ID Design Town Hall: Designing the David H. Koch Center for Cancer Care
Lionel Ohayon sat down with Interior Design EIC, Cindy Allen, MSK’s Suzen Heeley, and partners (Perkins Eastman and Ennead Architects) to discuss the designing and completion of David H. Koch Center for Cancer Care at Memorial Sloan Kettering.
You can click the image to watch the town hall, and read the full transcript below.
DesignTV by SANDOW: Design Town Hall: David H. Koch Center for Cancer Care
Interior Design Editor in Chief Cindy Allen hosts Mary-Jean Eastman of Perkins Eastman, Lionel Ohayon of ICRAVE, Todd Schliemann of Ennead Architects, and Suzen Heeley of Memorial Sloan Kettering Cancer Center for a discussion on the David H. Koch Center for Cancer Care.
CINDY: 00:11
Hey, everybody. This is Cindy Allen, editor in chief of Interior Design. We are digging in deeper with a subject everyone is talking about; health and wellness, with a newly completed project that can be a role model for how we think about the future of health and wellness. The timing is crazy. It's called the David H. Koch Center for Cancer Care at Memorial Sloan Kettering, right here in New York. And it answered the question of how design and technology can improve the cancer care experience for patients, families, and caregivers. So we have a great town hall today, and I'd love to introduce you to them. We have Todd Schliemann, principal of Ennead Architects. Mary-Jean Eastman, co-founder of Perkins Eastman. Hi, Mary-Jean.
MARY-JEAN: 01:01
Hi.
CINDY: 01:02
Lionel Ohayon, founder, and CEO of ICRAVE. Hey there, Lionel.
LIONEL: 01:07
Hey, Cindy. How are you?
CINDY: 01:09
And we're so fortunate to have the client with us. Suzen Heeley, executive director of design and construction for, we say MSK, right? That's the inside speak the Memorial Sloan Kettering. How are you?
SUZEN: 01:23
I'm great. How are you?
CINDY: 01:25
Great. Look, I know it's complicated, but I understand you all collaborated really well together, which I was very happy to hear.
SUZEN: 01:38
Mm-hmm. Not an easy task.
MARY-JEAN: 01:39
It was a 10-year-long project.
CINDY: 01:42
Right.
LIONEL: 01:43
We had the opportunity to work together on the Josie Robertson project--
CINDY: 01:50
Right before that, right.
LIONEL: 01:51
--which we started designing this one while that one was in construction, and this one was just going into construction. So we had a team of people that aren't represented on this call who obviously had worked together, and then we parlayed that into the new project. And I think that that was very helpful in being able to sort of understand how to communicate with each other and what the desired outcomes were and what Memorial Sloan Kettering was really searching for in terms of really finding innovation and trying to move the dial forward on what the hospital could be and what it can mean today to build a hospital.
CINDY: 02:30
And Mary-Jean, Perkins Eastman has had a long history. I understand 25 years you've been working with them.
MARY-JEAN: 02:38
This is true. We encountered the administrator of MSK in the mid-'90s. And MSK was renowned for their research, but they also want to be renowned for patient-centered care. And they've been recreating themselves, I think again and again, and looking at their processes very carefully and how they make every aspect of what they do from the attitude of their staff till-- of course, their environments reflect their care for patients.
CINDY: 03:14
Yeah, and I'm sure it'd be really, really interesting to even just look at that history, and how far healthcare and now health and wellness has come. I mean, it's quite a journey. Okay, so we're going to set-- so we have a half an hour. We're going to do your 10-years in a half an hour or so. Let's talk about the building first, Todd. Give us an overview. It's a gorgeous building and the setting; it's just splendid.
TODD: 03:44
Yeah, it was an interesting design situation. I think we were mostly responsible for the exterior with Perkins Eastman. Fascinating process. Very collaborative. As we were developing the exterior, we had to be responsive to exactly what they were doing, laying the building out, how many floors, there was a long public approvals process that we had to take it through. But in the end, the sort of destination, and I think it was synchronous with MSK's approach to care, was to create an environment that built confidence in the quality of care the patient would receive. I mean, its location is perfect. You get away from the hustle and bustle of New York, off the avenue, headed to the river. We tried and weighed it out with Perkins Eastman to create a drop-off sequence which was welcoming, covered, calm, some transparency to the interior, and ICRAVE did a wonderful job beginning to continue that idea of welcoming. So that was the intent. The materials warm, welcoming, terracotta, very light-colored, natural materials. So that was what we tried to do, and we think it turned out pretty well.
