How Co-Creation Redefined the Cancer Center Design Process

  • July 30, 2015
  • Author: Tonia Burnette

In my last post I wrote about an innovative, collaborative approach we took in designing the new UW Cancer Center at ProHealth Care (Figure 1). Using a health-centered approach helped us assure that every design decision was rooted in a comprehensive understanding of how it would impact the health and well-being of every patient, clinician, staff member, and visitor. By elevating the role of both patient and staff in the design-process, we were able to co-create a space that promotes health, wellness, and restoration. While my last post focused on the role of the Patient Advisory Group, today I want to share how creating a “Whole Person Health Design Team” impacted our design solution.

ProHealth_Exterior

Figure 1: Both Patient Advisory Groups and a “Whole Person Health” design team consisting of staff that spend a majority of their time with patients worked along CannonDesign’s design time to co-create the new UW Cancer Center at ProHealth Care.

An Elevated Role for Patient-Oriented Staff

While most design processes incorporate interviews with a broad range of stakeholders and departments that will be using the new building, staff who spend most of their time with patients are often spoken to in isolation about the aspect of the project that most strongly relates to their particular role. For example, registration personnel are asked about the registration desk. Social workers are asked about their offices. But that isn’t really where they work. They interact with patients in an array of different environments throughout the building. Grouping these departments under the word “support” and only seeking their input in siloed user groups does not do justice to the important role they play in patient care.

Recognizing this, we identified the staff who work with patients in multiple settings, people who spend the most time with patients – patient/family support, cancer center intake, social work, rehab services, lobby personnel, clinical research, palliative care, complimentary/alternative medicine, food and nutrition, survivorship, patient education, and prevention/cancer control – and formed them into a design team. This team was collectively responsible for identifying how to make the patient experience the best it could possibly be and how to create the best environment possible for every person in the new facility.

Renaming this group the “Whole Person Health Design Team” sent the message that this group was to take on responsibility beyond giving individual input about a singular location. Instead, they were encouraged to use their vast experience in multiple healthcare settings to help design an environment focused on health…whole person health.

A Layered Environment of Discovery and Surprise

There were numerous discussions about the number of times a cancer patient will visit a Cancer Center during the course of their treatment…more than 100 times.  The Whole Person Health Team helped develop the concept that each visit should present the opportunity for a new experience, a small surprise, a moment of respite. This concept became ubiquitous throughout the new Center.  There are numerous points of discovery where natural light, multi-story spaces, subtlety changing colors, and quiet nooks create a dynamic environment (Figure 2).  At the recent opening of the Center, I came upon a group from the team as they were excitedly discussing the numerous “discovery moments” and how much they would be appreciated by patients, visitors and staff.

ProHealth_Lobby

Figure 2: Throughout the new cancer center, natural light, multi-story spaces, subtlety changing colors, and quiet nooks create a dynamic environment that allows patients to discover something new in the space every time they visit.

Creating Greater Function Based on Experience

ProHealth_Living Room

Figure 3: The living room is an infusion area that offer patients control over their environment with options for varying levels of privacy that include private rooms, semi-enclosed bays, or small clusters.

The team worked collectively to bring forward great ideas about what would be most helpful for their interactions with patients in various settings. For example, when we were designing the “living room” (Figure 3) in the new facility – an infusion center option that provides an array of different settings for receiving treatment in intimate clusters – it was this team that identified the need for privacy nooks adjacent to the space. These lounges can be used to have sensitive conversations (e.g. about financials) as opposed to having to use a private room for this function.

Healthy Behaviors Take Priority

When it came down to finalizing the location and size of key programmatic elements of the space, the team advocated for keeping the Rehab Center as the center of activity in the building and expanding the role it plays to also offer prehab services. We took that back to the executive team and made sure they understood how vital the location of this element was to encouraging cancer patients to participate in prehab and rehab before, during and after their treatment.  By having this space central and visible, patient use will be increased, which evidence shows reduces overall length of treatment and improves overall health.

The health of staff was also a focus of this group.  Access to off-stage respite spaces and fresh air are critical to the clinicians who face stressful and heart-breaking situations every day.  Every staff lounge has access to a private outdoor patio.

There were numerous other examples like this throughout the process that demonstrate the tremendous impact of co-creating with the whole person health team. As a result of working with both this team and the Patient Advisory throughout the design process, the cancer center is truly transformative in both operations and design – with one informing the other in very fluid ways.

