By Amanda Sangster - May 08, 2023
Four years ago, an aging one-story building sat nearly vacant on 22 acres of land. In its heyday, the old building produced parts for rocket ships and allegedly held government secrets. Most recently, the plot was used as a temporary office building for Moffitt Cancer Center’s administrative departments. Located directly across from the Richard M. Schulze Family Foundation McKinley Outpatient Center, it was a logical choice for the cancer center’s future expansion.
A normally quiet piece of property, the building buzzed with energy in 2019. Within its humble walls, more than 170 people gathered to imagine a 500,000-square-foot, state-of-the-art inpatient surgical hospital.
Sprouts of weeds emerged from the worn pavement as patient and family advisors Laura Barber, Jason Bever, Rae Sawyer, Ron Giovannelli and Bruce Mackey walked into the building. As longtime volunteer advisors within Moffitt’s Patient and Family Advisory Program, the small group was elated to be invited to a design session for a future hospital. They arrived fully prepared to give their best insight as patients and caregivers. However, none of them anticipated being the guests of honor.
As they entered the large, crowded room, the advisory group stood on the sidelines and allowed others to take their seats first. As the back rows began to fill, the front row remained open and marked as reserved. The group suddenly found themselves being nudged toward the front row. They were surprised when they learned the reserved seats were for them.
“That’s how valuable they felt our input was,” said Barber, a breast cancer survivor and caregiver.
“Everywhere you go, hospitals want to do the right thing,” said Bever, a caregiver. “Hospitals want patient input, but Moffitt put us in the front row. The hospital executives were sitting three rows behind us.”
Alongside architects and neurosurgeons, Moffitt’s Patient and Family Advisory Program oversaw the entire construction of Moffitt McKinley Hospital. When designing a new hospital to treat the growing cancer burden, leaders knew that building a facility that is truly patient and family centered requires the expertise of the patients who will be treated there and the families that will help them heal.
Building Blocks and Yarn
The advisors joined a diverse group of surgeons, nurses, pharmacy staff, lab personnel, interior designers and architects as they worked through huge floor plans spread across tables. They were given small cardboard blocks to build the outline of patient rooms, workspaces and storage areas. One by one, each floor of the hospital was imagined.
The groups were charged with identifying the flow of the hospital. Pieces of colored yarn wound along drawn hallways to represent the movement of staff, supplies and patients throughout the building. Nurses planned their workflows using green yarn. Light blue pieces helped the pharmacy staff follow the delivery of medications. Pink yarn depicted the flow of patients through every floor. Red followed family members and caregivers. When traffic intersected or hit a roadblock, the workgroups collaborated to find a solution.
"The collaboration that exists between Moffitt and patients, it was always recognized. And we saw the changes being made in real time as the plans progressed. The administration at Moffitt really goes out of their way to make sure the patients are heard."- Rae Sawyer, Patient and Family Advisor
Following these immersive design exercises, patient rooms and operating suites were constructed from cardboard to give everyone a realistic feel for the spaces. A few years later, a full-scale mockup room was built within another Moffitt campus. The advisors were invited to provide their feedback every step of the way.
“The collaboration that exists between Moffitt and patients, it was always recognized,” Sawyer said. “And we saw the changes being made in real time as the plans progressed. The administration at Moffitt really goes out of their way to make sure the patients are heard.”
When asked what the most important element of the new hospital will be, the advisors all shared a common thread. They all agreed that it’s truly not one major thing that will make the biggest difference in the lives of patients and their families at Moffitt. It’s actually all the little things.
Making It All Accessible
Laura Barber knows quite a bit about the little details and the inpatient experience. The average stay at Moffitt McKinley Hospital will be between three and seven days. In 2012, after husband Steve’s stem cell transplant to treat myelodysplastic syndrome, she slept on a cot in his room at Moffitt’s Magnolia campus for 56 days. As a Master Gardener, she enjoyed exploring the grounds of the campus. Once her husband was discharged, Barber was his caregiver for his first 100 days post-transplant, the most crucial time for transplant recipients.
“Anytime I put on my advisor hat, I try to think about my own experiences and the details, but I also try to think about the typical patient at Moffitt,” Barber reflected. “They’re usually older, maybe not very mobile. At Magnolia, there are beautiful gardens, but they’re not easy to get to. I really wanted things to be accessible at this new hospital.”