CINDY: 05:15
Suzen, as the client, how would you respond to that?
SUZEN: 05:22
Well, you talked about the team and really, as the client and the owner, it's on us as we're looking to kind of push to the next level or levels beyond. This was a 10-year project, so you imagine that the day you kick-off, you have to be at that much more forward-thinking about what this project could be, and that's really where we came from, imagining what cancer care could be. And so curating a team that could help us get there was really integral in making that vision happen. So I think really it was almost like matchmaking in a way. Think about how the personalities of the firms will get together and really understand what we're looking for, and what we're trying to achieve, and make it happen. And I think just in terms of the location we were so fortunate to have found it. It isn't often that you find a huge site for a 750,000 square foot building on the Upper East Side overlooking the East River so that in itself was a gift. And then being able to put this team together, and work with them from day one to where we are now where patients are enjoying the space was just a dream come true. It's an opportunity of a lifetime.
CINDY: 06:56
Yeah, Todd, really bravo, bravo on the building. And also, just the fact if you think about what we were going through, and where we stood in terms of health and wellness healthcare. I don't even know health and wellness was even on the radar 10-years ago, it was probably like 7-years ago, so I'm sure that the project kept evolving, and that you really need a good team to keep moving it forward. I was there, so I toured it, and I can attest that it is like nothing I've experienced before. Okay, so we're going to-- let's move inside. We've now moved inside. We're in the lobby. So let's talk about-- let's talk about what you all have done for the patients and how the technology works in the space.
MARY-JEAN: 07:48
Okay, so obviously, you know what you see is the wonderful interior design led by Suzen and her team, and Lionel and our folks making it happen, but there's also huge technology there. And one of the first piece of technology is the fact that it's resilient. In the middle of this, we also had Sandy. Since we were in a 100-year flood plain, we already took all of the heavy-duty mechanical and put it up in the building. It wasn't underground. But then we had to design for a 500-year flood. So then we had flood gates. We tested them. If we have another Sandy, we're going to be okay [laughter]. But, of course, the other thing that's up in the building is all of what we call the big boxes. We have linear accelerators, one that's guided by an MRI. We have, of course, a lot of imaging equipment, and so that bottom box of the building includes all of those things. And then, of course, there's a floor that there's a kind of little gap above that, and that's the floor where we have the-- some of my clients call it an all-day eatery. We have a cafe for the staff, of course, but also for the patients, and meeting rooms, and all of that, and access to outdoor space. And then above that are the treatment spaces with the-- you walk into a wonderful reception area that Lionel can talk about. But backed up by that are all of the spaces where patients get treatment, and where staff work, and where the whole care team that plots a patient's course gets together and plans the development of their treatment. And then on the top of the building, you have three floors of offices for the staff. They're really academic offices, but that space is also designed so that in the future if certain facilities need to grow, certain clinical facilities, they can expand into that space.
CINDY: 10:35
[crosstalk].
MARY-JEAN: 10:35
And [crosstalk] is a co-generation plant.
CINDY: 10:39
Lionel, there's something that you said that resonated with me. You had said something, "How do you create a building that was an active participant in the patient's cure? Could the building actually help make you better?" I thought that was very beautiful. And I think in many ways that's what you all were thinking about when you were designing this building.
LIONEL: 11:01
Yeah, so that was early on in our strategy phase when we were trying to figure out the experience strategy and what is the building going to do, and I think it came on the heels of a lot of collaboration. A lot of strategy work we did with the team at MSK from Jodi Robertson was like, okay, the first project we worked on together was a 23-hour outpatient center. It had its own challenges, and it had its own needs, and this was something completely different, right? Where it's like, you're coming back, and you're coming back. And in that kind of engagement, and that relationship that you might have with a place is really important to understand when we're trying to figure out the design and the experience for what people are going to go through. And that led us to just really understanding as we built our own kind of model with the MSK team about what is the brand as it pertains to what we're about to do, right? The brand of MSK is a lot of things. It's so many parts and so many angles you take to it. But in terms of how our work can engage and stitch into what they do in curing people and helping people get through the most intense moments of their lives, we're going to build this facility. People are going to come here over and over again. Our research led us to understand that people would react to the smell of a Pine-Sol, or the color green, or whatever that might be that they would just be like, "I don't ever want to see that color ever again. I don't ever want to smell that cleaner ever again." Right? So we're like, people have a real emotional response to the place. So it came to-- I remember we were in-- Suzen, and Wendy, and the whole team were up in the studio, and we were like, "Well, what if you actually wanted to come to the building?" How could we actually turn this thing on its ear, and create a platform that made people want to come, and might even say-- because people might be coming several times a week for several months or even years over and over and over again, and it becomes a campus for them. It's like a third place.
