AT DIGNITY HEALTH ST. JOSEPH’S HOSPITAL AND MEDICAL CENTER
AT DIGNITY HEALTH ST. JOSEPH’S HOSPITAL AND MEDICAL CENTER
AT DIGNITY HEALTH ST. JOSEPH’S HOSPITAL AND MEDICAL CENTER
PROJECT GOALS The underlying goal for this project was to bring the highest standard of cancer care to Phoenix.
LEFT The architecture
reflects the culture and character of the community, with materials that conform to the environment.
The University of Arizona Cancer Center (UACC) is the only National Cancer Institute-designated comprehensive cancer center in Arizona. In order to expand their reach, The UACC teamed with St. Joseph’s Hospital and Medical Center, part of Dignity Health, to bring cancer care to central Phoenix. The Center is located on the Phoenix Biomedical Campus (PBC), a 28-acre medical and bioscience development for medical education and innovation situated in the downtown center, thereby adding a clinical healthcare component to the campus that will enhance the synergy between the cluster of bioindustry organizations located there. The new 220,000 SF UACC is intended to deliver the highest standard of care within an evidence-based, multidisciplinary model, using the most modern technologies.
The building program includes spaces for radiation oncology, diagnostic imaging, endoscopy and interventional radiology, exam and procedure rooms, a support and wellness center, infusion, a clinical laboratory with a research component, a clinical pharmacy, and a healing garden.
N. 4TH STREET
E. GARFIELD STREET
THE UNIVERSITY OF ARIZONA CANCER CENTER E. PIERCE STREET
E. FILLMORE STREET
PHOENIX BIOMEDICAL CAMPUS Biosciences Partnership Building Health Sciences Education Building E. POLK STREET
COLLEGE OF MEDICINE
ABC 1
Building 1 E. VAN BUREN STREET
Building 4
N. 7TH STREET
N. 6TH STREET
Building 2 Building 3
N. 5TH STREET
N. 3RD STREET
Translational Genomics Research Institute
N
SITE CONTEXT The new UACC represents the first clinical healthcare component on the PBC.
LEFT The UACC is the
anchor at the north end of the PBC.
The UACC is located on the northwest block of N. 7th and E. Fillmore Streets, on the north side of the PBC. The site was organized to emphasize the user experience, integrate the natural beauty of the landscape, and address the needs of The UACC staff and patients for access to parking and amenities. Certain program elements, with specific requirements, guided the configuration of the building on the site. For instance, by locating infusion services on the north side of the building and elevating it to the second floor, patients undergoing treatment enjoy unobstructed views of the mountains to the north. Placing the drop-off / entrance to the building on N. 6th Street—a less traveled thoroughfare along the west side of the site—alleviated traffic congestion concerns on the busier E. Fillmore Street and created a better in-andout experience for patients with self-
parking located across E. Fillmore Street. Radiation vaults, which require additional shielding, were placed on the first floor and adjacent to an area available for future expansion of the building. These factors helped to shape the massing of the building. The design team was able to utilize the landscape and architectural features to provide shade, and to create a comfortable pedestrian experience within a walkable campus context.
The UACC offers a combination of translational research and exemplary patient care.
LANDSCAPE FEATURES Native desert plantings in a healing garden and around the building perimeter create connections to nature.
LEFT A healing garden
with native plantings is accessible just off of the main lobby, offering a natural, restorative environment for users.
Based on research and studies that show nature as being restorative, the landscape around the building was designed to be therapeutic. A comfortable pedestrian environment was developed along the perimeter sidewalks that is both welcoming and blends with the walkable downtown context. A healing garden located adjacent to the main lobby opens to an outdoor gathering plaza for large events. Smaller group areas and benches within the garden, and just beyond, provide privacy and the opportunity for reflection. This area is planted with Palo Brea trees and softer plants that attract wildlife to create a shaded and pleasant environment for patients and staff. In order to provide privacy for the ground floor program, the plaza and gathering areas of the garden are held away from the west side of the building with a cactus garden and bioswale. The bioswale is
served by the building’s roof drainage during a rain event, and filters water into underground pipes that nourish the rest of the garden. The sidewalks are also planted with Palo Brea trees to provide shade for pedestrians. The seeded / rocky areas adjacent to the sidewalks help redirect and drain stormwater through the bioswale.
