A leader in cancer treatment services in the region, Tennessee Oncology treats the largest number of cancer patients in the state, and enrolls more patients in clinical trials than any other community-based oncology practice in the nation. When the medical group outgrew their existing location at Saint Thomas West Hospital yet wanted to remain on site, they tasked GS&P with designing a new state-of-the-art oncology clinic—in shell space on the second floor of the campus’s S&E medical office building—that would better meet the unique needs of cancer patients and their families.
“Coping with cancer affects the whole family and is both mentally and physically draining for the patient,” says project designer Steve Verner. “Cancer patients are often weak and fatigued from the treatments they receive, and chemotherapy infusions can require them to remain in the one location for hours at a time. So it was crucial our design response place special emphasis on creating a supportive environment that aided the patient as well as their family members, and addressed efficiencies and the safety of treatment.
“To accomplish this, we focused on optimizing the overall program flow to reduce a patient’s stress and anxiety levels, and developed a plan that kept wayfinding simple, walking distances to a minimum and eliminated bottlenecks.”
Optimizing Program Flow
To create a natural flow of both patients and staff, the layout for the new 22,200-square-foot clinic was designed from the perspective of the patient.
“Every aspect of the design came from putting ourselves in the patient’s shoes and envisioning what their experience would be,” says project coordinator Chris Hoal. “Because of the nature of the treatments, we didn’t want patients to have to do any extra work for themselves. So we came up with a design solution that was extremely intuitive in terms of what they needed and where they needed to go.”
Starting with clear wayfinding, patients arrive at the new clinic via an elevator lobby and are immediately greeted by a receptionist. The reception desk serves as both a threshold to the waiting area as well as a security mechanism for patient safety. Waiting is centrally located on the floor so the patient never has to walk far to treatment locations.
“We weren’t starting out with a green-grass site, and that was one of the main challenges we faced with this project,” explains Verner. “We had an envelope, we had existing stairs and we had elevators. So we walked the client through what we felt were key opportunities for the shell space, and guided them to optimize the fact that they owned the entire second floor and weren’t simply a tenant—it was strictly dedicated to Tennessee Oncology.
“The main drivers became the placement of infusion alongside the best exterior views, as well as creating an entry at reception that sets the stage and lets patients and visitors know they’ve arrived at a place with its own identity, and not just a medical office building with a series of doctors’ offices.”
“The minute you step out of the elevator, prominent signage and the branding theme of the wood begins,” adds Hoal. “So you’re immediately received and greeted on a floor that is clearly its own separate entity.”
Further facilitating superior oncology care, the layout of treatment areas in the new space was specially tailored toward the specific types of treatment the clinic offers.
“A patient is either going to infusion to receive his or her scheduled dosage of chemotherapy, or they’re headed to an exam room for diagnosis,” says Verner. “So we designed both options to have a distinct and separate flow to keep patients localized and contained. And neither is far from the waiting room, so patients are always close to their attending staff. Also, by having two separate, dedicated nurse stations, it assists the nursing staff in supervising their patients, which helps them deliver a far more efficient level of care than they were able to provide in the previous facility.”
“And because our overarching goal was to minimize the steps a patient has to take, we located the common areas in the center of the program and essentially broke out a circle of treatment and exam areas that always come back to that center,” explains Hoal. “This way, no one has to get lost trying to make their way around the entire medical office building because waiting, infusion, blood draw and check-out are all visually connected to one another. So in terms of physical stress and anxiety, the design makes it so much easier on these patients as well as their accompanying family members.”
Instituting a far more organized infrastructure for doctors, exam rooms were clustered in pods that are assigned to an individual physician or specialist, allowing them to handle their patients’ needs in an efficient setting.
Dictation rooms located at the end of each pod are designed to keep physicians near the patient, and have been sized to be converted into an exam room to allow for future growth. Infusion areas open directly off the main corridor to improve wayfinding, and the clinic’s gynecology suite is nestled in a private setting that’s removed from the activity of non-gender-specific treatment areas.
“What’s different about the gynecology patients is they’re often wearing gowns,” says Hoal. “To allow them both dignity and privacy, we designed a space that was a little more secluded, where they can change if they have to, and then step out into a controlled environment. Only the gynecology suite staff is going to come into contact with a patient in this area, which helps support those patients, and allows them to feel comfortable in a very intimate space.”
