Architecting Care: A Cancer Journey Intersects with a Breast Center’s Design

:: 00:01:05

Tom Haederle

Welcome to Advancing Health and to a different kind of conversation today. Life and work collided when the architect of Charlotte, North Carolina-based Novant Health's new breast center was herself diagnosed with metastatic breast cancer. In this podcast, we learn more about how being both a breast cancer center designer and a breast cancer patient impacted her perspective on what patients want and need from an effective building design as they undergo treatment.

:: 00:33:04

Julia Resnick

Hi there. I'm Julia Resnick, director of strategic initiatives at the American Hospital Association. I'm here today for a fascinating conversation about designing health care spaces. Our first guest is Sara Robinson. She's a senior associate with McMillan Pazdan Smith Architecture where she focuses on health care design. She's joined by Jamie Feinour, vice president of operations at Novant Health Presbyterian Medical Center and also president of Novant Health Charlotte Orthopedic Hospital.

:: 01:00:21

Julia Resnick

Sara, Jamie, thank you so much for being here today to share your story. So, Sara, I want to start with you and learning a little bit more about your cancer diagnosis and your cancer story. Can you tell us a little bit about your experience?

:: 01:13:22

Sara Robinson

Sure. So I was actually in the midst of designing a breast health center for Novant. Jamie was our client. And at the time, I was feeling some pain in my neck and I had dismissed it. I was thinking, you know, I'm getting older. A little tech neck. Maybe I needed a new pillow. Of all the things we do to dismiss our aches and pains.

:: 01:32:21

Sara Robinson

And I decided to get it checked out. And fast forward, we found bone metastases. And so I was diagnosed with metastatic breast cancer. It was, of course, very shocking, especially to be, de novo breast cancer. You know, they found it metastasized from the very beginning. But I found myself kind of starting to navigate this process. I was also wearing my designer hat at the same time as navigating things from the perspective of the patient.

:: 01:58:29

Sara Robinson

And so I found myself going from somebody who always designed with patient experience in mind, but based on research and anecdotal evidence to suddenly having this giant bucket I was filling with all of this firsthand patient experience. And so it was really eye opening how I navigated having the experience that I have in design, but also what I do as a designer.

:: 02:20:15

Sara Robinson

So, so both ways.

:: 02:22:04

Julia Resnick

Yeah, that's such a powerful intersection of when your personal life and your professional life come together. It really changes everything, doesn't it?

:: 02:29:20

Sara Robinson

It really does. Absolutely.

:: 02:31:14

Julia Resnick

Can you tell us a little bit about how you got into health care architecture?

:: 02:35:02

Sara Robinson

Sure. So I was interested in the medical field, but also architecture. And I was trying to figure out how do you marry those two together? And I found out that there are colleges that actually focus on healthcare architecture as a degree. So it happened to be my home state at Clemson, where I was going to school already. They had one of two programs in the nation at the time, and I was very fortunate to be accepted.

:: 02:58:01

Sara Robinson

And so it was a master's of healthcare architecture, and it really exposed as to how to think about how things operate and how to work, but also look at that very human component of who are the people who are going to be occupying these spaces, and what can you do to shape their life based on the design?

:: 03:14:16

Sara Robinson

It can make it a lot better or it can make it a lot worse. And so I dug into that program and I have never looked back, and it was where I was meant to be, for sure.

:: 03:23:13

Julia Resnick

That's incredible. And I think anyone who's interacted with the health care system implicitly feels that, but doesn't explicitly, verbalize that. Absolutely. So I want to turn to Jamie for a minute and learn more about Novant and why you were building a new breast health center and what, you know, you were hoping to do differently with this new space.

:: 03:41:05

Jamie Feinour

Thank you for having me here today and super proud of our organization. Really looking at an investment for a new breast health center. Obviously, our focus was to improve the quality of care that our patients needed. Real heavy focus on patient experience and also looking at any operational efficiencies. While we were trying to also care for the patients today, but also expanding into the future.

:: 04:08:15

Jamie Feinour

And so making sure that we were building a center that was large enough to meet the demands of today, but also into many many years into the future. And I will tell you, as we go through our conversation today, there were several key focuses that we looked at. One, we wanted to make sure we were optimizing our patient flow in the workflow within the workspace.

