An eye toward the future
PHOTOGRAPHY BY SCOTT McDONALD, HEDRICH BLESSING
Cancer is more than a disease that attacks various parts of the body. For many patients it is a condition with severe emotional and psychological consequences as well.
Spectrum Health's new state-of-the-art Lemmen-Holton Cancer Pavilion (LHCP) in downtown Grand Rapids, Michigan, is intended to address both aspects of the illness.
Designed by URS, the six-story, 284,000-square-foot pavilion is part of the Medical Mile, which is the regional center for healthcare services, medical research, and medical education. It offers the region's widest, most advanced array of outpatient cancer services offering diagnoses and treatment for nearly 65% of the adult cancer cases in Kent County, Michigan. Housed in the single location are diagnostics, multidisciplinary teams of experts, advanced technology laboratories, an oncology research department, and specialty physician offices, allowing patients to receive comprehensive care in a matter of hours.
The impact of healthcare reform: Physician integration
For more than 20 years, healthcare delivery has been migrating toward low cost and convenience, moving away from the hospital-based structure of care. Lately, driven by the realities of the market, the realization has been growing that hospitals must integrate with physicians in order to define new care delivery models that support the value of aggregation. The LHCP facility has been able to favorably respond to the physician-integrated model. One of the driving factors of physician integration is healthcare reform and the need to achieve cost savings and operational efficiencies. Other factors driving the need are:
unsustainable growth in healthcare costs due to issues such as an aging population and failure of the managed care paradigm;
rapid technological advances, particularly in interventional surgery and radiology, which further accelerate the role of ambulatory services;
the move by the federal government and commercial payers to value-based reimbursement, pay-for-performance programs, and economic credentialing without increasing (and in some cases decreasing) the total funds available for provider reimbursement; and
consumerism, which includes provider fee schedules and other medical cost information, becoming increasingly transparent.
Among the benefits offered to the patient by the new model are increased quality of care, reduction in errors, superior coordination of care, increased convenience, cost-effectiveness, and programs with strong centers of excellence.
LHCP's basic design features a multispecialty team approach to diagnosing and treating cancer patients in an effort to make visits as efficient as possible. Design considerations were made to accommodate state-of-the-art information technology which permits faster and easier communication among specialists. Physician spaces were arranged in an open plan, encouraging collaboration and providing patients and family access to all essential specialists simultaneously.
Spectrum Health's Breast Care Services located in the LCHP illustrate the melding of specialists. The clinic includes breast surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, genetic counselors, medical social workers, nurse navigators, dieticians, and research nurses. With each specialist available in the same area, patients are spared the inconvenience of moving from office to office. The same concept is employed for lung cancer and other diseases.
The exam rooms were designed to be generic so that they can be used by any subspecialty. Modeled after the concept employed by the Mayo Clinic, they are large enough to accommodate the patient's family as well as multiple doctors, making it possible to conduct the entire consultation at one time, with all interested parties present. Since the room is larger than most exam rooms, it can be used as a mini-waiting room/consultation area as well as an education area where the family can be shown films or cat-scans right on the computer screen.
Flexibility by design
Aware that healthcare is a rapidly changing industry, Spectrum Health chose to invest heavily in shell space within the facility. The additional space allows for expansion for additional physicians.
“Having the additional shell space has provided the flexibility to look at bringing in new programs,” said Richard Funnell, FACHE, CMPE, senior director of the oncology program. “We're currently partnering with the Van Andel Research Institute and Cancer and Hematology Centers of Western Michigan to develop a design for a Phase I clinical trials unit which will occupy about 10,000-15,000 square feet of the building.
“Due to the need for flexibility, we added an additional floor to what was to be a five-story structure. However, we did not fill the space on the new floor. Instead, we left open space on floors four, five, and six to allow for functional expansion. Given the extra space, we would be able to add five medical oncologists, and radiation oncology could add five or six doctors or paraprofessionals, or anything else we thought necessary.”
Tunnel connects facilities
LHCP provides inpatient care for patients at Spectrum Health's Butterworth Hospital's Lettinga Cancer Center and Helen DeVos Children's Hospital, which are located across the street and separated by a major urban thoroughfare. After studying a number of potential solutions, URS determined that, in the interest of patient privacy, an underground tunnel would be built 40 feet below street level. The design of the tunnel emphasized the creature comfort of the patients. Indirect and accent lighting eliminated glare for patients being transported on beds. Inside LHCP, elevators controlled by staff transport patients to treatment areas, avoiding contact with other patients or their families.
