Coming Together To Improve Cancer Care
Cancer treatment at Cleveland Clinic’s main campus can take patients on a fragmented journey—from its main four-story Taussig Cancer Institute, to the Gamma Knife Center three blocks away, to radiation oncology in yet another building, and then across campus for surgery services. The splintered set-up also spreads out clinicians, care teams, and support services, making it difficult to deliver a team-based approach.
Compounding the problem is the fact that—like many systems across the country—its cancer patient volumes are growing. The National Cancer Institute reports an estimated 1.6 million new cases of cancer will be diagnosed in 2015, with the most common types projected to include breast, lung, bronchus, prostate, colon, rectum, and bladder cancers.
To address these issues, Cleveland Clinic broke ground in 2014 on a $276 million project that will create one central facility for outpatient cancer care. The new 377,000-square-foot building will include 126 exam rooms, 98 infusion chairs, six linear accelerators, designated space for Phase I clinical trials, and expanded patient services such as genetic counseling.
“When you look at cancer care as a whole, people are leaning toward a multidisciplinary care model where you’re bringing all the services to patients,” says Shannon Faulhaber, director of strategic growth for Cleveland Clinic’s Taussig Cancer Institute in Cleveland. “Surgeons, medical oncology, radiation oncology, and all the other support staff are really centering their care on the patient rather than having the patient travel to all the different areas.”
And Cleveland Clinic isn’t alone. As more organizations adapt to meet rising demand for more integrated, one-stop outpatient services, they’re renovating or building new facilities that also incorporate the latest technologies and still offer choices to patients during their treatment experience.
Under one roof
Treatment for cancer has long focused on a multidisciplinary approach, and today’s environments are better supporting those efforts with improved layouts and operations that allow for multiple tenants, care teams, and support services. At Cleveland Clinic’s new building, care will be organized by disease type on three floors, each with its own exam and infusion rooms. Faulhaber explains that this will allow physicians, caregivers, geneticist teams, social workers, and others in the field “to have direct access to the patients and keep the patient in one setting so they’re not traveling throughout the building for their care.”
Likewise, the UW Cancer Center at ProHealth Care in Pewaukee, Wis., opened in August with medical and radiation oncology, lab, pharmacy, and expanded cancer rehabilitation services. The design team, which included CannonDesign (Baltimore), consulted with a patient advisory council to get input on patient wants and needs for a modern, patient-centered cancer facility.
One of the ideas that came out of that process was an interconnected exam and consultation room that would allow private consultations between patients, families, caregivers, and the support team. Then, if a patient requires an exam, the family can stay in the consult room while the patient and caregiver go into the adjoining room.
On the provider side, we wanted to have nonclinical space to have a conversation with a patient, because not all visits have an exam,” says Pam Kleba, construction project manager for ProHealth Care. “It also recognizes that patients want to be close to their support system.”
Jason Schroer, principal and office director at HKS (Houston), says he’s also seeing a need for hybrid consult spaces where multidisciplinary teams can meet, whether in person or using telemedicine.
“When you begin to integrate things like a nutritionist or social care, you have teams of four, five, or six different caregivers and so you need enough space to accommodate those people and the technology to have conversations in real-time,” he says.
Providers are also using new building projects to free up space within their main hospitals by consolidating cancer services in outpatient locations. Memorial Sloan Kettering Cancer Center (MSK) was experiencing a capacity issue when it decided to shift its outpatient operative cases off its main campus to a new freestanding outpatient surgery center in Manhattan, which will open in early 2016.
Dr. Brett A. Simon, director of Memorial Sloan Kettering’s Josie Robertson Surgery Center, says the building is designed for short-stay populations, with the case mix expected to be about 70 percent traditional outpatient and 30 percent ambulatory extended-recovery patients who may need to spend more time in recovery but don’t need a full inpatient stay. “If patients don’t need to stay in the hospital, they are better off at home. Secondarily, shorter stays reduce costs for those procedures,” he says.
The approach required a new care model, so MSK worked with Perkins Eastman (New York) and Icrave (New York) to replace its traditional open recovery rooms with private rooms. “We move the patients once from the OR to their post-op room, and adjust the resources to meet the patient’s changing needs,” Simon says. “It reduces the number of transfers and handoffs and it enables incredible continuity of care.”