:: 04:32:03

Jamie Feinour

We obviously wanted to make sure we were enhancing the patient comfort and accessibility of the center. We also really wanted to make sure patient privacy and convenience were top of mind as well. You know, very fortunate that this is on a one story flat surface area. We did not have to do any type of parking deck. So really ease of access for parking.

:: 04:56:03

Jamie Feinour

Really building this space to work both for our patients, our clinicians and our team members was top of mind throughout the entire design process.

:: 05:06:01

Julia Resnick

So I know this is a very collaborative process between the hospital and the architecture firm. So can you talk me through the process of designing the space and what those priorities and guiding principles were that helped you imagine what this could look like?

:: 05:18:29

Sara Robinson

Absolutely. So first and foremost, one of the biggest challenges about this is that we designed this smack in the middle of Covid. So we were all remote. Jamie and her team were very preoccupied, obviously, but everybody was spread out and remote. And so we used a series of online tools that we found and tested out. I think at some point we at one point we had 47 stakeholders from the Novant side on a call.

:: 05:44:28

Sara Robinson

But it made it very apparent that when they gave us the design challenge of: we want this space to feel singular. They equated it to the hospitality experience of a day spa. When you go to a day spa, they anticipate your arrival. They know why you're there. And when you're there you feel like you're the most important person in the space at all times.

:: 06:04:14

Sara Robinson

So they really challenged us to think, how could you make something like that for these patients? We want women to come get their screening. We want to comfort the men and women who were coming for diagnosis because, you know, men are part of this, too. So how do you create that singular experience? How do we uplift and have, you know, their dignity protected?

:: 06:24:14

Sara Robinson

So one of the very first things we had to do was to establish what does Spa like? What does comforting mean to you? So we had everybody pull together images and words, and we threw them all together onto a board and actually started weeding through the images in the words until we found ones that everybody could agree on.

:: 06:42:21

Sara Robinson

And that way we were able to build a lot of consensus amongst a very large group. The next thing we did is we have a process that we developed and refined, that we've kind of coined: Motion plus emotion equals experience. And what that means is we use lean design tools to process map how the different groups were moving through the building.

:: 07:07:29

Sara Robinson

You have your screening patients, your diagnosed patients, your male patients, your transgender patients, your staff, your equipment, you know, all the things that move through the building. We mapped all of that out, and then we talked about what are the key moments in this process, and how is that person, patient or staff feeling in that moment? And then what can we do at that moment to make sure that that feeling is a positive one?

:: 07:33:00

Sara Robinson

And by focusing on those key milestones of the motion plus emotion, we were able to hopefully succeed very well in uplifting the experience of both the patient and staff who were in the building. So it was those guardrails and those guiding principles that we said at the very beginning that were our constant litmus test for every decision that we made, coupled with that thought process of how do we really define our experience goal, and then how do we actually put that into action and really identify the experience we want them to have?

:: 08:04:12

Julia Resnick

Jamie, anything you want to add to that?

:: 08:06:13

Jamie Feinour

Whatever we put into place as guardrails or important pillars and what we wanted to accomplish was always our guiding light. No matter what we were doing, related to, you know, workflows related to design or architecture, we always went back to our guiding principles to make sure we were still within what we were framing that the space to be.

:: 08:30:21

Jamie Feinour

I'd also like to take a moment to express our deepest gratitude to one of our grateful donors, Agnes Binder Weisiger, for her incredible generosity for us to be able to create, this amazing state of the art facility that will provide essential breast health to our community for years to come.

:: 08:51:00

Julia Resnick

So you've both mentioned that there were a lot of stakeholders and perspectives that were engaged as you were building out this project. I'd love to learn more about what you heard from them. What are patients saying is important? What are the clinicians saying is important? How do you design space that meets both of their needs? Jamie, we can start with you.

:: 09:09:25

Jamie Feinour

To your point. You got to get the buy in, the thoughts, the feedback from all of your key stakeholders. Taking a step back and making sure that you have everyone engaged it right at the beginning of the project is essential. So anytime you're building a space that works both for the patients and the clinicians, you have to always consider balancing your comfort, your functionality, as well as your efficiency.