“So far as I'm concerned, the tunnel was an absolute necessity,” said Dr. Mark Campbell, executive director of the Spectrum Health Regional Cancer Network. “It had to be connected to the hospital. Surgeons and pathologists are not going to run back and forth, if it means losing time from their practice every time they make the trip. The type of efficiency the tunnel offers is foundational to a modern healthcare system.”
Evidence-based design (EBD) in a healthcare setting involves using the best available information about how the physical environment affects patient care and the safety and comfort of both patients and staff. Recent studies show that noise reduction, large windows that permit natural light, and an aesthetically pleasing environment offer numerous patient benefits.
In support of furthering EBD, the Lemmen-Holton Cancer Pavilion is a registered member of the Pebble Project. Launched in 2000, the Pebble Project is a research initiative of The Center for Health Design and selected healthcare providers. Its purpose is to provide researched and documented examples of healthcare facilities whose design has improved patient recovery and staff performance as well as general operating efficiency. All the evidence indicates that a facility's design has an enormous impact on a patient's recovery.
Studies indicate that patients heal more quickly when they remain connected to nature. A premier design feature of the LHCP interior is the multilevel “life garden,” a six-story atrium with lush greenery, waterfalls, natural light, and materials that create a warm and welcoming environment.
The theme of the life garden is carried through on every floor and shares a 100-foot-high, sky-lit atrium. Each floor alternately undulates, maximizing the penetration of daylight, allowing for multistory trees, and offering views of adjacent floors. Each garden has different theme plantings, augmented by seasonal flowers.
The landscape is arranged to create niches of relaxing, private areas where families can gather in an intimate setting. A pond with a waterfall, boulders, and specimen trees anchors the main floor life garden. The water feature flows throughout the life garden with the soft sound of water resonating through the entire space. Additional water features are found on upper levels, including a pond and waterfall as well as an area where water flows across a stone bed, replacing a brook.
On the third floor there is a healing garden that provides cancer and hematology patients with an opportunity to walk on the deck when the weather is favorable, getting their infusion therapy in a serene and private atmosphere. Common spaces within the building were designed to offer the sense of an open-air environment, affording patients a feeling of tranquility that nourishes the process of healing.
The case for green buildings was compelling. Among the benefits were savings on energy costs, better recruitment and staff retention, increased productivity, and an overall healthier environment. All the green design decisions were based on the likelihood that they would foster patient healing. The abundantly day-lit atrium pacifies anxiety and relieves stress for patients and their families, as well as caregivers. The views of nature and the outdoor gardens help to improve recovery time and the selection of materials within the facility that improve air quality are especially critical for the immune-suppressed population. This factor is emphasized in the LEED 2009 Reference Guide for Green Building Design and Construction. The guide states: “Americans spend an average of 90% of their time indoors, so the quality of the indoor environment has a significant influence on their well-being, productivity, and quality of life. …Strategies to improve indoor environment quality have the potential to … improve the health of building occupants.”
These considerations are especially important to cancer patients who spend even more time indoors than the average. Specific actions taken by the design team for LHCP included the use of low-emitting materials for adhesives, sealant, paints and coatings, carpet systems, and wood materials. In addition, special attention was given to managing air contaminants and allowing occupants to control desired settings.
Spectrum Health was the first healthcare facility in Michigan to receive LEED Gold certification. “Not only did we create a space designed to compassionately care for cancer patients,” said Matt VanVranken, executive vice-president of Spectrum Health and president of Spectrum Health Hospital Group, “but we also designed a facility that conserves environmental resources.”
The LHCP building is on a previously registered Brownfield site. The building orientation of east-to-west maximizes the penetration of daylight. High-performance glass systems take full advantage of daylight and minimize heat loss/gain. An additional sustainable feature of the green building is a reduction in water usage through low water usage plumbing and rain harvesting for irrigation of landscaping.
Material selections were made based on percentage of recycled content and use of low-emitting properties to minimize interior air pollutants. A bus stop near the facility provides access to alternative transportation. The facility's commitment to sustainability is further demonstrated by the high-efficiency LED-based lights in the exterior sign and the gardens on the rooftops that help maintain the building's temperature and mitigate heat island effects.
All told, the Lemmen-Holton Cancer Pavilion was designed with an eye toward the future, providing specialized healthcare in an environment that encourages recovery and is designed to accommodate change as the industry progresses.
Heather Kazmierczak is a Healthcare Marketing and Business Development Manager with URS Corporation in Southfield, Michigan
For further information, visit www.spectrum-health.org.
Healthcare Design 2010 September;10(9):40-49