CINDY: 12:51
Right. It is a little bit like a campus. Let's talk about some specifics of what you did.
LIONEL: 12:57
So what we did was we created three typologies for experiences on floors, and we thought of them as neighborhoods. And we stacked those neighborhoods so that you had one of the three neighborhoods stacked on top of each other, and that repeated as you went up and down the building. And the intent there was to give different opportunities to people to engage in the building in ways that they could choose and make decisions about what they want to do, and therefore pick which floor they want to do because they encourage activation, or restoration, or what was it? Rejuvenate--
SUZEN: 13:31
Recreation.
LIONEL: 13:32
Recreation.
CINDY: 13:33
Yeah, yeah. Was that hard? Suzen, was that hard to decide those-- because this was all new, right? So-- yeah.
SUZEN: 13:39
Yeah. Oh yeah, brand new. And as resourceful as clinicians are, you really have to spell it out for them. So developing these design concepts is like a foreign language to them. And also, trying to get them to understand how the space will feel is a challenge as a design team. So a lot of what we did, we trialed first before we actually did it at the Koch Center. And we did it in some of our ambulatory care locations in New York, and outside of New York. So that there was then a level of comfort with the end-users about how the spaces would operate, and how they would feel, but the other thing that was really important in prepping for the design was to really examine the patient journey, which is what we did. And we took time to meet with those clinicians and all the stakeholders to say, tell us how a patient matriculates through this journey. And we wanted to also make sure that at the beginning, there was a warm welcome, so you talked about the lobby. So the lobby should feel like it's giving you a hug in a way and welcoming you. And then as you go through your journey when you leave, we want that same feeling. It needs to be a thoughtful send-off, as well. So that was the challenge to kind of look at that journey, examine what that is, and then take it from there into design solutions.
CINDY: 15:16
I mean, it was very hospitable. You walk in, and it feels like you're in a hotel for sure, but there is a lot of technology also in terms of the devices so that people have freedom to be anywhere in the hospital, correct?
SUZEN: 15:34
Yeah.
LIONEL: 15:34
And I think that that really unlocked the opportunity. I was like okay, so we're not all tethered here in front of that door, waiting for someone to call our name. That means with the population of people who are in the building, you can make choices about where you want to be and why you want to be in that space. So even looking forward, what kind of programming can you have in that space? And what kind of options can people choose? And just back to this choice thing, choosing when you're going through cancer is such a powerful kind of motivator, just being able to make your own choice. That can be anything. That could be temperature, where you sit, could be what you listen to because everything's been kind of taken out of your control. And so by having this technology, which is RTLS technology, which means Real-Time Location Services, the hospital can now understand where anybody is at any given time, and we can find them and bring them to where they need to be when we need them. And I think that that changed for everybody, this kind of sense of waiting, and what does waiting mean? Are you really waiting, or can we help program that time and give you opportunities for other things to happen? And without the technology evolution, the function of look, we have a throughput system of people who need to wait because we have doctors or clinicians who have to work with people, and that's how we have to find them, we'd never have unlocked these possibilities. And I think that's a really big point that should be understood. It's like the investment and the courage on MSK's part to say, look, let's do this. Let's actually engage on a level where technology can help our systems with every-- forget the patient side, just on the clinician, doctors, nurses side, and then understanding how that can flow over into the patients and their caregivers is-- that's to me like the big, big ah-ha moment that opened up new opportunity.
CINDY: 17:29
It was amazing. So I understand there's libraries, there's meditation, you have fitness centers and lots of other programming.
SUZEN: 17:36
So I can speak to how the technology has changed the interaction with patients. And in the past-- and we've all experienced it, it's very transactional. So there's a huge desk, and it's them against you. And I call them fortresses. These desks that are like 42 inches high. Why do we need them? What's the purpose of them? Who's hiding? And it's all about greeting the patient in a way that we would all want to be greeted. We're all humans, right? So we thought about breaking down those barriers and creating what we call beehives. We did those at Josie Robertson, and they're more approachable reception stations. And because we don't need to have people-- again, this is all about anxiety and patient's anxiety because they don't know what's going to happen. They've lost a sense of control, as Lionel has said, so how do we give some of that control back? They have these devices-- the staff have these devices that locate them at their GPS, essentially. So a patient will check-in at the beehive, and they can go sit wherever they want to. And the staff goes to them with a mobile device, and sits down across from them at eye-level in a lounge seating type scenario, and checks them in. And we also do that for checkout. So that has completely changed the game in terms of the way the interactions feel. And just from an emotional standpoint, it's so much more supportive to the patient. So some of the ways we did that was by selecting furniture that was a little more enclosed and cocoon-like to give that privacy that you need. So again, allowing options for seating, but also creating spaces where we can have those more personal interactions that mean so much.
