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First Things First
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First Things First

?When a patient finds out they have cancer, their mind starts to race and there are all different kinds of emotions that emerge. Some people become very determined. Some become angry. Some become confused. Some become hopeless and depressed. But at 10 am next Tuesday, they all have to go to the radiation center, whatever their feelings are,? said Edward J. Kaplan, MD, medical director of 1st Line Oncology, Coconut Creek, Fla.

Unfortunately, until recently, treatment environments often mirrored these emotions. Sterile atmospheres, rundown facilities, and intimidating machinery often contributed to a patient?s anxiety and concern. But it doesn?t have to be that way.

Research in evidence-based design has shown that improving the atmosphere and/or layout can positively impact both the quality of patient care and the facility?s financial performance. A review of the relevant literature by Ulrich et al concluded, ?Well-designed physical settings play an important role in making hospitals safer and more healing for patients and better places for staff to work.?¹

Research in evidence-based design has shown that the right setting can positively impact patient outcome as well as financial performance.

Kaplan did not know about this research when he designed and decorated 1st Line, which opened in August, but he did know he wanted to build a facility that would make people feel good. ?To me, when people are sick, they really seek and need to be somewhat coddled, or at least handled more gently. They are not looking for a sterile environment. They are looking for nurturing,? said Kaplan.

So Kaplan designed a facility that would ease patients? anxieties using himself as a guide. ?I asked myself, ?How does that make me feel?? Everybody might agree the Mona Lisa is a nice piece of artwork, but it might not make them feel good. I decided that it was important in the cancer environment to lay the palette out to make people feel good,? said Kaplan.

The Palette

Although some of the floor plan was predetermined by requirements for the radiation therapy equipment, Kaplan essentially had a blank canvas?the facility was new construction built to his specifications, which mirrored a luxurious spa. Every detail from the coffee maker to the linear accelerator was designed with the patient?s comfort in mind.

The waiting room features complimentary Wi-Fi Internet access, large flat-screen televisions, a coffee/espresso-maker, and comfortable seating. Design elements incorporate iridescent tiles, faux glass, faux wood flooring, and push-button doors. Infection control measures include easily accessible sinks (near the door rather than the back of the room) and hands-free technologies (eg, sinks and towel dispensers).

?There are certain things we can?t do,? said Kaplan, noting water effects and fragrances can irritate patients with full bladders or chemotherapy-induced nausea. ?But that doesn?t limit us,? he added.

The Canvas

Cost did not prove to be a large limitation either. ?The path of least resistance is to go with contract-grade materials, but I don?t think it costs a whole lot more,? said Kaplan.

Design elements, such as paint and flooring, may require a slightly larger investment, but not excessive. ?Paint is paint, and the color you choose is up to you,? said Kaplan.

Some decisions reflected dual purposes. For instance, glass panels on the office doors not only add a design element, but also provide benefits in lighting, security, and communication.

Kaplan did turn to a decorator two-thirds through the project to help him find the elements he envisioned. ?I didn?t have access to the styles and the resources that reflected what I wanted. I knew what I wanted, I just couldn?t find it anywhere,? said Kaplan.

The Brushes

Kaplan did find he had options in terms of the technologies he wanted to bring in and chose those he felt would accommodate his vision and the center?s workflow. Equipment was selected with an eye not only for performance and functionality but also for the patient experience.

Rather than select a leading linear accelerator, Kaplan acquired one from a smaller firm, Sweden?s Elekta, that he felt offered an improved experience. Because the system (the Elekta Synergy) incorporates a room partition, the patient does not need to be exposed to a cold treatment room or an intimidating machine. Upgrades can be handled simply through software, without requiring significant downtime or labor; maintenance can be managed remotely.

The entire office, in fact, is digital, with films and files completely electronic. ?We never lose a record. We have no clutter. And we have instantaneous access to patient files,? said Kaplan.

The Masterpiece

The result is a center that patients and staff want to be in. Kaplan recounts numerous instances of positive feedback?from patients, clinicians, vendors, and even hospital CEOs.

Patients are less distracted and able to absorb what they are told as well as ask intelligent questions. They are more relaxed and fidget less, making setup easier, exams smoother, and treatment more consistent.

The resulting buzz is a marketing boon. ?I think that by enhancing the facility, it establishes an identity for us,? said Kaplan. He envisions a center serving both domestic and international patients. Located near three airports, the spa-like facility could become a destination for medical tourists from Central America, South America, and the West Indies.

It could also become a new model for oncology centers. With organizations, such as The Center for Health Design and Planetree, Derby, Conn, expanding the research and awareness of evidence-based design, more centers may follow Kaplan?s lead in putting first things first.

?Renee Diiulio

Reference

1. Ulrich RS, Zimring C, Zhu X, et al. A review of the research literature on evidence-based health design. Health Environments Research and Design Journal. Summer 2009;1:3.