Imagining a new kind of hospital

By Anthony Treu
Healthcare design needs revolution, not gradual change, says Anthony Treu, Associate Director at architectural firm Skidmore, Owings & Merrill (SOM...

Some of the world’s most exciting medical advances are happening in the field of cancer care — but you probably wouldn’t know it from the street. Cutting-edge research and treatment often takes place in buildings that are bland, formulaic, and increasingly ill-suited to changing methods of care. Some of these facilities are fortress-like structures, isolated from the communities they serve. Inside, confusing corridors lead to dispiritingly generic waiting rooms; a clinical, impersonal atmosphere is all too common.

But what if the design of a cancer center was every bit as revolutionary as the medical breakthroughs that are changing the field?

When Emory Healthcare’s Winship Cancer Institute, one of the nation’s leading research and treatment centers, announced its intention to build "a cancer center that has never before been seen or imagined,” we jumped at the opportunity.

While our team at SOM has designed medical facilities around the world, we don’t define ourselves just as healthcare designers: our architects, interior designers, and planners bring expertise from many other fields. What excites us is the chance to question everything taken for granted about a project type, whether a hospital, a school, or civic building — and to reimagine how it can serve its users. We often say that any healthcare architect can design a great waiting room; we ask why patients should even wait at all.

We knew from the outset that Emory was looking to do something different. It wasn’t until we started working with them that we understood how deep their commitment goes to reinventing cancer care. Setting aside all preconceived notions of what this facility should be, we began the process by listening: our project delivery team worked with more than 150 end users, from patients and clinicians to custodians and volunteers. Together with Emory, we turned to the community this facility would serve, and asked them to help us imagine it.

Just as diverse as our stakeholder group was the team of professionals we worked with to make the vision a reality. Increasingly, our clients are using collaborative delivery models which bring together all of the participants in realizing a complex building project, from conceptual design all the way through construction. For Emory Winship, this group included the owner’s program manager, the construction manager, construction trade partners, and our own team of consultants. This assemblage of voices was the creative engine that allowed us to envision a building without precedent.

Toward community-centered care

As we began the workshops, we found that our stakeholder group was also willing to leave all received ideas at the door. We started from the very fundamentals of how the hospital should be organized. A typical urban medical facility follows a predictable “blocking and stacking” arrangement: inpatient departments are stacked on top of diagnostic services, which are in turn stacked on top of outpatient departments at the base. While the arrangement seems logical, an unintended result is that patients as well as providers are often spending time in elevators, moving up and down between these zones.

We asked the group how we could organize a hospital not according to function, but instead around the patient’s personal journey. Using a set of scaled cardboard models, easily reconfigurable to represent various clinics and services, we created a new concept: a hospital arranged not around equipment and departments, but instead broken down into “care communities,” each focused on a specific disease.

This model is particularIy suited to cancer treatment. Unlike in a general hospital, cancer patients make frequent visits, so we sought to create smaller, more efficient, and supportive clinics focused on patients’ needs. Each “care community” functions like a miniature hospital-within-a-hospital: it brings together an inpatient unit, outpatient unit, infusion, diagnostics, and even some procedural spaces, all connected by a two-story communal lobby.

This arrangement not onIy benefits patients, who find a “home” within the hospital, but also clinicians. Specialists can visit both inpatients and outpatients without ever leaving the two-story community. While it may seem like a simple change, it’s a complete reinvention of the building type.

Turning the clinic inside-out

With the big-picture planning in place, we continued the inclusive design process right down to the layout of each of the individual spaces. Working with cutouts of floor plans, we asked the users to show us how to compose the care communities to best serve patients’ needs. A breakthrough moment came when we realized we could turn the typical hospital floor plan inside out.

Normally, outpatient exam floors follow a predictable formula: grids of windowless exam rooms, with clinical offices segregated in the back. Instead, we inverted this layout, placing gracious, light-filled corridors along the perimeter, with efficient exam rooms and clinical space in the center of the floor. The day lit spaces and generous common areas are like nothing you might expect to find in a medical facility. 

That goes for the work spaces, as well — clinicians benefit from an efficient, centralized layout that encourages collaboration. Having designed workplace solutions for many types of organizations, we applied our insight to the medical environment. The result is miles away from the cookie-cutter design of a typical outpatient floor — and we’re convinced it sets a new standard for the industry.

Cancer center as civic resource

In every sense, Emory Winship at Midtown is focused on the communities it serves, and our notion of community extends not onIy to clinicians, staff, and patients, but more broadIy to the city at large. From the outset, we saw this as a civic project, and we focused on the benefits that it could bring to its Midtown Atlanta neighborhood.

Most urban hospitals are self-contained islands, with no relationship to their surroundings. We imagined how a medical facility could become a destination within its neighborhood — a place for wellness, not just a place to go when you’re sick. We worked together with Emory and also with the Atlanta Department of City Planning to envision the hospital as a civic and community asset.

The ground floor of the building is ringed by a mix of uses that you might not expect to find in a cancer hospital: retail storefronts, cafés, and even educational and wellness programs open to the public. Even the main vehicular dropoff is designed in such a way to maintain a human scale and to prioritize pedestrians at street level. It sends a bold message about the role of the medical center within the community: this place is a resource not just for cancer patients, but for everyone.

Cancer research is moving full speed ahead, as researchers and clinicians make advances every day. Institutions like Emory Winship are at the vanguard of the search for a cure. It’s about time that the design of these buildings rises to the standard of the innovative work happening within them. Architects and designers have a responsibility to better serve these institutions — and we’re honored to work with progressive clients like Emory to help raise the bar.

Anthony Treu, AIA, ACHA, LEED, is Associate Director at architectural firm Skidmore, Owings & Merrill (SOM) and leader of SOM's global healthcare practice.

Photo credit: Image © SOM


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