One of Barber’s biggest concerns was ensuring there would be enough open and welcoming spaces for caregivers and family members to enjoy. She remembers seeking respite in the spiritual room at Magnolia as hospital fatigue set in.
“People don’t bother me,” Barber explained. “But the space was so small that just one person entering the room rather disrupted my solitude.”
Based on Barber’s feedback, the architects of Moffitt McKinley Hospital designed the new spiritual room to be much larger and accommodating. It offers open spaces with soothing, wide-angled views of the gardens and distanced seating.
For Barber, accessibility goes beyond space. It also means convenience, safety and removing unnecessary stressors. Although the cancer center offers free valet parking for patients at various campuses, some patients and families prefer to self-park to avoid the introduction of additional germs into their cars. For transplant caregivers like Barber, fighting the fear of possible infections is like waging an unwinnable war. Every surface is potentially dangerous for their loved one. In those first 100 days post-transplant, any infection can jeopardize the treatment.
“When we got our car back after an appointment, I felt like I had to wipe it all down and drive home with the windows open,” she explained.
Barber and other advisors felt this was an unnecessary risk that could be easily avoided with additional parking options. When the architects of Moffitt McKinley Hospital planned a parking garage for the property, they reserved an entire floor solely for self-parking. They also added covered walkways to shield patients from the elements.
Making It All a Little Bigger
As a retired radiologist and parent of a son with cancer, Rae Sawyer offers a unique perspective. Her son Gregory had malignant melanoma and received immunotherapy when the science was in its early phases at Moffitt in 2013. After her son’s treatment, Sawyer joined Moffitt’s volunteer ranks as a family advisor in 2018.
When she was invited to contribute to the design of the new hospital, Sawyer’s focus was on improving the patient rooms. In fact, all advisors stressed that the patient rooms and the technology in them needed to be exceptional.
“I’ve worked in hospitals all my career,” Sawyer said. “And having been at several different hospitals with my son, I had seen the things that really worked well and things that didn’t. I have never seen a patient room that was so patient and family oriented as this one. It’s high-tech and pushing the envelope. It’s quite impressive.”
The patient rooms at Moffitt McKinley Hospital are equipped with virtual assistant technology, integrated pillow speakers and voice controls. Each room features large television screens that offer entertainment options and educational resources. Digital screens have replaced the standard dry-erase whiteboards known throughout all hospital systems. Information on the digital whiteboards will update in real time according to the patient’s medical records, allowing for patients to easily view their dietary restrictions, allergies, medical concerns and more. The digital screens will also display the names of the Moffitt staff entering the room, so patients will always know who’s caring for them.
To make lodging more comfortable, the patient rooms are larger than their predecessors. Every room offers a great window with vast views, a recliner and large sofa bed.
“It feels like a hotel room,” Sawyer said. “There’s a big window with lots of light, and directly under it, there’s a sofa that pulls out into a large bed so a family member can be there and help take care of them.”
The family area within the patient room was designed to be free from clinical interference, meaning clinical tools are all located on the other side of the room. So family members will never feel like they’re in the way of providers.
“I think the patient room is something big and small that will improve outcomes for patients,” Sawyer concluded. “Having a setting like that is so important for healing. That room is truly amazing.”
Measuring in Millimeters
The smallest things can make a significant difference in the survival and outcomes of patients.
“In our world, millimeters matter,” explained Moffitt Chief of Neurosurgery Michael Vogelbaum, M.D., Ph.D., who will be performing delicate brain surgeries at the new hospital. “Sometimes, the movement of the brain during surgery is in centimeters.”
Vogelbaum and other Moffitt team members gave extensive input into the new hospital’s design and technology. One of the most remarkable pieces of technology at the new hospital is the intraoperative magnetic resonance imaging (iMRI) system that will assist doctors like Vogelbaum during surgeries. An innovator in his field, Vogelbaum was an early adopter of iMRI technology. During his tenure at the Cleveland Clinic Foundation, he conducted research on the application of high-field iMRI in the removal of brain tumors.
Image guidance has revolutionized neurosurgery, enabling three-dimensional navigation systems to locate tumors, he explains. But more breakthroughs were needed to obtain intraoperative imaging that was truly diagnostic.
Ultrasounds and CT scanners don’t provide the detail required to pinpoint the location and state of a tumor. MRIs are the best option, but the challenge is the magnetic environment because operating room instruments are ferromagnetic.
