By Aran A. McCarthy, AIA, NCARB
From the June 2019 Issue
At its existing health and wellness campus located in Moorestown, NJ, Virtua Health was seeking to add to its healthcare services. The vision was to create a full-service state-of-the-art cancer center. With a goal to further its mission to be well, get well, and stay well, Virtua Health wanted to rezone and repurpose a 66,000 square foot former Acme Markets supermarket that sits adjacent to its Health and Wellness Center. The challenges of adaptive re-use were well-known to the experienced team, but the benefits of ample adjacent parking, proximity to other health system services, speed to market, and the space to create a flexible and appealing environment helped direct the design of the Virtua Samson Cancer Center in Moorestown, NJ.
Repositioning a familiar building welcomes the added benefit of being recognized as a former destination within the community. Making the building attractive as a cancer center required changing its perception—its visual impact needed to be instantly calming and recognizable, yet sophisticated enough to represent the complex and life saving treatments taking place inside. As a former supermarket, it came complete with its own loading dock to the rear, which was restored and is in use to serve the building. The building now accommodates a full radiation therapy suite complete with two linear accelerators, space for a future vault, a 14-bay infusion center complete with added windows for views to the healing garden, a cancer administration suite, and an adjacent space for an additional third-party infusion center. The infusion suite also has a dedicated pharmacy with the infrastructure required to mix chemotherapies, including emergency power.
Virtua Health teamed with a surgical practice and constructed a four operating room ambulatory surgical center directly adjacent to the cancer center, with its dedicated entrance and exit locations. The main cancer center lobby also contains a small coffee shop and a suite to assist with lifestyle replacement alternatives, all in a soothing and calming setting. Virtua has partnered with Penn Medicine in this joint venture to share resources and healthcare expertise.
Reworking The Building Structure
Reusing an existing big box shell has its challenges. Some of these included improving energy efficiency in the wall construction, an overabundance of building height, and existing concrete floor slab which needed extensive trenching to accommodate the plumbing for handwashing sinks required by code. In addition, a lightweight roof truss support system was needed to support overhead utilities, and undersized incoming utilities needed additional bracing.
Surveys and inspections found that the shell construction was not in accordance with the original design drawings, so some structural modifications and strengthening were completed during the interior demolition phase.
In order for the front entrance to be scaled and converted into a healthcare facility, the series of exterior false towers and shopping cart protection canopies were removed, along with selective sections of concrete block wall. These new openings allowed the team to create a destination and wayfinding entrance featuring the “White Box”—a glowing backlit acrylic main entry element representing the hope of success for the cancer treatment to take place in the building. The team also added six large skylights running through the spine of the building, introducing natural light and a wayfinding element to serve the cancer center functions located off “the mall.”
The concrete block walls were re-skinned with an insulated finish system, and the scale of the building was altered with the careful use of metal panels and a rainscreen panel system. Careful consideration was paid to the energy efficiency of the building with new mechanical and electrical systems. Understanding that most of the cancer center ceilings would be eight to nine feet above the floor meant that the interstitial space to the roof deck could be 15′ or more. For the mechanical and plumbing system subcontractors, this was a dream installation situation. From a building maintenance and operational standpoint, the extra clear space above the ceilings allows for plenty of access to the piping and utilities, which normally can be crowded in the traditional healthcare building. It also allowed for ample access points as many of the spaces can’t be accessed while patients are there receiving treatment, so alternative access was planned for, along with remote shut offs.
A separate structural grid was constructed and hung from the main roof to allow for support for the utilities, piping, and ductwork. It also served as an anchor point for many of the internal walls, avoiding the cost of running these walls to the deck. Acoustically, care was taken to isolate sensitive discussion areas for HIPAA compliance and reduce the overall distracting and harmful nature of unwanted noise.
Construction of the 3′ to 5′ thick concrete shielding vaults at the center of the building required careful planning, which included monitoring and control of the concrete curing and the expected settlement of the vaults within the building.