A seating area outside the cafĂŠ and near the garden can be used for dining or quiet reflection.
ARCHITECTURAL DESIGN Perforated copper-colored panels envelop the building as if to symbolize a protective layer of warmth and healing to those within.
LEFT Glass, metal, and
stone at the façade give identity to the building, yet function well in the hot, dry climate.
A deliberate layering of glass, coppercolored metal, and neutral stone forms the building’s architectural expression, which directly relates to the patient experience—their comfort, privacy, and warmth—while simultaneously establishing the building’s unique identity on the campus. A canopy over the dropoff ingress provides protection from the sun and rain. Travertine stone, which matches the desert palette, gives scale to the pedestrian environment and grounds the building. This stone flows inside to the main waiting spaces, bringing the outside in. The waiting areas on each floor are expressed on the exterior as a glass volume that rises through the center of the building, articulated with horizontal glass sunshades, with a dense frit that protects occupants from the glare of the sun. Because the sun interacts differently with every side of the building,
the double façade on the east and west is cloaked in an outer layer of folded, perforated metal sunshades that protect the exam rooms and offices from the glare of the morning and evening sun, helping to control heat gain and providing a sense of privacy, while still allowing for unobstructed views. These shades also represent a metaphoric blanket around the building, signifying a protective layer of warmth and healing for occupants. The north and south façades of the building are comprised of glass, and provide views to the mountains to the north and the campus buildings to the south. Horizontal sunshades on the south façade block the afternoon sun.
The rhythmic placement of folded copper-colored screens on the east and west faรงades not only serves as a shading feature, but also creates a unique identity for The UACC.
LEFT A protected outdoor
patio can be used for special events.
RIGHT The building offers
a unique expression at every elevation.
INTERIOR ENVIRONMENT Materials and furnishings used in the interior infuse this healthcare facility with warmth and hospitality.
LEFT A travertine stair
connects the first floor lobby with the second floor waiting room, check-in, a pharmacy, and access to other services.
The look and feel of The UACC’s interior environment more closely resembles a hotel or spa, with an elegantly designed lobby, floor-to-ceiling windows, valet parking, and a coffee bar. Travertine stone, in a variegated palette of creams, tans, and browns, used at the exterior building base was carried through to the interior public spaces, uniting all aspects of the building and creating connections to the desert backdrop. At each level, the public elevators open to a wood feature wall with an oversized graphic numeral in contrasting wood tones to highlight the level being accessed. Public restrooms tuck discretely behind these wood walls. Large waiting lounges on each floor, in close proximity to the elevators, are carpeted and appointed with chairs and sofas in mostly light neutral hues. A unique sense of transparency was achieved through the use of slatted
wood divider walls and a mix of clear and etched glass in the lounges and at check-in on the second floor. While the clinical spaces are more representative of medical facilities, the neutral palette is continued, binding the entire facility together. All of the exam and treatment rooms have access to daylight, which is supported by the floor-to-ceiling windows on all sides of the building. Those façades that receive the harshest sunlight rely on a series of see-through exterior screens to help maintain patient comfort.
Floor-to-ceiling windows bathe the main lobby in daylight, adding to the sense of openness and connection to the outdoors.
MEDICAL PLANNING Careful planning and organization of clinics and associated treatments reduces travel distance and time within the facility.
LEFT Radiotherapy
delivers high-energy radiation, usually x-rays, via a linear accelerator to damage cancer cells. The new UACC has two such machines, both of which are equipped for Image Guided Radiotherapy.
Designing a facility around patientcentered care, using a research-driven, evidence-based, multidisciplinary, and disease-oriented model of care was the overarching goal during the entire planning process. Careful attention was paid to the flow of patients, staff, and materials to support the most efficient delivery of care. Moreover, providing team-oriented spaces in close proximity to patients, in order to promote collaboration and research, was the driving factor in the layout of each department. By using Lean design principles, staff and patient travel distances within the facility were reduced, thereby improving the overall patient experience. Patient safety was also evaluated, with solutions that will alleviate patient falls, reduce unnecessary noise, and incorporate infection control best practices throughout the facility.