:: 09:36:09

Jamie Feinour

You know, for a patient, it really means creating a welcoming, accessible environment with private spaces, making sure we have clear signage and easy navigation for them. For a clinician is a focus on is efficient layout with ease of access to equipment. There are workstations and spaces that really promote collaboration among the entire team. And so, you know, a space anytime you're designing it really should focus in on integrating any of those technology for both care delivery as well as patient communication, as well as providing any of those areas for both patient education and/or clinician communication to be private is essential.

:: 10:21:27

Jamie Feinour

And so as we think about what we did there, we created a space not only that checked all those boxes, but also allowed for flexibility and sustainability into the future.

:: 10:34:27

Julia Resnick

Sara, anything to add to that?

:: 10:36:21

Sara Robinson

I do. So when we think about it, we, you know, we do try to hear from patients sometimes, but we also tap into what we as designers know about behavioral psychology of space. And so when we know that, Jamie - and you know, clients like Jamie - have a fixed budget, and we want to be really good stewards of that budget and help them really apply the money where it can make the most impact.

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:: 10:59:25

Sara Robinson

So we tap into things that we know. For example, on our diagnostic side, if you have men coming in they're going to maybe want a discreet entrance. So, you know, how do we work in things like that. When you're on the diagnostic side, you're probably going to be feeling more stressed. So we maximize those sides with the views to the nature and with some things like some pocket gardens that we can organize around.

:: 11:20:25

Sara Robinson

And so we really rely on that psychology of space, what we know about how patients operate. I was reading a study not too long ago that talks about how stress is contagious. We can't eliminate the stress that patients have before they get to the building, but we can do our best to eliminate the stress that they have in the building.

:: 11:38:25

Sara Robinson

So Jamie mentioned ease of parking. You know, parking is one of my big stressors. When I'm going somewhere new, where am I going to park? Will I be able to know where to go? Once you get in the building, you know you want to eliminate that stress because stress is contagious. And so it's this idea that if a patient is super stressed, then they could subconsciously pass it on to the provider, and then the provider maybe carries it out to their other providers or over to other patients.

:: 12:02:01

Sara Robinson

And so it's really understanding those types of things and how patients and people operate in buildings and how they think and feel that we apply that and use that to shape key moments so that we're really applying the money as judiciously as we can.

:: 12:17:09

Julia Resnick

I love that, and I know that since this is audio and our viewers can't see the breast center, can you walk us through what it looks like and what the patient experiences when they enter it?

:: 12:28:21

Sara Robinson

Sure. So when we were coming up with our organizational strategy, so we mapped the flow and that that lean efficient flow and that ideal flow of patients. And then we use those different flows just as diagrams, and we use those to figure out which spaces needed to be next to what. You want it to be comforting but also convenient so that they don't mind coming back, right?

:: 12:51:08

Sara Robinson

When you come in, you're greeted by a very tall volume of space with a lot of light. A feature wall that has the Novant branding. There's some key signage that tells the history of Novant and the donor behind the breast center, and really what the mission is to the community. And that wall was really important because it sets the tone that immediately, whatever reason you're there for, you were not alone.

:: 13:14:20

Sara Robinson

And that's one of the scariest things about my journey that I felt in a lot of people is when you're in this, you feel you feel very isolated. Even if other people have been through it, you still feel very alone, and you're immediately relying on those caregivers to say, hey, we're in this with you. We're going to see you through, you know, we're going to take care of you.

:: 13:32:07

Sara Robinson

And so that gave us an opportunity to really set that message from the entrance. From there, the screening side folks have the ability to quickly go into a changing room that's directly connected to the mammo room so that they can be private, they can lock their things in a private space. They are quickly in and out. It's a very efficient flow.

:: 13:51:10

Sara Robinson

On our diagnostic side, we looked at that locker room and we were thinking about, you know...When you're in that type of position - and I knew it anecdotally - and then I really felt it later - the idea that your body is betraying you and like you, you don't want to look at yourself in the mirror necessarily. Like it's just it's a very vulnerable place to be.