To further promote recovery, the layout is designed to encourage ambulation with hallways arranged in a figure-eight with an “oasis” area in the center, where patients can mingle with staff or family members or grab a bite to eat. “We don’t want patients to think that they’re bed-bound invalids but rather recovering people on their way to independence, so we’re going to get them out of bed and have them go get their breakfast,” he says.
Choice is key
Many designers and providers agree that an important goal for new projects should be creating a sense of choice for patients who are facing a life-altering diagnosis. And one area where that’s driving significant change is in infusion spaces. A decade ago most chemotherapy treatments were done in an open room that housed nothing more than chairs and IV poles, while today there’s more variety in room arrangements, from private to semiprivate to open bay to outdoor settings. Providers are also outfitting these spaces with patient-centric features, such as entertainment centers, views to the outdoors, and comfortable furniture options, as well as making space for family members and friends to stay nearby.
Julianne Fritz, northern Colorado regional director of oncology services and interim associate administrator for Banner MD Anderson Cancer Center and Programs at Banner Health (Gilbert, Ariz.), says during the recent renovation and expansion of Banner’s cancer care facility at North Colorado Medical Center in Greeley, Colo., the provider switched from an open infusion bay to a pod system, but kept three private infusion spaces. Each of the four pods is divided by half walls with semitransparent glass tops and includes four to five chairs and a decentralized nurses’ station, all
owing for quick contact between nursing staff and patients. “Our thought process has changed,” she says. “We still want patients to interact as they want to, but really, for the patient experience, they need to be in a more private area and they need to have better support space for caregivers or family members who are coming in with them.”
In some cases, facilities are updating these settings based on customer feedback. For example, ProHealth switched its infusion model from all-private to a mix of private and grouped bays when patients expressed a desire for both at its new facility. “They wanted privacy, but they also wanted the ability to have a conversation with another patient or create their own support network with another patient,” Kleba says. Furthermore, patients are given seating choices, including a daybed or recliner in the open bay areas and a bed or recliner in the private rooms.
Feedback from patients at Cleveland Clinic took that organization down a different path, with the urban facility moving from its current open-room pod structure to 98 private and semiprivate chemotherapy infusion rooms in its new building. Faulhaber says the major difference between the two options is that the private rooms will have a shared bathroom between two suites while the semiprivate rooms will access restrooms in the hallway.
Another evolution in cancer center design is a focus on providing more patient support and complementary care services alongside clinical offerings. Faulhaber says that during planning for Cleveland Clinic’s new building, space was purposely designated for such amenities as a wig boutique with fitting rooms and private viewing areas, a prosthetic room staffed by a therapist, and a shared art therapy and yoga room with direct access to an outdoor courtyard. These services are located on the first floor along with the lab and retail pharmacy so that patients will see them and know to use them during their visits. “One of the things that we found when we visited other cancer centers is that if you have the services removed from the main patient flow, they don’t go out of their way to find them,” Faulhaber says.
Facilities are also designing better spaces for information and patient navigation services to support patients and families during the treatment process. Fritz says one of the goals during Banner Health’s renovation project was to consolidate its business functions into an easily accessible area. “Oftentimes as healthcare providers, we focus more on the clinical aspect, technology, and the patient experience, and we’ve overlooked the business aspect. Patients and families worry about that,” she says. “Navigating through healthcare insurance, copays, registration, and HIPPA guidelines—all of those are critically important.”
While there are space implications in making room for more wellness and support programs, HKS’ Schroer says that more clients are realizing they not only benefit patients and families but can also be a brand differentiator. “They see a return on investment in terms of patient satisfaction and just a better experience for patients,” he says.
The expansion of these on-site service offerings along with the continued push for team-based care will continue to evolve cancer care facility design with a focus on creating more types of integrated spaces in the future. “Medicine is becoming more precise and personal and will require very specific treatment plans for every individual,” Schroer says. “This personalization will require more expertise and specialization, which will require a larger care team and perhaps more treatment options. To maintain a coherent treatment plan and provide the utmost convenience to patients, these services will need to be in one place.”
Anne DiNardo is senior editor of Healthcare Design. She can be reached at firstname.lastname@example.org.
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