CINDY: 19:46
Yeah, and also, I mean, as you said, for the patients, I'm sure at first it's like, what? But also for the families, right, because it will make them feel comfortable staying there because they're there for such long periods of time. It's just a complete game-changer. Now, I understand also that the rooms themselves have been completely updated.
MARY-JEAN: 20:15
Are you referring to inpatient rooms?
CINDY: 20:17
Yeah, yeah, yeah, sorry. The inpatient rooms.
MARY-JEAN: 20:19
So yes, indeed, but this is largely an outpatient facility. But we do have some inpatient rooms for very frail patients. But most patients are treated on an outpatient basis.
CINDY: 20:37
How many rooms are there? I know I saw a few floors of it.
MARY-JEAN: 20:42
I defer to-- how many--?
LIONEL: 20:45
I think there's 16 or 18.
SUZEN: 20:47
16 inpatient rooms, but we have a couple hundred infusion and a couple hundred exam, so just the sheer volume meant that operationally-- you can create a beautiful space, but if the operational side of things doesn't keep pace or follow that thinking then it all breaks down.
LIONEL: 21:12
Yeah, I think the [crosstalk]--
SUZEN: 21:12
So that was an integral piece in trying to make this experience happen.
LIONEL: 21:18
I think that's a really key point. We learned along the way, I think, more than we ever had on any other project because it's like innovation's cool and digital's fun and all that, but if you put a new innovative model together which changes the operational model and you haven't addressed how the operational model's going to work, you've just broken the system, right, without figuring out how to fix it. So that kind of Venn diagram of like, okay, this is our physical, this is our digital, and this is our operational was like a bible for us. Every decision we made, we made sure that we weren't-- if we were reinventing, like for example, as Suzen was talking about the patient experience, like understanding I go to the hospital, I get out of the car, I go inside, I have to check-in, someone ask me for ID, I have to try to find my way. I get upstairs, someone ask me for ID, someone gives me a piece of paper, blah, blah, blah. It's like how many steps are there before you get to what you need to get to? And really breaking that down, and understanding, and be like, well, do we really need these steps? Every time you remove one of those, you've got to fix it. You can't just throw it away. You've got to understand how it's going to get fixed and, so. You'll hear me say often that some of the greatest things that we did this project have nothing to do with how it looks, right? Just like there's so many parts of this project that are about all these teams understanding the future of health care and trying to optimize what those opportunities can be. I think that it's just [crosstalk].
MARY-JEAN: 22:45
Right. And I think that was key to our experience working with ICRAVE because we had never had the opportunity before the previous project to really sit down with the administrative and some clinical leadership, and break down the whole process, and try to reinvent what was happening. That was really new to us. That was a huge learning experience. Lionel's right that we did that on Josie, and then we took that experience into this building. And it's important to realize that these patients-- they may come to this facility over 100 times in a year, and their day involves; maybe they have to have their blood drawn, maybe they have to have imaging, maybe they have to have radiation treatment, they have to talk with their doctors. So part of the back end is programming their whole day, and their whole week, and what's going to happen over the ensuing months. The staff has an incredibly complex job.
CINDY: 24:00
Suzen, what are the patients saying? What are the patients saying? And what are the families saying?
SUZEN: 24:05
The response has been overwhelmingly positive. Patients walk in, and they think that they're in a hotel. It's disarming, and that's what we were after. And so I think too, as a client-- I'm a client, but I'm also a designer. So--
CINDY: 24:26
We know so well. We love you.
