Cancer centres: Designing for wellbeing and improved outcomes

Jonathan Wilson of Stantec discusses the factors affecting cancer centre design and how these can be addressed through innovative design concepts and specialist healthcare design expertise

The design team needs to understand how a proposed facility fits into the wider system, as well as its own specific requirements, in order to provide an effective design solution

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

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, impacting 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.

Collaboration and best practice are vital considerations

Consultation is key

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, 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, the design team needs to understand how a proposed facility fits into the wider system, as well as its own specific requirements, in order to provide an effective design solution.

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.

The design process is iterative, and consultation is required throughout in order to test the suitability of the design to user requirements.

Futureproofing the design of cancer centres is of particular relevance due to rapidly-changing treatment regimes and technologies

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.

Collaboration and best practice

21st- 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. And, 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.

BIM is now used as an effective communication tool in the consultation process. Design teams 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.

Technology is forever changing, so cancer centres need to be designed to be flexible

Wellbeing and outcomes

Successful design of cancer treatment centres must both support patient wellbeing and improve outcomes.

Integrating advanced treatment with a holistic patient-centred emphasis on care is the touchstone of cancer centre design

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.

By Jonathan Wilson, principal and healthcare sector Lead at architectural firm,Stantec

A good client ‘brief’ is service led, from the service context to services provided in the facility, the patient categories, and clinical pathways

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