Rewriting The Playbook: James Cancer Hospital
Four years into planning the $750 million James Cancer Hospital and Solove Research Institute—one of the largest cancer hospitals in the nation—The Ohio State University Wexner Medical Center received news that it had won a $100 million grant from the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services.
At the time, schematic design and design development were already completed and construction had started on the 1 million-square-foot replacement facility in Columbus, Ohio, which would house inpatient, outpatient, research, and ambulatory services. The only thing not moving to the new space was a radiation oncology unit, which was excluded for cost reasons and would remain in the existing James along with some shared support services.
The infusion of grant money in December 2010 sent the project team, including The Ohio State University (OSU) Wexner Medical Center, HOK, Moody Nolan, Turner Construction, and Lend Lease, back to the drawing board. “There was no doubt about [the money] going toward adding radiation oncology into the building,” says Henry Chao, principal and healthcare design principal at HOK (New York).
With years of work already underway, the question wasn’t just how but also where to add the department to the 306-bed hospital.
The project team reviewed the options, including demolishing an existing parking garage and adding a freestanding building that would attach to the new James, but that site was the last available real estate that could accommodate any future expansion. In consideration of the patient experience, the project team made a drastic decision to add another floor to the building and relocate radiation oncology from its basement in the existing building to the second floor of the new James.
“Radiation oncology has been this taboo service that is typically placed in the basement, with the connotation that bad things happen to you down there in the dark,” says Paul Strohm, principal-in-charge and director of HOK’s global healthcare practice (St. Louis). “We wanted to humanize the care environment and create a positive experience for patients. While the treatment impacts your body, appropriately killing the cancer cells or putting it into remission, it can also be a place that can be pleasant, cheerful, supportive, light-filled, calming, reassuring.”
For cost and structural change considerations, Strohm says the department needed to be as close to the ground floor as possible. However, several lower floors were set and strategically aligned with Wexner Medical Center, including the first floor as an expansion of the imaging department and the fourth floor for surgery. The ground level was dedicated to a new cancer-specific emergency department and lobby. So by process of elimination, the department was inserted on the second floor.
Moving out of the basement
To accommodate the additional floor, services and departments throughout the building had to be reshuffled. For example, mechanical/electrical systems were relocated to the eight floor and contractors redesigned the structural system from the eighth floor down to handle the added weight. Those services originally planned for the second floor, including outpatient and chemotherapy, were moved to the fifth floor.
To construct seven radiation vaults, which carry a total weight of 29 million pounds (excluding the structure), designers used two types of shielding: The floor and ceiling shielding was poured-in-place concrete, which was specially formulated with a metal alloy aggregate to minimize the thickness of the concrete and thus reduce the overall height of the building, Strohm says.
For the walls, a lead block system was chosen. The lead blocks are quicker to install and easier to remove than formed concrete walls, providing future flexibility should the floor use change or the vaults are no longer needed due to changes in cancer care.
The entire department has a visual connection to the lobby for wayfinding and is accessible by the same elevators as the other outpatient and inpatient services—an effort designed to introduce the idea of a “community of care” at the James, says Strohm. The location is also proximate to researchers and educators, which is another major focus in the new academic facility.
Despite the challenges, Dr. Michael A. Caligiuri, director of The Ohio State University Comprehensive Cancer Center and CEO of the James Cancer Hospital and Solove Research Institute, says the decision to locate radiation oncology on an upper floor was worth it for both the employees and the patients.
“It improves the healing process,” he says. “You’re coming up the stairs, not down the stairs, you’re seeing natural light, and you’re seeing staff and faculty who are happy about what they’re doing in part because of where they’re located and the beautiful facility. That all makes a difference.”
Adding a massive department midway into the $750 million project was just one of the adjustments that were made. Mark Banholzer, vice president and senior project designer for HOK (Chicago), says news came mid-project that the university wanted its healthcare buildings to be consistent with the brand aesthetic of the rest of the campus using the university’s signature scarlet and gray colors.
To meet this criteria, Banholzer says he used touches of the red with white and gray and balanced the cool colors with wood tones to create an inviting interior. The university’s signature buckeye leaf is also incorporated into custom carpets and a stainless-steel version is inset into the lobby’s terrazzo flooring. “We wanted to take a fresh look at that branding and those cues of the university and the campus in a more subtle and appropriate scale for a healthcare building,” he says.
The building lobby got another mid-project change. “We had a huge concern for how to make the lobby space elegant because it was 400 feet long and only 24 feet high,” Chao says.
Since radiation oncology required a smaller floorplate than the originally planned outpatient department on the second floor, the design teamed took that extra unused space to enlarge the lobby from two to three stories, improving the space proportion and bringing in natural light and views to new green space on campus.
“Columbus is frequently cloudy,” he says. “Now we have a 40-foot high glass wall on the south bringing in lots of natural light into the lobby space and penetrating much deeper [into the building].”
The elevator core was placed on the building perimeter rather than in the center, major air shafts are located along the south side, and egress stairs are on the north and south sides of the building—leaving an area the size of a football field open on each floor of the building podium, which houses diagnostic and treatment programs, to flex to changing space and technology needs.
“The intention was to set aside this area for surgery or imaging space because these are the medical and critical technologies that go through the most amount of change,” HOK’s Chao says. “If we put something in the middle, that drastically reduces the flexibility."
All about the experience
While planning for the fu
ture was an important aspect of building the James, the project team also looked to the past to guide some design decisions. Clinical floors at the former James were grouped according to a particular cancer type, and all of the staff and equipment on each floor were specific to those patients’ needs.
This set-up was carried over into the new James, but the floors also now integrate clinical, academic, and research areas to help accelerate new diagnostic tools and treatments. HOK’s Banholzer says that while it’s not an unusual set-up for an academic medical center, the James takes that design a step further by locating its glass-enclosed research areas in the public realm rather than behind the scenes. “Part of the notion is that they’re giving hope to patients and families by seeing that real-time research is happening,” he says.
To improve privacy and noise control, the new James features 306 private patient rooms, with space zoned for family. Prefabricated patient bathrooms with showers (inboard for acute care rooms and outboard in critical care rooms) were specified to save time on the construction schedule and improve quality control. One of the most striking features in the room is the view outside via floor-to-ceiling windows.
“In certain rooms, you can actually watch an OSU football game,” Banholzer says.
As the James project continued to morph and grow, the design team was tasked to remain focused on proving an intimate experience within such a large facility. A variety of textures, patterns, and wood materials are used in strategic areas as wayfinding elements. Attention was also paid to ensure hallways, corridors, and staff and patient rooms had access to natural light and those impressive views.
“Daylight becomes an amenity for everyone,” Banholzer says.
Natural light plays a big role in the fifth floor infusion department, too, says Lou Pallay, associate and project architect at Moody Nolan (Columbus, Ohio), the associate architecture firm on the project. All 18 infusion stations have exterior views and are arranged in an open format with a sliding screen available for privacy when it’s desired. There are also 20 private infusion rooms for patients. Pallay says an overall hospitality aesthetic helps to further create a sense of respite and community while trying to eliminate fear associated with the treatment process.
“The owner was excellent in reminding the entire team that this was not to look like a hospital,” Pallay says. “It was all about the patient experience.”
Anne DiNardo is senior editor of Healthcare Design. She can be reached at firstname.lastname@example.org.
For a source list relating to this project, see James Cancer Hospital and Solove Research Institute: Project Breakdown.
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