:: 14:12:09

Sara Robinson

So we use the idea of a spa locker room with very private changing rooms. We only have one mirror in the space because instead of like a spa dressing room where each little dressing bay has a mirror. We didn't want to have patients have to see themselves if they don't want to. Definitely no overhead lighting because nobody wants to see themselves undressed in overhead lighting and so we really kind of thought through what that was like.

:: 14:35:09

Sara Robinson

But all of that leads into a very private, sub-waiting area. Once you're gowned, you're feeling vulnerable, you're feeling stressed. We oriented that space around a pocket garden. And this pocket garden was based on the idea of the pocket gardens in Charleston, South Carolina, where you can maybe see it through a gate, or you can see a little aperture of the garden itself, but you really don't experience the garden unless you're on the inside.

:: 14:59:08

Sara Robinson

So we did the same thing for the patient. They get the full view of the garden and the fountain. Nobody can come in. It's very private. They just see it and that's their view. They don't see the parking lot. They see the fountain. They see the garden. They see this calming nature experience. We also set up that room to have different levels of waiting.

:: 15:16:17

Sara Robinson

Because some folks handle their nerves by they want to talk and talk, talk, talk and talk out their nerves. Some folks want to fully retreat and hide and be completely isolated, and some folks want to be on the perimeter and hear the conversations but not engage. So we set up a gowned waiting area that has all three seating options.

:: 15:34:21

Sara Robinson

You can be in the middle and be fully engaged. You can be fully removed, or you can be somewhere in between. And then in the rooms themselves we really thought about, you know, you're this patient and you're laying on a table and you're staring at the ceiling and like, what is happening? We really thought about what does the wall look like?

:: 15:48:25

Sara Robinson

What does the ceiling look like? What do you see in the room? Or more importantly, what don't you see in the room? All of the sharps disposal containers and all the devices and the linen waste bags, the things we have to have. But they can be very scary. And they're not pretty and they can be very intimidating. We think about the spa experience.

:: 16:08:07

Sara Robinson

You hide a lot of the stuff, so you really curate what the patient sees. And then in the staff, we really collected the staff work areas. They've got space in the back with large windows, a lot of daylight for them to keep their mood happy. And then we put storage strategically placed so that the staff can really get to the patient as quickly as possible.

:: 16:27:11

Sara Robinson

So overall, we were just really grateful to have a client like Jamie and Novant and the donor behind it who really had this vision for what the space would be and really allowed us to apply all of that knowledge and try to make the best space possible for the patients.

:: 16:41:18

Julia Resnick

That's wonderful, and I love how you approach it with so much intentionality and mindfulness about the experience that patients are going through, because having a health crisis is inevitably stressful, and anything you can do to reduce that stress is huge. So, Jamie, I wonder how you're thinking now that you've done this with the breast health center. How are you thinking about designing other spaces at Novant,

:: 17:04:19

Julia Resnick

And what of these principles can you, can you implement there?

:: 17:09:27

Jamie Feinour

Yeah. Thank you. I think there's a lot of principles that we took from this project and are paying it forward to other projects throughout Novant Health. So, you know, making sure that any time we're trying to build something new or renovate something, we're optimizing patient flow. Also making sure that whatever we're doing is also enhancing our patient comfort and accessibility.

:: 17:34:02

Jamie Feinour

We would love to always not have parking issues as well. So obviously looking for sites that are easy access for our patients is always there. And then really always thinking or planning for the future, right? Making sure that you're not just building a footprint, bricks and mortar for today, but into the future. What do we need to accommodate technology of the future and integration with that?

:: 18:01:11

Julia Resnick

Sara? Jamie, this is such inspiring work that you do, really thinking about the needs of patients when you're designing space. And I think our listeners are really going to learn a lot from this. Sara, I'm sorry that you've had to go through this, but I am confident that your experiences really just help you probably do the work you do better and differently to be really mindful of the experience of being a patient.

:: 18:27:05

Julia Resnick

Thank you both. We look forward to hearing more about this work as it continues to grow. And just really appreciate your dedication to serving your patients and community.

:: 18:35:28

Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.