Ambulatory cancer care for today and tomorrow
One doesn't necessarily have to be a fan of NBC's Today Show to remember the tragic death from colon cancer of coanchor Katie Couric's husband Jay Monahan in 1998 and Couric's subsequent nationwide broadcast of her colonoscopy to heighten awareness of this test and its importance. Another lesser-known but nonetheless positive offshoot of the tragedy is on an Upper East Side corner in New York, as part of the New York-Presbyterian Hospital/ Weill Medical College of Cornell University: a warm, welcoming ambulatory consultation/educational space called the Jay Monahan Center for Gastrointestinal Health.
This world-class wellness and cancer center, converted from what had been a somewhat crowded-feeling women's clinic, focuses specifically on gastrointestinal health. Combining an ingenious design by Guenther 5 Architects and a driving interest in design innovation by the center's director, Mark Pochapin, MD, the Monahan Center is exploring new frontiers of ambulatory cancer care. The design incorporates five examination rooms, three physicians' offices, a shared consultation room, and a restful, intimate waiting area in 3,500 square feet (with considerable storage space saved by the use of electronic health records). The focus is on the multidisciplinary, seamless coordination of all preventive, treatment, and support services.
Recently Robin Guenther, principal of Guenther 5, and Dr. Pochapin took
HEALTHCARE DESIGN Editor-in-Chief Richard L. Peck on a virtual tour of the comforting new facility.
Dr. Pochapin: During her husband Jay's illness, Katie was trying to pull together all the information she could about colon cancer and aspects of his care. Meanwhile, I had always felt that, although we had excellent physicians, we didn't really deliver care in the coordinated, seamless way we should. There had to be more of a focus on patients' needs—all their needs—and not just on the disease. Together, Katie and I came up with the concept for a center that would bring the healthcare team closer to patients and their families and add an educational component, as well. We would combine her outreach from the media perspective and my own from the medical side. I passionately wanted to be part of this project and to be involved in selecting the architect. A number of architects gave very elaborate, multimedia presentations, but Robin Guenther simply spoke, and I could tell right away that she understood the concept.
Guenther: This was going to be a very small space—about 3,500 square feet—and they wanted an educational component that would be welcoming to patients, families, and visitors. It would be open to the public and, in concept, resemble the Today Show set, with couches for conversation, multiple TV screens, and windows that look onto the street. In fact, the idea was that Katie could come from time to time and tape segments with cancer patients and their health professionals—and she's a very effective messenger.
The idea of this was fascinating to me because we've been designing chronic healthcare spaces since the 1990s, and I was interested in creating healthcare communities in these spaces, not just waiting areas. The traditional waiting area has a lot of don'ts—no eating, no talking on cell phones, etc. But in today's world everyone multitasks; why not have spaces where people are invited to use laptops, look up information, etc.? How far can we push this?
The Common Area
Dr. Pochapin: We have multiple TV screens (figure 1) on which we originally thought we would play educational videos, the taping of Katie's colonoscopy, and other positive health information. This was a useful resource for many patients, but others—especially those with a new diagnosis of cancer who just wanted something to take their minds off the disease—expressed a preference for non-health-related programming. So now, in addition to the educational videos, we play family movies like Finding Nemo, music videos, classic comedies like I Love Lucy—whatever people seem to want and find relaxing. We still give educational presentations and can even wheel a podium to the outside courtyard with a screen for this purpose. We also do cooking and meditation sessions out there.
Another thing we're still working on is helping people feel less intimidated by a healthcare facility. Despite the openness, there still has to be something that draws them in. Right now we have small speakers near the glass doors so passersby can watch the TVs and the videos if they wish. This resource, coupled with our frequent community outreach activities, helps to make people feel welcome.
Guenther: This area, though small, is very flexibly designed, with lightweight furniture that people can easily move about to watch the TV screens or create conversation areas (figures 2, 3). The furniture and the walls are painted in light colors to enlarge the appearance of the space. There is a fair amount of wood (figure 4), including a bamboo floor that is warm and calming, holds up well, and is easily cleanable and rapidly renewable—altogether an amazing product. We always try to use authentic materials to give people a feeling of authenticity because so much of what we encounter in typical healthcare environments is not authentic—it's mechanical and contributes to a sense of visual paucity, with nothing that's unique or handmade. With a wood floor, you know that someone laid every plank.
Behind the reception desk we have handworked plaster that gives off a pearlescent bluish-green glow that changes with daylight (figure 5). As I mentioned, the space is set up informally so that patients can sit in various discrete areas. The health professional comes out to greet the patient; patients go to the consultation rooms and then exit behind the reception desk, without having to go through the public area again. I feel pretty passionate about giving patients under stress a discreet way out.
Other features include sustainable products like no-VOC paints; formaldehyde-free insulation, casework, and millwork; and linoleum in exam rooms that can be easily cleaned without chemicals or waxes. The ceilings are quite low; this worried us a bit acoustically, but we used sound-absorptive panels that look like drywall but behave like acoustic panels. They're taped and finished to give a monolithic appearance.
The Consultation Areas
Guenther: The physician consultation areas are 120 square feet and the exam rooms are 100 square feet—small but, by New York standards, they're fine. There is also a larger conference room (figure 6) that seems to float next to the space, with capability for videoconferencing and large family group consultations with physicians. It seems to be working well.
Dr. Pochapin: The physicians and healthcare team love it here. The way we have planned this, our ancillary services are conveniently available and everything is here for them. The consultation rooms are comfortable, and the physicians' offices have the big desk pushed against a wall and a small table between the physician and patient to encourage conversation. Despite its proximity to the street and the windows that admit abundant natural light in the common area, people are stunned by how quiet it is here, largely because of the materials Robin has used on the walls and ceiling. Because of the success of this space, we are now trying to expand the concept of multidisciplinary, seamlessly coordinated care in other areas throughout the institution.
Medicine has become so specialized and subspecialized that, as physicians, we can sometimes have blinders on. We have to take a few steps back and see the ways we can bring it all together.
I'd like to leave a legacy of offering a different way—focused on the patient and family experience—to provide care. Since the Monahan Center's creation, the leadership have been incredibly supportive and it's working out beautifully. HD