Opened to patients in October 2014, the St. Francis Cancer Center on the Millennium Campus in Greenville, S.C., is a comprehensive cancer treatment facility for outpatient care. The 65,000-square-foot facility houses multispecialty cancer diagnostics and treatment spaces along with retail, educational, and ancillary support services—all focusing on the patient care experience.
The site was initially selected by Bon Secours Hospital as its main outpatient campus for the sustainable development and strategic location of the Millennium Campus within the city. The overall plan comprises “neighborhoods” linked by a system of interconnected open spaces and pedestrian pathways. A network of cycling lanes, pedestrian walkways, and trails promote fitness; meditation gardens, public art plazas, and wetlands encourage the day-to-day use of outdoor space.
While the need for healthier work environments holds true across a wide range of workplaces, the symptoms are further exaggerated in a healthcare setting. Consider typical staffing patterns within acute healthcare organizations: The regular 12-hour shift of clinical staff members keeps them indoors for the majority of the workday.
As one of the largest service industries in the U.S. economy, healthcare represents approximately 17 percent of the gross domestic product. On average, healthcare facilities use more energy than other workplace structures and produce millions of tons of solid waste each year. Extensive use of cleaning compounds and other hazardous chemicals directly affects wastewater effluents and air emissions.
Taken together, these unique design conditions factor into an unusual opportunity for sensitive healthcare design to have a substantial, positive impact on environmental sustainability initiatives. And through the Affordable Care Act and Triple Aim Initiatives, healthcare providers have been tasked with improving health outcomes while reducing costs. Providers, in turn, are investing in new ways to engage with and educate people to adopt more lifestyle-oriented and preventive approaches to good health, particularly in the face of an increased incidence of chronic diseases. We know that primarily modifiable risk factors simultaneously affect both employee medical costs and performance measures in the workplace.
Given the direct tie between employee engagement and patient satisfaction, the business case for careful consideration of the interactions between humans and the built environment includes a meaningful return on investment. Improving productivity by reducing absenteeism and working while sick has a major impact on personnel, the single most costly operating expense.
Employee engagement is a complex issue in which culture, opportunity for meaningful work, advancement, and leadership all play a role. But design, too, can have a strong influence. By using environmental design as an instrument to establish desirable, healthy behaviors, we can align the goals of both healthcare and architecture in ways that create healthy and sustainable human environments.
By embracing the objectives at work on the campus as a whole, the St. Francis Cancer Center was designed to further enhance and improve overall health and well-being. To do this, McMillan Pazdan Smith Architecture aligned the more detailed strategies of the WELL Building Standard—which sets performance requirements in seven categories relevant to occupant health in the built environment—with the American Institute of Architects’ (AIA) six approaches to health.
The aim of this approach is to prevent, mitigate, and reverse chemical and microbial pollutants in the built environment. The impacts of these factors on well-being include increased rates of cancer, low birth weights, incidences of waterborne illness, and cardiovascular and respiratory disease. Material selections
at the Cancer Center play a major role in achieving this objective: PVC- and formaldehyde-free millwork and fabric; elimination of antimicrobial materials; low-VOC paint; mold- and moisture-resistant wall materials; and permeable exterior walking surfaces to reduce standing water.
“Natural systems” refers to natural forms, diverse species, and ecosystems that influence design. The impacts on well-being include stress relief and acceleration of recuperation times. In addition, McMillan Pazdan Smith Architecture worked within an overall system of promoting healthy eating, physical activity, and social engagement. The Cancer Center design strategies include a centralized staff lounge and natural food café offering multiple seating options; appropriate application of natural interior materials (concrete, glass, stone, and wood); natural patterns and color in design; and green roofs, native landscaping materials, and natural water management provide wildlife habitat.
Physical activity is the exercise, recreation, and other activities that comprise everyday life. Physical activity is a public health priority because it promotes individual choices and habits that reduce the risk of cardiovascular disease and other health problems. Design strategies include point-of-decision prompts at elevators to use stairs; prominent stairs with windows, color, and graphics to encourage use; stairs conveniently linking amenities (second-floor family waiting room to ground floor café); and an accessible nature walking trail.
The promotion of safety is a public health priority because it removes both real and perceived impediments and disincentives influencing physical activity. It also helps alleviate stress and reduce anxiety that can increase the risk of hypertension, hyperglycemia, and obesity. Considerations in this project’s design scheme include adequate lighting, clear signage, open sightlines for staff and patients, visual access to entries and exits, communal social spaces, and ergonomic furniture.
Diversifying the tactile, olfactory, acoustic, and aesthetic qualities of a space contributes to our physical, mental, and emotional well-being and enhances quality of life. To meet these needs, the Cancer Center features thoughtful placement of diverse art mediums and scale; a variety of textures providing acoustical control; use of fritted, frosted, and clear glass to provide privacy options; and careful placement of food vending areas to reduce food smells in patient care areas.
Social connectedness refers to the networks of relationships that bind people together in the workplace environment. This is a public health priority because it helps communities function more effectively, predicts higher levels of happiness, and predicts better overall well-being. Related design strategies employed in this project are flexible public spaces such as lobbies; education and community rooms; café and outdoor seating open to the public; and space
for spiritual reflection, meditation, and respite for patients, families, and staff.
The design process at St. Francis Cancer Center was participatory (inclusive of the client, staff, and patient), holistic (taking all six approaches into account), and haptic (recognizing human experience through all five senses). This allowed the McMillan team to anticipate how we could best expand the atmosphere of safety, well-being, quality of life, and happiness for the engaged employee. This design resulted in lower absenteeism, higher productivity, and fewer work-related injuries.
The engagement of employees in their own workplace, moreover, translated into a higher sense of patient satisfaction. When measured against its national peers, St. Francis Cancer Center ranks in the top 10 percent in a survey of more than 1,200 outpatient service centers. This includes an overall ranking in the 91st percentile, as well as the 97th percentile for patient care, and the 98th percentile in likelihood to recommend the facility to others. We know that this perception of excellence is based on the level of care, but we also learned the contribution that a distinctly healthful environment can play in this equation.
By adopting a comprehensive approach to design, the team was able to come to terms with the effects of the broader setting on the one hand and the smallest details on the other. The ease of connectedness to the greater campus invites our neighbors to think of the center as a destination, and the comfortable setting of the lounge and café makes the walk seem worthwhile. The details of the building’s envelope, daylight, color, sound, thermal comfort, and human comfort within the furniture are greatly appreciated by healthcare workers and visitors alike. Even more important, it is the overall attention to detail that is most noticed by patients.