In 2011, Memorial Sloan Kettering Cancer Center (MSK) was acting on a strategic plan to roll out regional facilities in New York\u2019s tri-state area, bringing care and services delivered at its main campus in Manhattan closer to where patients live outside the city. Two had been completed, one in New Jersey and another in Long Island, N.Y., prior to a significant change taking place: the hiring of Suzen L. Heeley as executive director of design and construction for MSK.<\/p>\n
Heeley came to the organization after spending 16 years at New Jersey\u2019s Hackensack University Medical Center, where, as director of design and construction, she helped guide the hospital\u2019s development as it tripled in size and worked to take on big-city competitors. A major component of that strategy was taking risks and pushing the envelope on patient experience, she says.<\/p>\n
But when Heeley landed at MSK, she saw something different in those regional projects being delivered. \u201cI noticed that each location and project had been done well, but each project looked very different. Coming from a hospital that was creating a new brand, I thought it strange that MSK, which already was a very well-known brand, wasn\u2019t creating branded environments in its facilities. I made it my mission as we moved forward to create spaces that have a common thread tying them together,\u201d she says.<\/p>\n
The origination of that common thread largely came from one key project, MSK Westchester in West Harrison, N.Y., and one key collaborator, Mary L. Frazier, principal at EwingCole (New York). EwingCole had already been working with MSK since 2001, but the Westchester site was the first that brought Heeley and Frazier together, launching a nine-year partnership that\u2019s inspired a design evolution in MSK\u2019s facilities and set a new standard for cancer center design.<\/p>\n
One design goal for the Westchester project was to create a new aesthetic that pushed the envelope for cancer care environments but in a way that didn\u2019t feel like a New York City hospital got transplanted to the suburbs. \u201cWe wanted to create elements that were warm, inviting, and friendly, yet had a more elevated design,\u201d Heeley says.<\/p>\n
Part of that process was introducing an aesthetic heavily influenced by hospitality and even some residential design. One striking element is a 35-foot glass wall that serves as a backdrop to the reception desk and beyond, delivering a wow moment upon entry that\u2019s also representative of the community as an abstracted map of the surrounding area. Other highlights include waiting spaces broken down into smaller nodes, public areas that offer variety in seating options such as small secluded nooks and large communal tables, and even an iPad bar (an innovation in its day). \u201cWe started with a number of different ideas that developed a design language that has morphed over time,\u201d Frazier says.<\/p>\n
MSK\u2019s approach to enhancing patient experience was designed into operations and care delivery, as well. For example, at the time, chemotherapy was largely delivered in open bay settings organized around staff stations,<\/p>\n
designed more to serve staff than patients. \u201cThe Westchester site is one of the first where all rooms are private, with views to the exterior and garden spaces,\u201d Frazier says. Additionally, adjacent \u201cmobility zones\u201d were created to support families or for patients to use if they wished for more social interaction during infusion. Exam rooms and consult rooms were also combined into a single exam\/consult space, allowing easier communication between physician, patient, and caregivers. \u201cThat\u2019s an example of the thought processes that transformed this whole built environment design,\u201d Heeley says.<\/p>\n
While many of these solutions are commonplace in healthcare today, MSK was a trailblazer in considering patient experience and how design can better support it. However, taking that leap didn\u2019t come without some pain points\u2014specifically, Heeley\u2019s insistence that design partners challenge the healthcare status quo. \u201cWe, as an owner, push our consultants to a point where we always say, \u2018make us uncomfortable,\u2019 which in turn makes our consultants uncomfortable,\u201d she says.<\/p>\n
Heeley and Frazier agree that it\u2019s been a journey from that original Westchester facility, noting that the two didn\u2019t come to the project with the same mindset at the time\u2014in fact, it took a lot of work. For example, while in agreement that communal tables and variation in seating choices were good starting points, specifying materials that were interesting and different\u2014decidedly not healthcare\u2014took more time, Frazier says. In the end, the firm has been able to embrace products traditionally specified for other environments, such as hospitality, to achieve MSK\u2019s desired look. \u201cWhat I appreciate with MSK is that all they want to ensure is that a design meets their cleaning protocol and is maintainable. And as long as we can do that, we can come up with some very interesting and beautiful environments,\u201d Frazier says.<\/p>\n
The partners also had to work to refine the overall aesthetic of Westchester to achieve what today Heeley describes as \u201cspaces that are timeless, stripped down to the basics, and have good, strong design bones. We don\u2019t have the luxury like hotels to refresh every few years. We live with these things for 10, 15, 20 years, so whatever we put in place, we want to make sure it\u2019s enduring.\u201d That\u2019s meant pushing back on some of<\/p>\n