The overall planning of the building was focused on organizing departments by disease site. Due to the level of mobility of some of the cancer patients, travel distance to access services was carefully considered. The large, 48,000 SF floor plate made it particularly important to collocate complementary services on each floor so that patients can be treated with the highest level of compassionate, comprehensive clinical care. Wherever it was feasible, an on-stage / off-stage approach was implemented. For instance, the staff entrance and elevators are separate from the patient entrance and elevators, with staff having a back door entrance to all departments. This helps relieve congestion and facilitates quicker movement through the facility.
ABOVE The imaging
equipment that supports the various modalities, such as the CT scanner shown above, were concealed behind copper-colored laminate doors, which emulate the perforated screen on the exterior. RIGHT Registration is
located on the second floor off of the main waiting area, yet offers privacy.
Traditionally, Radiation Oncology is located in the basement. For this project, the goal was to move Radiation Oncology out of the basement to bring healing daylight into the department. While this presented challenges, it also resulted in a unique planning strategy for the building. By locating Radiation Oncology on the first floor along with other services, such as the loading dock and the heavy imaging modalities—MRI, PET / CT, and Nuclear Medicine—the retail and public functions were then moved up to the second floor, thus making that floor the primary public access point. As the nerve center for the building, the second floor lobby required a clear connection with the entrance lobby for public wayfinding. The solution was an open atrium and grand
stair adjacent to the reception and lobby area. With the Radiation Oncology linear accelerator vaults necessitating a high 18-foot floor-to-floor height, this large atrium was easily achieved.
1
LEVEL
C A D
B E
A Welcome Desk B CafĂŠ C Radiology D Dry Research E Radiation Oncology
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Design excellence is reflected in every aspect of the building.
ABOVE The lobby layout
offers clear pathways to a welcome desk, a cafĂŠ, and a radiology suite, as well as access to upper floors.
Upon entering the building, one is greeted by an open atrium to the right and a welcoming, more intimate, reception area with check-in kiosks to the left, where returning patients can check in electronically and receive their appointment schedule. From there, one can either use the stairs or the elevator to attend to the day’s first appointment. First-time visitors check in at the reception desk to receive instructions for their appointment and be directed to registration on the second floor. A healing garden adjacent to the main entrance of the building is visible from the main lobby, providing patients and staff access to the natural environment.
All of the elevator lobbies on the upper floors open onto generously-sized waiting areas, from which all departments can be accessed. These spaces have large floorto-ceiling windows looking south to allow as much natural light into the building as possible. These main waiting spaces also have a nutrition area and various seating options for those waiting for a patient to finish treatment.
2 LEVEL
A
C
B D E
F G
A Infusion Therapy B Registration C Pharmacy D Boutique E Survivorship Program F Laboratory G Administration
N
Waiting areas are both peaceful and elegant.
ABOVE The idea behind
the interior design was to create comfortable spaces—both public and private—to lend a sense of security and tranquility.
The second floor contains all of the public activities, such as registration, a boutique, meditation space, a demonstration kitchen, supportive care, and survivorship services. While registration and checkin are centralized, check-out and procedure scheduling are decentralized by department. The infusion suite, with 36 open treatment chairs and nine private treatment rooms, is located at the north end of this floor to allow for maximized natural light through floor-toceiling windows along the entire north façade. This placement also opens up views toward the Camelback Mountains. Individual seating is oriented toward the exterior, and staggered, so that the view outside is available from each chair. Along the northern edge of the second
floor are satellite nurse stations to ensure that nurses all have a direct sight line to each patient. Locating infusion on the second floor necessitated collocating the pharmacy adjacent to infusion to provide direct support for the administration of chemotherapy and other drugs. This allows pharmacists to be embedded within infusion, and provides the nurses administering the medications direct access to speak to a pharmacist when picking up the medications. Phlebotomy is primarily centralized on the second floor, though each clinic has an evaluation area where blood can be drawn and delivered via pneumatic tube to the clinical laboratory.
A transparent design in the infusion area brings daylight to every treatment space.
