momentum VOLUME 1 Issue 3
Skylights and a central staircase provide light and depth to the Memorial Sloan Kettering Cancer Center in Harrison, NY.
⇐ CONTEMPORARY ⇒ CONTINUING
⇐ CONTEMPORARY ⇒ CONTINUING
VOLUME 1 Issue 3
CONTENTS: ⇐ CONTEMPORARY ⇒
Classic Bringing Nature into the Healthcare Environment......... Page 4
Continuing The Future of Healthcare Design............................. Page 10
Contemporary Firm Growth in New York City........................................Page 18
Tall interior plantings provide screens and optimistic, aesthetic benefits.
Bringing Nature into the Healthcare Environment It may be difficult for the modern mind to consider the impact Ralph Waldo Emerson’s 1836 essay Nature made when it’s so easy to picture how green and untapped the United States was only 60 years after its birth. Emerson’s tutelage later inspired Henry David Thoreau’s Walden, a benchmark in American literature and transcendentalism, which famously espoused the healing properties of nature. After nearly two centuries of growth, industry, and development, we’ve come back to embracing that idea. Perhaps nowhere does it seem as pronounced and poignant than in the design of 21st Century healthcare facilities, a field in which EwingCole has proved a leader. In 1984, a hospital was just a hospital: a typically large building for the treatment of the sick and injured, a place built for procedure. But a paper published that year in the journal Science ignited a paradigm shift. Environmental psychologist Roger Ulrich studied
patients recovering from gallbladder surgery at a Pennsylvania hospital and was able to quantify their outcomes. Reviewing hundreds of records over nine years, he determined that patients with views of trees and nature healed faster
Patients with views of trees and nature healed faster and logged fewer complaints than those with views of a brick wall. and logged fewer complaints than those with views of a brick wall. While that seems like common sense now, the quantifiable data was
groundbreaking then. Some three decades later, nature in healthcare design has gone beyond trend—it has become paramount. “The Ulrich study turned a corner,” says Andy Jarvis, EwingCole principal and director of the Healthcare Practice. “What we’ve seen through this [change] is not just new buildings, but new best practices.” Indeed, Ulrich’s work has made an impact. Since 1984, he’s produced several additional studies regarding the role of the physical environment in healthcare, and he’s credited with coining the term “evidencebased design,” a concept which has shaped the approach to designing healthcare facilities by emphasizing evidence from research and evaluations on patients’ relief,
A walkway through Pocono Medical Centerâ&#x20AC;&#x2122;s healing garden provides a meditative, calming environment for patients.
recovery, and well-being. Frequently, that includes views of, and access to, nature.
Sutter Health | Anderson Lucchetti Women’s & Children’s Hospital | Sacramento, CA Sacramento’s historic Sutter Medical Center continues its growth with the opening of this 10-story women’s and children’s acute care center in summer 2015. Wood and woodgrain materials bring the feel of the outdoors inside, and large, back-lit scenes of nature throughout the facility offer a relaxed, comforting environment.
“Even small vistas are meaningful,” says Colleen Harrington, EwingCole Director of Healthcare Interior Design. “When we bring themes of nature indoors—plants, maximized daylight, natural materials—it really reduces stress and provides a more optimistic, therapeutic setting.” Working with, and learning from, some of the top healthcare centers in the country, EwingCole has incorporated natural aspects into its
“Even small vistas are meaningful,” says Colleen Harrington, EwingCole Director of Healthcare Interior Design. “When we bring themes of nature indoors—plants, maximized daylight, natural materials—it really reduces stress and provides a more optimistic, therapeutic setting.” design to connect people to the world beyond the walls of the hospital, providing solace and facilitating healing. Here are four examples where nature and natural elements have driven a successful design.
Pocono Medical Center | Outpatient Cancer Center | East Stroudsburg, PA Surrounded by parking and Interstate 80, Pocono’s outpatient cancer center immediately welcomes the visitor with a healing garden. Opened in June 2012, the grounds prominently feature native plants built into the design—rhododendron and mountain laurel, birch trees, and boulders—which continue inside the facility, bringing the landscape of Pocono indoors.