EwingCole\u2019s original ideas, stripping away some of the detail to achieve a simpler vision: a spa-like neutral palette with lots of wood tones and pops of color introduced in more easily replaced elements like furniture.<\/p>\n
The evolution<\/strong><\/p>\n Westchester remains the favorite for both Heeley and Frazier, setting the tone and design language for numerous follow-up projects including the lauded MSK Bergen in Montvale, N.J. (opened in 2018), and the most recent MSK Nassau in Nassau County, N.Y. (opened in 2019). And while it was a very strong start to their collaboration, solutions have evolved over time.<\/p>\n For example, when planning Westchester, the duo recognized that chemotherapy was changing and unknowns existed on how exactly treatment might be delivered in years to come\u2014potentially in pill form or even within a patient\u2019s home. To ensure chemotherapy\/infusion spaces would remain useful, they were\u2014and continue to be\u2014built using demountable partitions. Additionally, a single room module of 120 square feet for both exam\/consult rooms and offices, also first introduced at Westchester, is now the norm to allow easy reassignment of space in the future.<\/p>\n In fact, flexibility has come to define solutions being delivered today. With their latest collaboration, MSK Nassau, space for the future expansion of each program housed there is already carved out. \u201cIt seems all of these facilities become such local institutions; \u2018if you build it, they will come\u2019 really does occur,\u201d Frazier says. On top of expansion plans in place, the 120-square-foot room module allows academic\/office space to be repurposed for clinical space over time.<\/p>\n Care environments have also evolved to answer the needs of today\u2019s cancer patients and treatment protocols. \u201cPatients in the ambulatory environment are much more acute than they\u2019ve ever been,\u201d Heeley says. For example, the organization is working to ensure its waiting spaces can accommodate several wheelchairs at once, while seat heights throughout MSK are being addressed via a new organizational requirement that chairs have arms to assist patients as they sit and stand.<\/p>\n Also, recently at the Westchester site, shell space was completed to support an emerging \u201ctele-triage\u201d program, allowing patients who have concerns in off-hours to call into a clinician who can direct them to an appropriate next step for care. That location added an urgent care center, too. \u201cCancer patients have such a challenging medical history. Sometimes for them to go to a local emergency department might be a larger and longer process than they might want to go through. They can now go to the urgent care center that has clinicians there 24 hours a day to respond to their needs,\u201d Frazier says. Telehealth is being introduced to the ambulatory sites, as well. \u201cWe\u2019re thinking about what that experience is for patients in telemedicine: If they\u2019re calling in, who are they looking at, what is the lighting level like, how does that potentially make it feel?\u201d Heeley says.<\/p>\n Personalized medicine\u2014treating a person\u2019s genetic makeup rather than simply the disease\u2014is taking a front seat in cancer treatment at MSK, too, calling for new built environment solutions. \u201cFor example, clinical trial spaces are being included in some of these ambulatory care facilities that we didn\u2019t have before. We\u2019re also having to beef up our clinical IT component to be able to track this information. We\u2019re working to cull all of this data, a huge amount of data collection that we do \u2026 we had to build a data center to support that,\u201d Heeley says.<\/p>\n Why not?<\/strong><\/p>\n All of the original elements Heeley and Frazier introduced on MSK Westchester and that continue to be delivered today are inspired by the goal of improving the patient experience, particularly in clinical spaces. \u201cHow do we make this less of a scary place and more spa-like and comfortable, but still provide the clinicians with everything they need close at hand?\u201d Frazier says. Solutions over time have been refined to the smallest of details, such as medical instruments in exam rooms not hanging on a wall but tucked into cabinetry and sharps containers kept out of sight.<\/p>\n And a lot of that has come from Heeley\u2019s insistence on pushing her consultants, including Frazier, to that level of discomfort that she strives to reach, asking the question \u201cwhy not?\u201d \u201cThere have been many meetings where we\u2019re all frustrated because we\u2019re not where we want to be, but without that, we\u2019re not getting to the level we want,\u201d she says.<\/p>\n When thinking about what the pair has accomplished in the past 10 years, Heeley says she looks deeper than simply the work itself but at the finances, too, finding that it\u2019s only \u201cmarginally more expensive\u201d to create the facilities MSK is delivering. And at the end of the day, it\u2019s the patients who are inspiring the provider\u2019s journey to differentiate itself in a world where there\u2019s more choice than ever in where to seek care. \u201cPatients are doing research, talking to friends, and looking online for best options, who\u2019s getting the best outcomes, who has the best care. And they care about what the spaces look and feel like, believe it or not,\u201d Heeley says. \u201cFor us, it\u2019s all about pushing forward and creating the next level.\u201d \uf07a<\/p>\n