Case Study: Cancer Care Re-imagined Part II

A Deeper LookThe Scully-Welsh Cancer Center at Indian River Medical Center has been imagined as a place where patients can receive state-of-the-art treatment in an environment that is tuned to the evidence-based healing effects of nature. The bucolic, subtropical setting within the overall campus allows patients, visitors and staff a variety of opportunities for socialization and solitude within nature.

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ImprovIng outcomes wIth Lean DesIgn

To ensure maximum efficiencies for delivering patient care, The Scully-Welsh Cancer Center at Indian River Medical Center has been designed using Lean Design and Operational principles.

The team was guided by the understanding that the building industry has an ethical obligation to be stewards of both natural and fiscal resources; Lean Design practices were employed to conceptualize and validate operational processes so the team could ensure the project was accurately sized to meet the needs of the caregivers and patients. By right-sizing the facility, environmentally-focused reductions in energy usage, construction time and materials were realized which allowed fiscal resources to be directed toward patient and staff amenities where the spending would be more impactful for those using and working in the building.

CHALLENGEusing natural and fiscal resources, the design team needed to accurately tune the project program and design to the specific needs of the patients and care protocols.

SOLUTIONLean Design practices were used such as process-led design work sessions to engage stakeholders, define key goals and develop the patient and provider experience. tools such as empathy mapping, process mapping, virtual mock-ups and visual programming allowed users and administrators to swiftly evaluate options and advance the eco-friendly project.

Focusing on Patient Healthcare & Staff Performance

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Using a process-led Lean approach to design, the voice of all clinical representatives was prominent at each phase of design. Together, architects and clinicians created new ways to deliver care and spaces that best facilitated it. Focusing on process-led, outcome-driven data as the forerunner to design, the cancer center demonstrates the amplified value created for hospitals and their customers. Process data combined with desired patient experience allow the healthcare design industry to better approach the many hard decisions that must be made as capital is scarce and needs are great.

enhancIng the center’s envIronment

The project design incorporates three significant ecological strategies. As previously stated, the first strategy was a utilization of Lean principles to “right size” the project. By accurately tuning the project program and design to the specific needs of the patients and care protocols, the design team was able to reduce the constructed area of the project by approximately 10% from the initial area forecast. This savings was further enhanced by the team’s efforts to incorporate the existing linear accelerator vaults into the design of the facility instead of demolishing and replacing them.

Another area of focus for the design team was limiting the long-term operating energy footprint of the facility. While the hospital’s central energy plant was outside the project scope, the team selected materials, systems and equipment with efficiency as a driver, meeting or exceeding ASHRAE standards. One particular area that illustrates the team’s approach is the two-story glass lobby. While providing peaceful, natural views was paramount, the articulation of the design required significant study to eliminate solar heat gain from the south facing glass in the project’s subtropical climate. The shading system chosen has proven effective from both a spatial/experiential perspective and an environmental comfort/efficiency perspective.

Finally, and most importantly for this project, the overall impact of delivering treatment to the hospital’s community has been reduced by providing care within the community. Until the construction of the Scully-Welsh Cancer Center, patients in need of treatment needed to travel significant distances to obtain quality care. By providing community-based care integrating state-of-the-art telehealth consultation from leading practitioners and researchers from Duke University, Indian River Medical Center is leading the charge to manage population health.

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Cancer care requires a holistic approach to the patient and their family. Treatment must be integrated with total physical care (nutrition, fitness, pain management, dermatology, etc.) as well as psychological care. A healing garden, community education space and public resource library access combined with spiritu-al and psychological advisors serve the full community. In addi-tion, this Center advocates for community involvement though spaces for existing support programs to meet and thrive.

IncreasIng access to comprehensIve cancer care

This project significantly improves access to comprehensive cancer care for the members of the Indian River community. Through a partnership with the Duke University Cancer Network, this new building brings current academic research facility quality cancer care directly into this south Florida community. This robust infusion will allow patients to remain in their community during the full continuum of their cancer care, ensuring access to their support networks and resources. Cancer has long been a destination healthcare reality. Bringing care to people rather than expecting them to travel is the hallmark of population health, and this new Center in Vero Beach advances this important mission.

Community Advancements

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DIstInguIshIng Features oF the cancer center

The ecotherapeutic benefits of nature have been integrated in a wide variety of methods which allow each patient to choose the most comforting and beneficial immersion based on their personal preference and their specific care plan.

The transition from the “outside” world to the healing environment progresses through the landscaped drive and includes a subtropical butterfly garden in the interstitial space between the patient drop-off canopy and the building entrance.

The main lobby is articulated as a double-height glass box which allows waiting patients on both floors to take in the views of the surrounding landscape. Realizing that some cancer treatments result in a sensitivity to sunlight and that solar control was required, the design includes louvers that have been carefully positioned to both allow uninterrupted views while also preventing solar penetration.

An array of patient education and respite resources are provided along a concourse that gives access to the healing garden which includes areas for group socialization and individual solitude for both patients and staff. The staff lounge is positioned to have views and direct access to the garden so that staff can also mentally recharge from their sometimes emotionally stressful duties.

In the treatment zones, each exam room and infusion bay was positioned to have evidence-based, outcome enhancing views toward the natural landscape. The ground floor infusion bays also have easy access to the healing garden so patients who are well enough can choose to have their treatment outdoors.

A natural material palette is seamlessly blended between the exterior and interior spaces. The metaphorical merging of these environments is expressed in the main lobby as the horizontal solar control louvers penetrate the interior and “twist” to become interior wood paneling which in turn wraps the lobby and runs back outside to become the rain screen siding of the garden facades.

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