LEFT A layering of materials is evident in this view across the second floor waiting room toward the elevator lobby. ABOVE The pharmacy
is easily accessible near the elevator core. BELOW Nutritional
instruction is provided for patients and their family members in the demonstration kitchen.
3 LEVEL
B
A
C
D E
A
Gynecology Program B Breast Program C Radiology D Supportive Care E Dermatology
N
A neutral materials palette with pops of color, along with transparency in public spaces, eases wayfinding between departments and fits with the overall plan to maximize patient comfort.
ABOVE Floor-to-
ceiling windows let in significant natural light, adding to the comfort of those spending time in waiting lounges.
The third floor contains a Women’s Health Clinic for breast and gynecological cancer treatment and collocates the Breast and Diagnostic Imaging Center adjacent to it. Each department has its own front entrance from the main lobby waiting area, however, they are interconnected to allow patients to easily be transferred to imaging and then back to complete their clinic visit without having to leave the department. In addition, there is a Dermatology and Mohs procedure clinic with three large Mohs procedure rooms, tissue processing, and a staff workroom.
4 LEVEL
A B
C E
D F G
A Gastrointestinal Program B Head and Neck Program C Genitourinary Program D Thoracic Program E Interventional Radiology F Prep / Recovery G Endoscopy
N
All delivered care is focused on the whole person, through teams that include physicians, dietitians, and social workers.
ABOVE Exam and
procedure rooms are designed to house the sizable equipment required for cancer care.
The fourth floor contains a Head and Neck and Thoracic Cancer Treatment Clinic and a Gastrointestinal and Genitourinary Cancer Clinic collocated with Endoscopy and Interventional Radiology (IR). Again, each of these departments has its own front entrance, but all are interconnected to provide easy access for both staff and patients. Together, the Endoscopy and IR Departments contain three large procedure rooms, angiography, CT, ultrasound, and dedicated central sterile processing with a 12-bay pre- / postprocedure recovery area among other support spaces. The layout of the pre- / post-recovery areas is extremely important in order to support both Endoscopy and IR procedures, and to swing between a high percentage of pre-procedure patients in the morning to a high percentage
of post-procedure patients in the late afternoon. The centrally located open nurse station and adjacent support spaces provide maximum visibility to pre- / postprocedure areas. Additionally, the adjacent Endoscopy and IR procedure spaces are conveniently located directly off of this area with very short travel distances. The Endoscopy and sterile processing areas are collocated and separated from the IR procedure areas to support infection control best practices. All clinics are designed to support a multidisciplinary and inter-professional approach to cancer treatment, including large physician and clinic workrooms and a conference room to support a team-based approach.
LEFT Oversized
directional graphics provide clarity at each level within the elevator lobbies. ABOVE A central
stair connects all levels to encourage interconnectivity between program areas.
The exam rooms on all levels are located around workrooms for easy and direct access. The layout of the exam room separates the space into distinct zones for staff, family, exam, and discussion. Additionally, each clinic houses supportive care services, such as nutritionists, social workers, pain and symptom management, and financial counselors, with the goal of bringing all services directly to the patient.
LEVEL 4
LEVEL 3
PERFORATED PTD ALUM SCREEN CEMENT PLASTER VISION GLASS
° 80 ° 88 ° 3 11
Multiple scenarios for the exterior screens on the east and west façades were tested for their performance and optimal design related to materiality, perforation size, fold, and distance from window.
SUMMER SOLSTICE
LEVEL 2
BLOCK SUN
DAYLIGHTING OPPORTUNITY
MAY 1, 6 PM -80 DEGREES
JUNE 21, 4 PM -88 DEGREES
SEP 21, 4 PM -113 DEGREES
SUSTAINABLE STRATEGIES An exterior shade system, along with chilled beams—the first in Arizona in a healthcare setting—contribute to the building’s sustainability. With the desire to design a building that would be energy efficient, as well as one that meets functional requirements, the team began early in Programming to investigate all viable options for sustainability. Analyses indicated that the integration of 40% open exterior shading would lead to interior perimeter spaces receiving well-distributed, usable daylight for the majority of the year. Additionally, these spaces would meet the visual comfort requirements for a program in which occupant comfort and the performance of critical visual tasks are of the highest priority. Lifecycle cost analyses were also developed to assist the University in understanding the shortand long-term benefits of different systems. Through these studies, the team was able to implement a chilled
beam mechanical system, the first in Phoenix, as well as the first in Arizona in a healthcare setting. Having utilized chilled beams in other projects, the team relied on precedence and substantiated calculations to ensure the viability of this system for The UACC. The building utilizes a decoupled HVAC system, using chilled beams for heating and cooling, and a dedicated outdoor air handling unit to provide ventilation air only. By decoupling ventilation from heating and cooling, the air handlers were one-third of the size required by a traditional mixed air system. Chilled beams also deliver an elevated temperature to the space, supplying air at lower velocities and eliminating drafts, a critical consideration for infusion therapy patients spending long stretches of time in treatment.
