Jonathan Wilson, Principal and Healthcare Sector Lead at architectural firm Stantec, discusses the factors affecting cancer centre design and how these can be addressed through innovative design concepts and specialist healthcare design expertise
All healthcare environments must be designed to accommodate a range of considerations, including operational requirements, clinical demands and patient wellbeing. In specialist cancer treatment centres these considerations are multiplied due the complexities of the treatment pathways, the anxiety and fragility of cancer patients and the increasing integration of treatment and research.
Futureproofing the design of cancer centres is of particular relevance due to rapidly changing treatment regimes and technologies. The two main non-surgical treatments – chemotherapy and radiotherapy - are likely to be around for some years to come; however, we have seen significant changes in the pharmacology and technology in recent years, affecting space allocation, building structure and MEP services. Delivery of a major cancer centre typically takes around five years from concept to completion, so some degree of obsolescence can be expected, even within a project life span. Adaptability is therefore a prerequisite of good design.
Chemotherapy and radiotherapy are likely to be around for some years to come
Improving patient access to cancer treatment while balancing costly resources is driving a shift to a ‘hub and spoke’ model for cancer care. Specialist treatment, research and medical technology are becoming centrally located in comprehensive cancer centres or ‘hubs’ with links to local treatment centres (the ‘spokes’), sometimes referred to as satellites. Integrated ICT networks support electronic patient records and real time data sharing, which allows clinicians to collaborate in the delivery of effective services between local and more specialised centres. Patients travel to the central hub only when essential for diagnosis and/or treatment.
Given this trend, to provide an effective design solution the design team needs to understand how a proposed facility fits into the wider system, as well as its own specific requirements, A good client ‘brief’ is service-led: it proceeds from the service context to services provided in the facility, the patient categories and clinical pathways. Once these have been defined conceptually and organisationally, physical resources – buildings, space and equipment - can be allocated and configured.
Patients travel to the central hub only when essential for diagnosis and/or treatment
The design process is iterative, and consultation is required throughout to test the suitability of the design to user requirements. From experience, we have found that administrators, clinicians, estates personnel, patients and families can all make valuable contributions to an evolving design. This was certainly the case in the design of the new Cancer Centre at Guy’s Hospital where a strong initial design concept was refined through five months of user consultation.
Twenty-first century cancer centres need to do three things to be successful: first, they must facilitate teamwork across different professional and knowledge disciplines; second, they must offer to the patient a sense of personal choice and control in the uptake and implementation of their treatment; finally, they must bring clinicians and patients together in a sensitively structured spatial culture that caters for the needs of both. To reconcile these often competing agendas, the design must be tailored to the culture of the service provider, and indeed to local culture, as well as embedding best practice. In a multi-disciplinary treatment environment, a structured consultation process is essential to ensure that the detailed layout works for clinicians, patients and research teams, while building in flexibility for future change.
Administrators, clinicians, estates personnel, patients and families can all make valuable contributions to an evolving design
BIM is now used as an effective communication tool in the consultation process. Design teams are able to make changes in real time in the 3D model during consultation meetings, making it much easier for users to understand how a layout or design feature will work for them. This in turn speeds up the response time, helping to complete the consultation cycle more quickly and efficiently.
Successful design of cancer treatment centres must both support patient wellbeing and improve outcomes. To this end a wide range of strategies is needed – from broad organisational concepts to the detailed design of interiors and finishes. A good understanding of the cancer patient’s experience is essential. For example, some patients undergoing chemotherapy may arrive at the centre feeling nauseous. This can influence the location and design of food outlets.
Integrating advanced treatment with a holistic patient-centred emphasis on care is the touchstone of cancer centre design.