Infusion was the most carefully designed space in the new clinic simply because it’s where patients spend the vast majority of their time. Its prime location in the second-floor shell space was selected early in the design process to take full advantage of the best exterior views. Twenty-one open infusion bays were broken up into four pods, creating more intimate spaces where patients can rest, recline, watch TV, view the outdoors or even socialize with other patients.
“Right off the bat, we determined where the infusion area needed to be,” says Verner. “The views from some of the windows were either of the parking garage or of buildings that were a part of the campus. We wanted infusion patients to occupy this particular corner of the second floor so they could experience views of the surrounding green space as well as the best source of natural light.
“Because of the sheer amount of time a patient can spend receiving infusion treatments, it was vital to create an environment that fostered both comfort and calm. We achieved this by not only by providing views and natural light which offer positive distractions for patients, but also by giving the patient the ability to control his or her environment—and that can be as simple as controlling the lighting in their pod so they can read, sleep or meditate. This sense of control gives patients a true feeling of independence, and that ultimately contributes to the success of the overall healing process.”
Promoting a supportive and healing environment, the open plan combined with vision glass offers nurses clear sight lines to every patient receiving treatment, and glass walls between the bays align with ribbon windows to blur the distinction between the inside and outside, inviting nature in and providing all-import acoustical separation for enhanced privacy. The design improves both efficiency and work flow, and lets nursing staff closely observe their patients.
“Spokes” in the ceiling—similar to that of a bicycle’s—create a distinctive design feature that organizes the infusion area in a way that supports the nurses. It achieves this by keeping both staff and resources centralized in one location while patients are arranged around the nurse station. This allows nursing staff to support one another, keeps more eyes on more patients, and ensures an increased ability for multiple staff members to respond quickly to emergencies.
For higher acuity patients, two private infusion rooms—located next to the open bay infusion area—offer an extra level of privacy while still providing visual contact with nursing staff.
Once a patient has completed his or her treatment, they proceed to check-out. To cut down on confusion, checkout areas were designed to be clearly visible from the treatment spaces. For the convenience of the patient, each check-out area is dedicated to either infusion or the exam rooms. From check-out, patients can exit the clinic without having to backtrack through the waiting area. This private and convenient exit—hidden behind a translucent serpentine wall which obscures existing core functions such as maintenance elevators and janitors’ closets—allows patients who have just undergone chemo-therapy treatment to avoid an often busy waiting area.
“Patients are most likely not going to look or feel their best when they’ve just gone through chemotherapy, and the last thing they need to do is walk back through a crowded waiting room—it puts pressure on them and it’s uncomfortable for the other patients,” says Verner. “So we designed the serpentine wall to give patients privacy and dignity as they make their way out of the clinic—and that’s better for everyone. And as a pure design feature, the translucent panels make the waiting room feel far more spacious.”
Also important to end users who may feel vulnerable before or after treatment, all patient-related spaces were subtly color coded to their function. This extra layer of wayfinding emphasizes Tennessee Oncology’s cutting-edge treatment methodologies and dedication to exceptional care through the use of a bright, warm and contemporary color palette.
“Associating spaces with a specific color tone adds a layer of organization that helps patients navigate the clinic,” says Verner. “For example, the exam check-out area uses the same colors and materials as the infusion check-out to create visual consistency. We also used bright colors and visually compelling local photography to mark other areas that are important for patient wayfinding.”
Featuring 23 infusion stations, 21 exam rooms, two procedure rooms, a gynecology suite, an in-practice pharmacy and a blood-analysis laboratory, the new Tennessee Oncology clinic at Saint Thomas West Hospital boasts a larger, streamlined layout, which not only enhances the overall cancer-care experience, but vastly improves pathways to care by providing all oncology and hematology-related services in one convenient location.
“One of the main things I will take away from this experience is the way in which we focused so clearly on what the patient was feeling,” says Hoal. “There was nothing that went into this effort that came from anybody’s design ego. It was literally: imagine yourself with cancer, and when you’re walking around this corner, what would you want to see as a cancer patient? Every single design decision—from the finishes to the program—was made from their viewpoint.”
“And because we did our very best to see things from a patient’s perspective, it’s extremely gratifying when we get feedback related to the patients themselves,” adds Verner. “For example, Karen Edwards, the director for Tennessee Oncology, told us that the day after the Open House, she helped a patient—who was using her IV pole to support herself—walk around the clinic so she could take pictures with her iPhone because she thought it was such a great space. And if a patient is able to notice that someone has put a great deal of care and attention into their environment instead of focusing on the treatment they’re receiving, then we’ve really done our job right.”