FLOOR SLAB
CHILLED BEAM
FLOOR SLAB
LEFT Perforated metal
sunshades protect building occupants from glare and heat gain, while still allowing for views out. ABOVE Mechanical
spaces throughout the building are well organized and easily accessible for servicing and repairs. RIGHT Diagram
showing how air flows through the chilled beam system.
Though an inherently quiet system, this particular chilled beam system was designed to be louder in select spaces to mask conversations in adjacent areas. Overall, the end result is a quiet, comfortable, efficient HVAC system that realized a $300,000 first-cost savings, and a 21% annual energy-cost savings. Lighting controls are another factor for reducing energy consumption in the building. The lights are all on occupancy sensors, but have overrides in certain spaces allowing users to turn off lights when there is adequate natural light.
Other sustainable strategies include the reduction of VOC’s in the building through the use of appropriate finishes, low-flow fixtures to reduce water use, and reflective roofing to reduce heat gain.
DESIGN-BUILD APPROACH With a unified team collaborating from the project start, project goals were better understood and achieved.
LEFT Metal panels were
tested on site to ensure the shading properties were precise.
The University of Arizona chose the Design-Build (D-B) construction method, and the partnership of ZGF and Hensel Phelps. Beginning with Programming, the firms were able to forge a strong relationship, which allowed each to holistically understand the goals of design and construction. Another key benefit to the D-B relationship was being able to work closely with the contractor and subcontractors to review constructability as the design was being developed. This led to effective value engineering of ideas created collaboratively by the architect / engineer / contractor team to maximize design and functionality, while maintaining budget and schedule. This further reduced the number of RFI’s, and allowed the subcontractors to understand what they were building before they went onto the project site, helping them schedule their sequence of
work ahead of time, thereby reducing the overall project schedule. By strategizing as a team on schedule and sequence, there was an overlap of design and construction. Separating the core + shell from the tenant improvements allowed for construction to begin early. This ultimately provided the client with the finished building two months ahead of their expected delivery date. By working collaboratively as one team— developing drawings and specifications, and constructing a fully-functioning facility—change orders were eliminated, allowing each entity to oversee the risks they were best positioned to manage.
The UACC is an outpatient facility serving the greater Phoenix area, with St. Joseph’s Hospital and Medical Center supporting inpatient needs.
PROJECT TEAM OWNER
CONSULTANTS
PHOTOGRAPHERS
The University of Arizona
Affiliated Engineers
Nick Merrick © Hedrich Blessing Photographers
ARCHITECT / INTERIOR DESIGNER / MEDICAL PLANNER
ZGF Architects LLP
MECHANICAL / ELECTRICAL / PLUMBING ENGINEER
Martin, White & Griffis Structural Engineers / John A. Martin & Associates STRUCTURAL ENGINEER
GENERAL CONTRACTOR
Hensel Phelps Construction Company
Dibble & Associates Consulting Engineers CIVIL ENGINEER
Atelier Ten ENVIRONMENTAL DESIGNER
Francis Krahe & Associates LIGHTING DESIGNER
Wheat Design Group LANDSCAPE ARCHITECT
Colin Gordon Associates ACOUSTICAL / VIBRATION CONSULTANT
Jensen Hughes CODE CONSULTANT
Lerch Bates VERTICAL TRANSPORTATION CONSULTANT
Tom Harris © Hedrich Blessing Photographers
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