SUZEN: 24:29
Well, and so what's interesting about that is that there are very few health care organizations that have an in-house design team. So just the fact that MSK believes so much in the patient and staff experience that they've allocated this team is unusual. And what we've done is even our administrators when we launch these projects, we challenge the design teams to make us uncomfortable. So push us so far that we feel uncomfortable. And interestingly, what's happened is that the design teams feel uncomfortable too, but that's great because then we're all kind of at the same level footing, and we can kind of jump from there. But I think too, just also to the point of staff engagement and satisfaction, we're in an industry, especially now, where we don't have the pick of the litter anymore. Less people are going into nursing, so how do we recruit the best and brightest in nursing and physicians, as well, because we're the top in our field, so we're always looking to recruit the best. And the environment and the progressive attitude of an organization is a draw, and that's fine. We get them here, but how do we keep them engaged, and happy, and satisfied? So much consideration was given to those staff spaces, and Lionel and Mary-Jean can speak about that. But that's such an important component that's been forgotten in health and wellness, and now it's coming back to that from the patient [crosstalk]--
LIONEL: 26:24
[Awake?]. [crosstalk].
CINDY: 26:26
And I do think [crosstalk]--
MARY-JEAN: 26:26
For what they do--
CINDY: 26:28
Go ahead.
MARY-JEAN: 26:29
What they do is so stressful. They do get emotionally involved with patients who they see many, many, many times. It's really stressful in [inaudible] care.
LIONEL: 26:42
I remember--
CINDY: 26:42
I was going to say--
LIONEL: 26:44
No, go ahead. Go, Cindy, please.
CINDY: 26:46
No, no. I was just saying that I think once you take care of-- you take care of the staff better then everything changes. And by the way, and then they'll never leave you also, right? And then their expectation is completely changed, which--
LIONEL: 27:01
I remember this conversation early on where we were like, well, if you really mean your patient-centric, if we really want to say that and we're not just-- it's not just like this kind of flag that we want to wave, then your staff has to be taken care of because if they're tired all the time, and they can't facilitate their everyday life, if they don't have an area to go help their kid do homework, and work all these long shifts or whatever, book a flight or whatever they-- just the everyday banality of living that, we would see so many staff in corridors or on a little shelf with a sandwich tray trying to eat and get the stuff done between minutes of time, and I think that that was a big, big deal. We saw how the staff reacted at Josie Robertson, right? They were like people who wanted to work there. It was like that carried over to this project where it's like, if you're going to be patient-centric, you need to look at everybody working in that building so that everyone's focused on the patient when they're in that space. I think this one does that.
SUZEN: 27:57
It develops a culture that you can't explain. When employees feel like the organization they work for cares about them and their-- not just well-being but emotional well-being that means so much, and it really solidifies the culture.
CINDY: 28:17
And can I ask all of you, has this project changed your firm in some way?
LIONEL: 28:26
That's an easy answer for me.
CINDY: 28:28
Yeah, I know your answer. Lionel's a yes. Mary-Jean?
MARY-JEAN: 28:33
Oh, so I think for Todd and I, this is definitely one of the largest projects in the city that was built in the last decade. Certainly one of the top ten. It is a legacy of the Bloomberg administration wanting to have this site be used by this kind of facility. Todd had to convince Amanda Burden that this was the right thing to do and did that successfully. And then once we finally got approved to do this, which actually happened in incredibly short time. It was less than two years, which is kind of a record for a major ULURP like this. Then there was a whole other process that started-- I mean, we had started with the medical planning, and we had had hundreds of meetings with clinical leadership, but then envisioning the interior, and Lionel getting involved with us again. And again, meetings with so many-- their administrative leaders and then Suzen's team putting a lot of time into thinking everything through.
CINDY: 30:00
I think we should just follow Suzen around because she always been [laughter] [inaudible].
TODD: 30:06
I think that's what we did.
MARY-JEAN: 30:06
I mean it-- [crosstalk].
MARY-JEAN: 30:10
[crosstalk] a legacy.
TODD: 30:15
For me, being an architect, I want to help. I make my buildings to make humanity better. And part of the satisfaction in this project-- I heard a doctor briefly talk about what everybody here has talked about. He said, "It makes it so much easier for me when someone comes in, and they're not terrified, they're more relaxed. It's much easier for me to help them. It takes less time." This is exactly what the building is doing. Then the satisfaction I get from a doctor saying that that warms my heart and makes this big building very personal. It's very satisfying.
CINDY: 31:08
Well, you all are honestly amazing. We are talking about it more, but I think the one word that resonates that humanity for everyone going through something so potentially tragic and also potentially healing. And I want to thank you all so much for being such an amazing team. It can get really hectic and hairy, I know that, and you all have such respect for one another. And actually, the end result is really a testament to that too. So my hat's off to you, and thank goodness we have people who really, really care about what's going to happen in health care and in health and wellness in the future. So thank you all so much. We're going to keep this conversation going.