Moving a patient during surgery to get an MRI presents problems, though. When the patient is ready for imaging, they would be transferred between beds. However, moving a patient under anesthesia increases the risk of dislodging a breathing tube or other lifesaving apparatus. Additionally, every time the patient is moved, the brain shifts within the skull.
The iMRI allows the surgeon to conduct intraoperative imaging without moving the patient. The machine glides into the operating room from a centralized diagnostic room using a rail system. The operating room instruments and patient are secured before the imaging is performed. Once images are obtained, the machine recedes back into its shielded unit and the surgery continues.
“What we know for certain is that for the highest-grade brain tumors, the extent of resection, or the removal of the tumor, matters in terms of outcomes and survival,” Vogelbaum explained. “High-grade brain tumors grow and spread quickly through brain tissue, making them harder to treat and remove. In the past, surgeons did their best using image guidance but wouldn’t know how well they did until the following day when new scans could be obtained. Having real-time imaging will allow them to remove the tumor to its margins.”
“This has been a long time coming,” Vogelbaum added. “Having these kinds of state-of-the-art and cutting-edge technologies that help us to do our jobs most effectively as neurosurgeons, Moffitt will be better equipped than any other major hospital doing brain tumor surgery.”
Removing the Bumps in the Road
Undergoing cancer surgery is a transformative process for patients. The patient entering Moffitt for surgery is very different from the patient who is leaving. The former may walk in feeling anxious and scared, while the latter leaves with a different mindset as they’ve moved into the next part of the journey. Jason Bever knows this firsthand.
“Sometimes our emotions were super high,” explained Bever, whose wife, Joanna, had a mastectomy at Moffitt after being diagnosed with breast cancer. “Sometimes we were really down because it’s such a scary thing.”
Some patients, like those recovering from mastectomies, may leave the building in a fragile state, feeling less than whole following surgery. Wheelchairs and bandages can draw unwanted attention for someone in a vulnerable state.
That’s why, when invited to help design the new hospital, Bever advocated for a private surgical discharge lounge. He wanted to help patients who are on their way out avoid the feelings his wife experienced.
“Going down to an open lobby with people coming and going can feel uncomfortable after surgery,” Bever said. “It can feel chaotic and like you’re in the way.”
Bever and the advisory group talked with project leaders about the need for a separate area where discharged patients could wait while their car is brought around. Although patients will enter and exit at the same location on the northern side of the new hospital, there are two separate areas for those arriving and leaving. This design offers departing families privacy while also increasing the efficiency for patients flowing in and out of the building.
Based on Bever’s feedback, there was also one element excluded from the plans for the new hospital: cobblestones.
At other campuses, there are cobblestone pavers leading from outdoor valet areas to lobby entrances. Bever never noticed these until the day his wife was wheeled out of the hospital following her mastectomy. As he pushed her toward an exit, a member of the patient transport team redirected them through a different door. Bever quickly realized why.
“I learned there were cobblestones outside the door that I was heading to,” Bever said. “For a patient who just had a double mastectomy and is coming out of anesthesia, going over the bumpy cobblestones could be painful. That team member made sure my wife was comfortable and took the time to take her through another door.”
This small gesture left a lasting impression on Bever.
“I started crying,” Bever recalled. “It was emotional. Who takes the time to do something like that when they’re so busy? I was blown away. And as we went through building a new hospital, I really wanted to make sure we paid attention to all these little things.”
It All Adds Up
The experiences gleaned from the advisory group and expertise from Moffitt team members resulted in far more than peaceful respite areas, self-parking spaces, bigger rooms, cutting-edge technology and smoother walkways. Their input resulted in small details throughout the hospital that will make a world of difference in the patients’ healing environment.
Ultimately, though, there is one feature that couldn’t be physically built for the new hospital but permeates the space nonetheless. Bever says it is the most important part.
“I think there’s a difference between treatment and care,” Bever said. “Treatment is medicine, and anyone can provide that. But care is a team member taking my wife out a different door so she’s not in pain. Care is listening to advisors. It’s not necessarily a fixture or the type of elevator being installed that’s going to make the difference at the hospital. It’s the people at Moffitt who understand what’s important.”
Moffitt would like to especially thank Bruce Mackey, longtime supporter, friend and volunteer, for his contributions to Moffitt McKinley Hospital and the Patient and Family Advisory Program. Mackey passed away in March 2023.
This article originally appeared in Moffitt’s Momentum magazine.