Northwell Health Center for Advanced Medicine | Lake Success, NY Opened in May 2012, Northwell Health’s sophisticated cancer treatment center breathes new life into the one-time home of the United Nations. This adaptive reuse takes a circa-1940 building, home to the UN while its headquarters were under construction in Manhattan, and reimagines it as an energy-efficient, optimistic environment for patients and staff alike. Skylights and monitors fill the building’s “Main Street” with light, wood slat ceilings mimic trellises, and bamboo plantings both create screens for patients and serve as wayfinding devices.
Memorial Sloan Kettering Cancer Center | West Harrison, NY The newest in Memorial Sloan Kettering Cancer Center’s growing regional network of state-of-the-art cancer care facilities, opened in October 2014, builds on the bones of an existing 1950s office building. A new addition establishes a primary spine through the building and includes an airy, two-story lobby. The lobby, envisioned as a Garden Room, uses vegetation, skylights, and natural materials to blend the experience inside with that of the landscaped gardens and meadow outside. Themes of the Garden Room, including smaller courtyards, skylights, and natural materials, continue through the medical treatment areas.
The Future of Healthcare Design Hospital. On its own, the word might conjure images of nurses pushing patients on stretchers down fluorescent-lit halls to the sound of beeping monitors. But those images are changing, as 21st Century facilities build themselves around 21st Century medicine and technology, and not the other way around. “If you have a hospital designed in 1956, you’ll be forced to practice medicine the way it was in 1956,” observes Mary Frazier, EwingCole principal. “Design used to be about the organization of space. But now, we begin design with an understanding of clinical processes. Because clinical process will dictate space.” This shift has been advanced by the Patient Protection and Affordable Care Act (PPACA), enacted in March 2010. In order to drive the delivery of affordable care, clinical processes have to be more efficient. And the most conspicuous gauge of efficiency comes from HCAHPS results. Patients rate their hospital and healthcare experiences with a standardized survey called HCAHPS: Hospital Consumer Assessment of
Healthcare Providers and Systems. Their results, made available to both the providers and the public, determine strengths and weaknesses in the provider’s performance and facilities—and compel them to improve where necessary, especially since their competition faces the same scrutiny. Moreover, the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees hospital reimbursements, has shifted from a volume-based model to one based on quality. That is, the CMS rewards healthcare providers for higher HCAHPS scores. It makes sense, then, if a higher HCAHPS score is the very definition of patient satisfaction, patient satisfaction must drive the design process. With the patient in mind, EwingCole’s Healthcare team considers two critical criteria.
DESIGN TOUCHSTONES In effect, the principles of anticipatory nausea and the placebo effect are the opposite sides of the same coin. In the former, if you see things that remind you of your sickness, you’ll get sick; likewise in the latter, if you’re in a more optimistic environment, you’ll have a more optimistic outlook. Especially in the case of chemotherapy, where the phenomenon occurs in up to 80% of patients (National Cancer Institute, 2015), prevention of anticipatory nausea is paramount. Oncologist Vincent DeVita, whose new book The Death of Cancer provides a doctor’s firsthand experience in fighting the disease, discussed this on NPR’s Fresh Air. “The minute I walked in the room, [patients] would vomit—it was like a Pavlovian dog,” he told host Terry Gross. “We used to have a van
Vibrant, positive colors pop in a flood of natural light at the SUNY Upstate Cancer Center.
A great view to the outdoors is carried inside, with plantings, wood finishes, and a giant backlit photo of a local waterway at Memorial Sloan Kettering Cancer Center.
As healthcare design shifts around processes and procedures, nurses are never too far away from what they need.
