Imagining a new kind of hospital
Some of the world’s most exciting medical advances are happening in the field of cancer care — but you probably wouldn’t know it from the street. Cutting-edge research and treatment often takes place in buildings that are bland, formulaic, and increasingly ill-suited to changing methods of care. Some of these facilities are fortress-like structures, isolated from the communities they serve. Inside, confusing corridors lead to dispiritingly generic waiting rooms; a clinical, impersonal atmosphere is all too common.
But what if the design of a cancer center was every bit as revolutionary as the medical breakthroughs that are changing the field?
When Emory Healthcare’s Winship Cancer Institute, one of the nation’s leading research and treatment centers, announced its intention to build "a cancer center that has never before been seen or imagined,” we jumped at the opportunity.
While our team at SOM has designed medical facilities around the world, we don’t define ourselves just as healthcare designers: our architects, interior designers, and planners bring expertise from many other fields. What excites us is the chance to question everything taken for granted about a project type, whether a hospital, a school, or civic building — and to reimagine how it can serve its users. We often say that any healthcare architect can design a great waiting room; we ask why patients should even wait at all.
We knew from the outset that Emory was looking to do something different. It wasn’t until we started working with them that we understood how deep their commitment goes to reinventing cancer care. Setting aside all preconceived notions of what this facility should be, we began the process by listening: our project delivery team worked with more than 150 end users, from patients and clinicians to custodians and volunteers. Together with Emory, we turned to the community this facility would serve, and asked them to help us imagine it.
Just as diverse as our stakeholder group was the team of professionals we worked with to make the vision a reality. Increasingly, our clients are using collaborative delivery models which bring together all of the participants in realizing a complex building project, from conceptual design all the way through construction. For Emory Winship, this group included the owner’s program manager, the construction manager, construction trade partners, and our own team of consultants. This assemblage of voices was the creative engine that allowed us to envision a building without precedent.
Toward community-centered care
As we began the workshops, we found that our stakeholder group was also willing to leave all received ideas at the door. We started from the very fundamentals of how the hospital should be organized. A typical urban medical facility follows a predictable “blocking and stacking” arrangement: inpatient departments are stacked on top of diagnostic services, which are in turn stacked on top of outpatient departments at the base. While the arrangement seems logical, an unintended result is that patients as well as providers are often spending time in elevators, moving up and down between these zones.
We asked the group how we could organize a hospital not according to function, but instead around the patient’s personal journey. Using a set of scaled cardboard models, easily reconfigurable to represent various clinics and services, we created a new concept: a hospital arranged not around equipment and departments, but instead broken down into “care communities,” each focused on a specific disease.
This model is particularIy suited to cancer treatment. Unlike in a general hospital, cancer patients make frequent visits, so we sought to create smaller, more efficient, and supportive clinics focused on patients’ needs. Each “care community” functions like a miniature hospital-within-a-hospital: it brings together an inpatient unit, outpatient unit, infusion, diagnostics, and even some procedural spaces, all connected by a two-story communal lobby.
This arrangement not onIy benefits patients, who find a “home” within the hospital, but also clinicians. Specialists can visit both inpatients and outpatients without ever leaving the two-story community. While it may seem like a simple change, it’s a complete reinvention of the building type.
Turning the clinic inside-out
With the big-picture planning in place, we continued the inclusive design process right down to the layout of each of the individual spaces. Working with cutouts of floor plans, we asked the users to show us how to compose the care communities to best serve patients’ needs. A breakthrough moment came when we realized we could turn the typical hospital floor plan inside out.
Normally, outpatient exam floors follow a predictable formula: grids of windowless exam rooms, with clinical offices segregated in the back. Instead, we inverted this layout, placing gracious, light-filled corridors along the perimeter, with efficient exam rooms and clinical space in the center of the floor. The day lit spaces and generous common areas are like nothing you might expect to find in a medical facility.
That goes for the work spaces, as well — clinicians benefit from an efficient, centralized layout that encourages collaboration. Having designed workplace solutions for many types of organizations, we applied our insight to the medical environment. The result is miles away from the cookie-cutter design of a typical outpatient floor — and we’re convinced it sets a new standard for the industry.
Cancer center as civic resource
In every sense, Emory Winship at Midtown is focused on the communities it serves, and our notion of community extends not onIy to clinicians, staff, and patients, but more broadIy to the city at large. From the outset, we saw this as a civic project, and we focused on the benefits that it could bring to its Midtown Atlanta neighborhood.
Most urban hospitals are self-contained islands, with no relationship to their surroundings. We imagined how a medical facility could become a destination within its neighborhood — a place for wellness, not just a place to go when you’re sick. We worked together with Emory and also with the Atlanta Department of City Planning to envision the hospital as a civic and community asset.
The ground floor of the building is ringed by a mix of uses that you might not expect to find in a cancer hospital: retail storefronts, cafés, and even educational and wellness programs open to the public. Even the main vehicular dropoff is designed in such a way to maintain a human scale and to prioritize pedestrians at street level. It sends a bold message about the role of the medical center within the community: this place is a resource not just for cancer patients, but for everyone.
Cancer research is moving full speed ahead, as researchers and clinicians make advances every day. Institutions like Emory Winship are at the vanguard of the search for a cure. It’s about time that the design of these buildings rises to the standard of the innovative work happening within them. Architects and designers have a responsibility to better serve these institutions — and we’re honored to work with progressive clients like Emory to help raise the bar.
Anthony Treu, AIA, ACHA, LEED, is Associate Director at architectural firm Skidmore, Owings & Merrill (SOM) and leader of SOM's global healthcare practice.
Photo credit: Image © SOM
How healthcare can safeguard itself against cyberthreats
One of the most fundamental lessons from the COVID crisis is that health should always be a priority. In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.
The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics.
From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world.
The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years.
This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate.
Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.
To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care.
Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change.
It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device.
These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.
Despite this, there are fundamentals that any organisation should implement:
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.
In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.
Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents.
Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.
This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents.
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.
Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.
As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.
Fighting future threats
With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.
To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced.
This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.