Creating an ambulatory oncology center that comforts
In today's design and construction process, the architect is committed to the balance of function and aesthetics. Buildings-certainly healthcare buildings-are machines for doing things. If you design and build a bad building, it will slow you down each day. Building it right the first time assists you in achieving your client's goals. And capturing the aesthetics in the look and feel of the building fuels and invigorates the spirit.
In the architecture of healthcare, it is our goal to capture the genius and power of technology in concert with the warmth and comfort of care.
Nowhere is design simplicity and sophistication more significant than in today's world of oncology, the medical specialty that focuses on the diagnosis and treatment of cancer using radiation therapy and chemotherapy.
Discovering the right healthcare architect
It was the successful design of Shore Memorial Cancer Center, Somers Point, New Jersey (see HEALTHCARE DESIGN, November 2005, p. 36), that brought Fenwick Architects in nearby Linwood to the attention of noted New Jersey medical oncologist Naim T. Nazha, MD. In six short years, Nazha had established a highly successful oncology practice in Linwood. However, he was not able to see patients throughout their entire cancer journey, as this facility lacked such services as radiation therapy and diagnostic radiology. That meant his vision was not yet complete. “I always wanted a place for patients to receive chemotherapy and radiation therapy without having to go to the hospital-a place that was friendly and comforting,” Nazha says. In 2007, he purchased a small, aging shopping center site two blocks south and searched for an architectural firm to create a new design to match his vision.
Laying out the design challenge for Fenwick Architects, Nazha said, “Diagnosing cancer and discovering that a loved one needs treatment is one of the most trying emotional experiences a family will ever face. The last thing a family needs is to incur the hassle of having to journey to different centers for diagnostics, radiation therapy, and chemotherapy treatment. They should have all of these services conveniently tucked into one venue.”
Essential ingredients for nuclear oncology center design
Endeavoring to articulate his dream for Fenwick Architects, Nazha created a specific list of design demands. It had to:
encompass a complete approach to quality cancer care
present soothing spaces for radiation oncology and imaging
include sensitivity to the relationship between patient and caregiver
have consideration for providing compassion for patients' families
respect the human aspects of a patient's life
create an environment in which patient comfort and care are the top priorities
provide a structure for the most precise cancer treatment possible
establish a setting for the finest diagnostic and therapeutic care in the region
accommodate smart spaces for the following equipment/technology:
- PET and CT Scans
- PET/CT Fusion
- IGRT (Image-Guided Radiotherapy)
- IMRT (Intensity-Modulated Radiotherapy)
- SRS (Stereotactic Radiosurgery)
- RPG (Respiratory Gating)
- Electronic Brachytherapy
- Chemotherapy and Infusion
have a pleasing exterior that seamlessly fits into the surrounding neighborhood while eliciting a sense of warmth and technological sophistication
In short, Nazha asked us to design a warm, welcoming, friendly mini-hospital where patients would receive immediate service and a full level of cancer care under one roof. “I want my new center to be practical, handsome, and affordable, with masonry exterior to match my original center, plus space for future expansion,” he told us.
Moreover, he wanted us to provide interior design concepts for the new center that had the feeling of home: comfortable, welcoming, and friendly, but not too austere. Because of the high heat generated by the linear accelerators, and because of the usual smells associated with medical centers, we needed to specify the equipment, system, and technology for outstanding air handling and indoor air quality (IAQ).
He warned that radiation oncology and nuclear medicine require high levels of radiation security in the structural design of the treatment rooms-not only do these treatment areas demand heavily shielded walls, but specific HVAC requirements as well. How to do this without designing a room that looks like a military bunker would be our greatest challenge. He also cautioned that in these treatment areas, his clinical staff needed its tools close at hand, but instructed us to minimize clutter to maintain the center's aesthetics.
Architect's design goals
In developing our design goals we said, “Let's use the building as a tool to help to minimize unnecessary stress for the patient.” Patients always want the latest technology because getting well is priority one, but we created our design to make the cancer treatment process as comfortable as possible.
The project goals were focused on keeping the patients close to home and family, performing as many services in-house as possible, making daily visits quick, and treating patients in an environment that doesn't constantly remind them of where they are and why they are there. We were encouraged in the understanding that there is a lot more to cancer treatment than the latest and greatest. It's all about being surrounded with compassion by the people who treat you and the environment in which you are treated.
Nazha gave us a fine site to work with. Still, the building presented many challenges-especially the two massive concrete vaults for the linear accelerators, the shielding for the PET/CT, and the provision of space for future growth.
Regarding the latest medical technology, one thing you can always count on is that it won't remain the latest technology for long. Knowing this, Nazha had us design a second vault right beside the first one because he knew that adding another linear accelerator was inevitable. We realized that it would be less expensive in the long run to pour both vaults together and integrate, rough-in, and otherwise make provisions for the complex power, data, and HVAC systems in the initial construction process.
We also encountered the not uncommon problem hospitals face in trying to accommodate changing technology-although in this case, a new model GE PET scanner, the equipment got larger rather than smaller, and we had to adjust the room length by about three feet and reorganize the electrical connections in the floor.
“A design concept that matched my vision”
The final design for the new center evolved into a $5 million, three-level, 17,515-square-foot building centered on the two reinforced (two to seven feet thick) concrete vaults for state-of-the-art linear accelerators, a Positron Emission Tomography (PET/CT) center, and a treatment center for medical oncology and chemotherapy.
As specified by the consultant physicists, each vault consisted of poured concrete walls ranging from three to seven feet thick-an equally safe and much cheaper alternative to lead. We used lead lining around doorways and ductwork apertures. The vault is approached via a maze-like hallway, which limits and dissipates the pathway of any errant radiation. We used lead shielding in the PET/CT areas where patients are temporarily “hot” from the diagnostic procedure.
All chilled water pipes and electrical conduits come up from the basement through the floor. There are no wall penetrations in the treatment areas.
For future planning considerations, we roughed in an imaging center in the very large basement space, so it will be easily put into commission when Nazha is ready.
“The Fenwick team delivered a design concept that perfectly matched my vision,” Nazha says. “Like a veteran law enforcement partner, Fenwick Architects became my eyes and ears, and protected my back. They successfully translated my ideas into concrete and brick. Because of a very busy practice, I depended on them to protect my investment and deliver a product unlike any other in New Jersey. This is exactly what they did and I am extremely pleased with the results.”
The two-story, all-brick structure stands out in a neighborhood of sleek, elegant, glassy physician office buildings. Nazha didn't want that look. In fact, when we proposed value engineering the rear brick wall that no one would normally see, he declined. He just wanted an excellent building.
Says Nazha, “Today, we have a free-standing outpatient center that operates the same, if not better, than big city centers such as those in Philadelphia and New York City. Our community patients are now close to home and their families find it unnecessary to travel to these locations. The interior of our new facility is designed for optimal comfort, something that many facilities overlook. Fenwick designed customized, elaborate cabinetry in each of the treatment areas where every tool has its place. My staff is happy because they have ample storage, and all the patient sees is the beautiful faéade of the custom woodwork.”
To Nazha, it all paid off in one patient's note: “The environment, especially the waiting area, is very comfortable and pleasing on the eyes. The areas are immaculately clean, organized, and neat. All equipment is very new and ‘top drawer’ with very few delays.”
That was his dream. HD