciences campus for research and acute-care expansion. UMC purchased an abandoned medical center on the site and left one building, which we totally gutted and expanded to become the cancer clinic, Phase I of the new campus. This project presented a great opportunity for UMC to reinvent and improve itself.
The process evolved as it went on; when we first started, we knew the programmatic goals and metrics but did not have a clear vision of the appropriate image and aesthetics. The pivotal change happened following our interviews with current and former cancer patients. They had strong input on amenities and aesthetics related to the treatment of the disease. They used words like, “soft,” “warm,” and “non-sterile” to describe what they wanted from a facility.
Dennis McFadden: The biggest move was to cut the courts into the building. The existing building had a very deep floor plate, and there was very little natural light in the middle of the building. Cutting the courts into the existing structure transformed the existing building and allowed it to become something completely different.
James Simeo: The patients we interviewed were adamant that light be omnipresent throughout the building for all patient areas. Infusion can take as long as eight to 10 hours, so access to light and views was very important; cutting the courts into the building helped create a plan to accommodate that.
Yundt: The planning responded directly to the notion of the creation of healing environments. Every exam room, infusion space, and public space has direct visual access to either courts or the healing gardens.
McFadden: The courts allow the infusion centers to be broken up into three different modules. Facing the street is a series of support spaces, and the waiting rooms and public spaces look out towards the garden. On the south side of the building, a new entrance piece was added, which also holds administrative offices.
Yundt: UMC wanted to provide a comprehensive set of services for a one-stop shop. The building has three pods of 12 exam rooms each for a total of 36 exam rooms on the first floor. On the second floor, there are 36 infusion spaces with a combination of private and open cubicles, clinical research, pharmacy, and laboratory services. Elsewhere, there are a variety of amenities, including a resource room where patients and family can access educational materials, a retail component with wig fitting and make-up stations, and some complementary medicine programs, such as massage and Reiki therapy.
McFadden: This building was originally rendered in brick in an effort to brand it with the existing medical center campus. The more we worked with UMC on the project, the more it became apparent to everyone that the materials should be indigenous to the environment, and so a local sandstone was introduced as a cladding material. There are some sandstone elements on the existing campus, as well, but here the sandstone really connects the building to the landscape around it. The sandstone wall at the major entrance is pulled away from the building, creating a shaded area that serves as a kind of porch. It is a transitional element that protects the glass on the south-facing side and sets the tone of the building.
As you proceed around the garden, the sandstone drops away; the infusion and clinic modules are rendered in a more residential scale with plaster in colors that relate to the surrounding land, as well as a lot of shade elements. These shade elements not only give light and shadow to the building, but they also extend the feeling of the building from the inside toward the outside, integrating the interior with the exterior. The trellis elements are important transition elements, as well, moving from the hard walls of the building to the enclosed interior space.
Simeo: The idea was that patients arriving at the clinic needed to be protected from the minute that they were dropped off at the entry point, thus the large overhang that articulates the front entry sequence. As they enter the building, the welcome desk needed to be prominent. Patients in cancer treatment are sometimes disoriented and frightened, so there needed to be someone there to welcome and guide them through the building on their first visit.
Throughout the building there are places to sit and wait because these patients tire easily and cannot travel long distances. Many patients also come with extended family members, and it was important to be able to accommodate them; thus, the large open waiting rooms with views and the healing garden.
McFadden: The building forms a protective L on the west and south side of the support spaces and entry/administrative module; those spaces wrap the clinic and infusion module. The clinic and infusion modules are almost separate houses or pavilions that are set into the landscape and protected by this wrapper of support spaces. With the incorporation of the courts, these spaces were designed to be open and flowing, allowing views out to the distant mountains, the healing gardens, and courts.
Simeo: The concept for the garden was to return the site to the natural desert landscape. We developed an arroyo in the healing garden that collects water when it rains, functioning just as it does in the natural desert where plants will grow near the arroyo. From a sustainability standpoint, rainwater is collected from the roof and deposited in the arroyo, as well as the condensate water from the air handlers on the roof, so even in the summer, there is water feeding this landscape.
This also inspired the series of bridges that extend from each of the pods to the parking lot. As patients return for treatment over a series of weeks or months, they can go directly from the parking lot to the specific pod where they are receiving treatment as they become more familiar with the building. This also provides direct access for the staff, or for family members who may have dropped off a patient and gone to park their car.
McFadden: The bridges also act as a symbolic element, that you are leaving one world and entering another. You are transported from the parking lot through the gardens to a healing environment.
Simeo: All the plant life was selected to represent the desert, but also to attract birds and butterflies to the garden. This provides an additional visual distraction, allowing those in the building to really “escape” to a different realm.
Simeo: Each pod has a different color scheme, a relatively bright, natural color. We used saturated colors to take the building out of the pastel nature of the typical medical center, and to tie back to the landscape. We tied the landscape colors to the walls, furniture, and fabric colors. We worked hard to develop an individual identity for each pod, yet to coordinate them as one progression through the building. To unify interior spaces, we used natural cherry wood throughout the building on the individual room doors, casework, bookshelves, and room dividers. Stone flooring is a unifying element throughout the first level.
One of the important things we learned through this process is how sensitive the patients are during their illness; their bodies are fragile and they often have a heightened sense of smell while undergoing treatment. We had to be cognizant of the type of flooring we used to provide comfortable walking surfaces. In the case of the stone flooring, we paid particular attention to the joints between the stones to make sure they weren't too jarring to patients in wheelchairs or those walking with canes. Because the most seemingly benign smell can cause nausea in a cancer patient, the food service area was removed to a discrete corner location in the building with its own outdoor patio, as well as its own air-handling system to remove any food smells quickly and efficiently. We also paid attention to chair and sofa designs to insure that patients were able to get in and out of them easily. All these, and many more small details came together to make this a comprehensive facility for the patients.
Yundt: There is also a significant art program in the building. There was only a modest budget, so thankfully a local photographer donated many images of his work portraying the natural desert landscape. It is very complementary to the interior design.
McFadden: Landscape architect Christy Ten Eyck was also a significant contributor to this project. Within six months of opening, the landscape had changed significantly, and there is now a lushness to the garden that doesn't come across in these early photographs. It is an astounding and diverse landscape that shows the strength and beauty of the desert. HD