that would drive patients back to the hotel where they were staying. And most of them wouldn’t take it because they would get sick on the van.” The EwingCole Healthcare team recognizes the need to minimize visual triggers. “We don’t want this place to announce ‘healthcare,” Frazier says. “So we remove or hide things we call “medical artifacts” that remind you you’re in a hospital, and instead, provide amenities to put you in a better place and take your mind off your sickness.” Thus the placebo effect: a more positive environment can actually train the mind to feel better. To that end, incorporating nature—actual green space and natural materials—has become essential, and they’re built into the cost up front. “When you walk in there’s a lot of light that shines through the window, you can see the garden, and you feel like
you’re in a place that’s going to take care of you,” says Chau Dang, Chief Medical Oncologist, in Memorial Sloan Kettering Cancer Center West Harrison’s introductory video. West Harrison is one of seven regional facilities EwingCole has helped MSKCC bring online since
“Together, we’re not just developing new buildings, but also new best practices.” they started expanding outside of New York City some 20 years ago. [See previous story: Bringing Nature into the Healthcare Environment] NEW BEST PRACTICES It certainly helps when your clients are the leaders of a rapidly evolving industry. “Each of these providers hires
us as co-inventors or co-conspirators,” says Andy Jarvis, EwingCole principal and Director of the Healthcare Practice. “They know more than architects know about how to deliver high tech care or cancer care. And they know we understand their game plan and help lead it. Together, we’re not just developing new buildings, but also new best practices.” With great pressure on hospitals to make things more friendly and less expensive for patients, healthcare design is best led through a processbased approach, with constant input from industry professionals: doctors, nurses, and consultants. “I like designing for healthcare because it makes you use analytic and critical thinking skills—it’s not just about choosing colors and materials,” says Lyudmyla Matyushko, EwingCole interior designer “We work with equipment consultants to make sure
MRI equipment is correctly placed and the room is designed around it accordingly. And each time an MRI machine or ultrasound diagnostic equipment is upgraded, you have to fit them appropriately within the facilities.” Efficiency also drove the design at the Northwell Health’s Zuckerberg Pavilion Medical / Surgical Unit Fitout. Working closely with Northwell Health staff, says Jim Wolters, EwingCole principal, “we determined that a nurse spends at least 70% of their time face to face with a patient in their room. So you have to organize space around the nurse’s time to allow that to happen.” To do that, the team mapped out what the nurse does when they’re not in the patient’s room—when they have to retrieve supplies, when they have a private conversation with the doctor, when they have to use the bathroom. “We looked at the processes of the nurse and recognized the need to put everything he or she does within a few footsteps of the patient’s room, so they’re never far away.” And then there’s one technological advancement which not only determined a space, it eliminated it altogether. At MSKCC West Harrison, the reception desk is gone. Instead, a concierge welcomes patients with an iPad to check in and a badge with a tracking device. This, along with the doctors’ and nurses’ tracking devices, allows transponders wired throughout the building to know where everyone is at any given time. In turn, the greeter can immediately say, “you don’t need to wait, Exam Room 4 is clean and available, and Dr. Smith will be in to see you shortly.” PREVENTIVE CARE INFLUENCING DESIGN Perhaps the most pronounced departure from the old model is one that, in a sense, works against the profession itself: preventive care. The optimistic approach to contemporary healthcare design makes it less about treating disease and more about preventing them. “This is very important, especially in underprivileged areas,” explains Jarvis. “It’s not enough for a physician to say,
Even deep inside the SUNY Upstate Cancer Center, optimistic colors and natural scenes soften the often hard realities of a healthcare facility.
The Stephen and Sandra Sheller 11th Street Family Health Services Center provides preventive health services and includes a fitness center (inset).
‘you need to watch your weight and eat better.’ Now you need to build in space to manage that.” At Drexel University’s 11th Street Family Health Services in Philadelphia, for example, there are programs on how to cook nutritious food, how to have a better balanced diet, what kinds of exercise you can do, and a fitness center to try them out. And it’s incentivized: qualified patients can receive insurance discounts for good Body Mass Index (BMI) ratings, similar to nonsmoker discounts. Despite the dramatic shift and the trend toward the optimistic, there’s still an uncertainty in the future of healthcare itself. While technology continues to advance, so too does the healthcare industry itself, with mergers and acquisitions, and intense competition.
That’s why new best practices are so important to identify, as they drive efficiency, and efficiency drives patient satisfaction. And patient satisfaction, after all, defines the delivery of quality healthcare. Outside influences like the economy and politics can affect performance as well. The PPACA itself stands at risk to the whims of Washington. That’s why new best practices are so important to identify, as they drive efficiency, and efficiency drives patient satisfaction, which after all, defines the delivery of quality healthcare.
