Cancer patients experience a range of care and an enormous amount of services during what can be an extraordinary difficult period – from diagnosis to treatment and the aftermath. The ability to treat this patient and offer a streamlined process is indeed preferable. Based on our experience, here are some items to consider when building an integrated cancer care center:
Integrated Cancer Care
Holding separate and large group meetings that allow time for discussion from all participants. Comments should be listed on easel boards so everyone could see what others feel are valuable and intrinsic characteristics. The fear of the unknown was eliminated after site visits to similar facilities. CKA can arrange staff and physicians tours of a variety of Seattle and Portland cancer centers. Pictures taken should be distributed so the group can tag features they most want to emulate.
After time, the group may realize their goals are all the same, to provide the most accessible cancer center for their patients. With Samaritan Regional Cancer Center the physicians pushed for all services to be on one level, so they could go between departments for advice and assistance –and in fact insisted that their offices be grouped near each other, even if it meant more travel time on their part.
Expanded patient services
Similar to SCMC, SRCC’s had a one story, 11,883 sf building that had become inadequate in size and program to meet current patient demand, much less future patient use. In addition, the centrally located, open Reception/Nurse station could not meet new HIPAA regulations, setting off another series of remodels to better accommodate patient privacy. The linear accelerators were to be kept in place.
CKA provided three pods, each with 4 exam rooms and storage for medical Oncology. A central nurse station, blood draw and clean utility room allowed 1-2 staff to efficiently prep patients for exams. And because Medical Oncology was generally the patient’s first foray into cancer awareness, much thought was given to private check in and check out at the receptionist, with consult rooms adjacent.
The SRCC administrators also wished to have a full complement of traditional and non-traditional cancer resources -a library, massage therapies, acupuncture, retail space, offices for navigators, social services, nutritional counseling –but the issue was whether they should all be grouped in one location, or spread out over the facility. From a patient perspective, and then a staffing one, it was decided to group them together, but keep office functions separate. All of this was on the building’s second level, purposely away from the treatment floor so as to refocus patient and family.
An inner garden separates new from existing at SRCC. It serves as the feature for not only gowned waiting for Radiation oncology patients, but it was designed to strategically place rocks and landscape features so that both Infusion and Medical Oncology patients could also view into the courtyard.
The SRCC program was for 24 infusion beds, which we broke down into pods of six for maximum staff efficiency. Each pod contained similar basic services, with every other pod providing a more centrally utilized function, in this case nutrition services or storage.
LEAN Design Techniques
LEAN principles manifest themselves not only as efficient design, but design for efficient staff and services. Through our work at SRCC, we incorporated several techniques we would advocate for your consideration:
- Cluster infusion stations in pod configurations for ease of staffing and visual contact
- Incorporate separate staff lounge and toilet facilities for each department
- Provide exam rooms in pods with support around a central nurse station
- Use central reception points with check in/check out adjacent;
- Offices grouped together can easily share workrooms, resource centers and reception staff
- Share check in points with as many departments as possible to provide coverage in off hours and break times