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Elevating Patient Engagement to Improve Whole Person Health

  • March 31, 2015
  • Author: Tonia Burnette

At the 2015 American College of Healthcare Executive Annual Meeting earlier this month, I had the opportunity to present alongside Ken Price, ProHealth Care, and Whitney Austin Gray, Well Building Institute, on the lessons we are learning about cost containment in designing ProHealth Care – which is scheduled to open later this year.


Form Follows Experience

The first step in partnering with ProHealth Care, based outside of Milwaukee, WI, to design its new, freestanding ambulatory cancer center focused on defining performance goals and exploring how the design of the building could help achieve these goals. Two of ProHealth Care’s main focus areas  included reducing the costs of cancer care and promoting whole person health for all patients. Our exploration quickly uncovered these two are intrinsically linked. The best way to drive down the cost of care is to develop strategies that enable patients to avoid ED visits, inpatient stays and missed clinic appointments while also helping them develop strong support groups and increase their strength during chemo treatment. These collective efforts enhance the quality of care for patients and improve overall health and wellness.

The best way to drive down the cost of care is to develop strategies that enable patients to avoid ED visits, inpatient stays and missed clinic appointments while also helping them develop strong support groups and increase their strength during chemo treatment.

The result is a design emulating the idea that form doesn’t follow function, form follows experience – a cancer center designed from the inside out.  Together with ProHealth, we are collecting data to help us see whether this premise – that the use of health-centered design approach can help contain cancer costs – is validated by the outcomes ProHealth realizes after they occupy the building later this year.  While time will tell the ultimate impact of this approach on cost-containment, we have already seen the impact of this approach on the patients, staff and physicians as well as the design solution.

So what did we do differently with ProHealth and how did this impact the design? Two of the most impactful steps we took were:

  1. Reimagining the structure and engagement-level of the Patient Advisory Group, and
  2. Creating “Whole Person Health Design Team.”

In today’s post, I’m going to focus on the elevated role the Patient Advisory Group played throughout the design process.

Engaging Patient Advisory Groups

Patient Advisory Groups are one of my favorite aspects of my job. I’ve done many of them and they area great chance to meet those most impacted by the space and see issues from their perspective. However, the amount of new information you get from these is typically fairly minimal and can focus on comfortable furniture, better wayfinding, etc. That said, when we met with the cancer survivors, current patients, and family members that formed the Patient Advisory Group at ProHealth we approached it very differently. We started with a presentation on whole person health and asked them to help us define what whole person health means in a localized context. We know what it means to be a whole, healthy person in Waukesha, Wisconsin is different than what it means in Phoenix, Arizona or New York City. So we asked this group to define for us what whole person health means in their community.  They were transformed from their role as “sick people” into champions for making the community healthier.

Exam Consult RoomOne of the best examples of how this group influenced the design was in the creation of Multi-D Day Suites. We identified with the Patient Advisory Group that Multi-disciplinary Days – where patients come in and have more than one consecutive meeting with different specialists – can be exhausting for patients and therefore patients opt out of this superior care model.  They challenged us all to think about transforming that experience, instead of shying away from it. As a result, we transformed the consultation and exam room into a connected “Multi-D Day Suite” – allowing patients who have examinations and consultations with members of their multidisciplinary team (e.g., physician, navigator, social worker, nutritionists, financial counsellors, etc.) to stay in the their suite for these appointments with comfortable space for them and their families. When not used for a Multi-D Day visit, rooms can be used separately for individual exams and consultations.

Another important example is the creation of respite spaces for staff. The Patient Advisory Group’s definition of Whole Person Health included the following:

  • A need for peaceful environments without negative distractions from activity and noises.
  • A need to be able to internally focus, meditate, reduce stress, and support healing

The group was adamant these requirements apply to not only patients and their families, but also their care team.  As a result, we developed private outdoor patios directly accessible from every staff lounge that are isolated from patient outdoor areas.  These areas provide fresh air and respite for caregivers that work in very stressful professions.  The patients are very proud of their role in providing this gift to those who have taken such good care of them.

These are just two of the innovations that this group helped us develop after we empowered them to have a voice in the design process. It demonstrates the impact of taking a health-centered approach to design and how it can dramatically impact solutions. In my next post – I’ll share about another strategy we used – the “Whole Person Health Design Team” which was made up of staff that has interaction with patients in multiple settings on a daily basis.

Read PART 2: THE WHOLE PERSON HEALTH DESIGN TEAM >

Learn more about the UW Cancer Care Center at ProHealth Care >