Work in progress: Expansion of EwingColeâ&#x20AC;&#x2122;s New York office.
Firm Growth in New York City There was no ribbon cutting when EwingCole opened the doors to its Manhattan office, considering the firm had already been working with clients in New York for 15 years prior. And what began as a small, logistical necessity has quickly outgrown its space. EwingCole’s New York office will double its size, fostering further growth of the Healthcare practice. “Our work here actually began back in 1998, with The Morgan Stanley Children's Hospital of NewYorkPresbyterian and Memorial Sloan Kettering Cancer Center’s first
freestanding building outside of Manhattan, on Long Island,” says Andy Jarvis, EwingCole principal and director of the Healthcare Practice, whose team made the trips from Philadelphia as needed. “When two different clients said to us, ‘it would be even better if you were here in New York,’ we agreed.” With a modest, workmanlike buildout, EwingCole’s New York
⇐ CONTEMPORARY ⇒
Mike Hoak and Lyudmyla Matyushko review plans in EwingCole’s New York office.
office opened on the 14th floor of 14 Penn Plaza. Designed by the early 20th Century New York firm Schwartz & Gross, the building opened in 1925 as the Pennsylvania
The central location is key to the office’s success. “We’re kind of at the center point between design showrooms, clients, and consultants,” says Mike Hoak, EwingCole architect. “We’re very
We’ve got a group of really talented, creative young designers who recognize the importance of bringing that talent to people who are sick and their caregivers, it’s difficult to find people who are passionate about both design and healthcare. Building, its name borrowing from the famous train station by McKim, Mead & White directly across 34th Street. After the station’s demolition, the name changed to 14 Penn Plaza, becoming a de facto part of the redevelopment that brought about the current station and Madison Square Garden.
close to Chelsea and other Midtown places that are design-oriented, so we’re never too far away if you need something that day.” Considering the industry’s growth and continued evolution, it’s wise to have a healthcare-specific office in America’s largest metropolis, where
some of the best providers draw talent from across the globe for new approaches to healthcare. On a small scale, the EwingCole office represents the diversity that makes New York, New York, bringing in young talent and minds for new approaches to healthcare design. “We have a diversity here represented by people from different nations and different backgrounds, and that’s very important [in this industry] because
everyone brings in something from their own culture,” notes Lyudmyla Matyushko, a EwingCole interior designer and native of Ukraine. “It’s very New York.” Where the diversity seems most pronounced, though, is through the tasks each team member carries out. “Something that’s really great about this office is, every designer—architects and interior designers—is multifunctional, multitalented,” says Jarvis. “You don’t want someone getting stuck early in their career being good at just rendering, or construction drawing, or space planning. You gotta mix it up and grow in a very balanced way, and this group has seized on that, becoming well-rounded as their careers advance.” “This is not a common thing in architecture firms,” says Matyushko. “Often you get stuck doing one thing, but because we’ve grown from a small office, we’ve cultivated a culture where everyone is doing everything.” Especially in the field of modern healthcare, that requires hands-on coordination and collaboration with the providers, which again, makes New York such an important location. “In
most cases, we are getting direction from our clients,” says Xiao Chen, EwingCole designer. “Memorial Sloan Kettering Cancer Center, for example, has a clear direction about how they want to approach their facility. This helps us grow the concept and deliver exactly what they need.”
Hoak agrees: “The collaborative approach to healthcare design teaches you how to successfully execute a beautiful design under very strict parameters.” Jarvis, who joined EwingCole in 1983, is proud to watch the team he leads grow in New York. “We’ve got a group of really talented, creative young designers who recognize the importance of bringing that talent to people who are sick and their caregivers,” he says. “It’s difficult to find people who are passionate about both design and healthcare.” After the last hire, when the office definitively ran out of space, it became apparent that EwingCole has a team full of them. And with an expansion of the New York office, that team is growing.
Andrew Jarvis Healthcare Practice Leader
Mike Hoak Architect
Lyudmyla Matyushko Interior Designer
EwingCole’s first project in New York City – The Morgan Stanley Children's Hospital of NewYork-Presbyterian.
Xiao Chen Designer