A Focus On Well-Being
A visit to a cancer center can induce anxiety and concerns for the unknown. Will the treatment be successful? Will I be treated with dignity and respect? How will I manage this disease?
This cancer center was designed to reduce and redirect this stressful energy to benefit the patient and their friends and family members. Evidence based design has taught us that stress reduction has a measurable impact on healing, and Virtua Health and the design team chose this as a guiding principle for the new facility.
The white box of light was used throughout as a calming element and can be found on the exterior and interior wall of the main lobby, and at the entrance to each of the suites along the main axis. Keeping the pathways simple and understandable, in such a large building, reduces any stress the facility itself may cause. This also reduces the likelihood that a patient or family member would get lost inside, and helps to ease the patient handoff from the main waiting desk and greeter to the sub-waiting department receptions, located right off the corridor.
The project team was cognizant of the fact that this facility could leave patients feeling sicker when leaving compared to their arrival, a reversal of the traditional role of healing. Before patients leave the center, they can spend time in the lifestyle replacement suite, including the cancer care hair boutique. The use of color throughout the building was a blend of calming tones, accentuated by artwork to provide visual interest and distractions. The colors also complement Virtua Health’s branding throughout its facilities and becomes a recognizable element.
Wayfinding And Windows
The introduction of six skylights along the length of the corridor, each one 11′ long and 5′ wide, 24′ above the floor add a connection to the outside world and change the lighting and perception of the internal space. Adding natural light also reduced the need for supplemental lighting. Care was taken to ensure no direct sunlight would reach the floor level and a patient, whose chemotherapy had induced a sensitivity to light. At almost 180′ long, this main axis corridor is unlike any other in the building in size, scale, lighting level, and finishes. It is used as the main wayfinding path that links directly to the main entrance and lobby. A full height window was added to the facade in the lobby, in line with the skylights to complete the visual link between the parking lot and the main corridor. The infusion suite has seven new windows added to the façade to connect the resting patient to the healing garden outside, providing orientation and comfort.
The population is aging, and in this emerging time of immunotherapy coupled with the rapid advancement of infusion therapy over surgery and radiation, an adaptable, flexible, and recognizable facility is needed to serve this patient population well into the future of their cancer journey. The Virtua Samson Cancer Center was designed with that important mission as a guide.
Facility: Virtua Samson Cancer Center. Square Footage: 66,000. Construction Timetable: Completed in October 2018. Facility Owner: Virtua Health. Project Manager/Facility Manager: Aegis Property Group. Architect: FCA. General Contractor/Construction Manager: P. Agnes Inc. Electrical & Mechanical Engineer: BR+A. Structural Engineer: O Donnell & Naccarato Engineers..
Furniture: Cofco (dealer). Flooring: Mannington (carpet); Shaw, Mannington (sheet vinyl); Roman Mosaic (terrazzo). Lighting Products/Systems: Metalux, Finelite, Tech Lighting, Axis, NeoRay, Portfolio. HVAC: Falasca Mechanical. Fire/Life Safety: Oliver Fire Protection and Security. Building Envelope/Roofing: EFIS, 3form, Trespa, Glen Gery Corporation, Carlisle SynTec. Windows: Kawneer. Doors: Kawneer.
McCarthy is principal of healthcare for Francis Cauffman Architects, a full-service architectural and design firm. Over the past 23 years he has led collaborative teams for national healthcare clients across the United States and Europe. A leading advocate and participant in the Integrated Project Delivery (IPD) process, McCarthy’s work has resulted in award winning projects, such as the 2008 Best in Healthcare International Interior Design Award (IIDA), and the 2010 Vista Award for New Construction for Geisinger Health Systems Critical Care Building. He has written many articles on architecture, and has presented to the American College of Healthcare Executives (ACHE) on high performance healthcare buildings. He is a member of the AIA, NCARB and The Carpenters Company of Philadelphia.
Do you have a comment on this article? Share your thoughts in the Comments section below or send an e-mail to the Editor at firstname.lastname@example.org.