Winship Cancer Institute at Emory Midtown | SOM - Skidmore Owings & Merrill

In 2018, Emory Healthcare and Winship Cancer Institute of Emory University put forth a vision to create a cancer care center that has “never before been seen or imagined.” Winship Cancer Institute—the only National Cancer Institute (NCI)-designated Comprehensive Cancer Center in the state of Georgia—aspired to fundamentally change the way patients with cancer are treated. For SOM, in collaboration with May Architecture, the project represented an opportunity to reimagine the role of architecture in healthcare.

Emory’s new 17-story, 450,000-square-foot building in the Midtown neighborhood of Atlanta introduces a new kind of cancer care facility that reflects the research and medical advances happening in the field. Drawing from SOM’s expertise across various typologies—including civic, workplace, hospitality, and residential design—the project was guided by a set of principles that questioned the established practices of hospital design. Rather than aiming to design great waiting rooms, SOM sought to find a way to minimize, or in some cases eliminate, the need to wait. The architecture rethinks the typical organization of floors that routinely move patients throughout a hospital building. And at the street level, rather than creating a standard, self-contained facility, Winship at Emory Midtown is designed to enhance the public realm.

The organization of the floors lies at the heart of this paradigm shift, and the process of its creation was equally unorthodox. Working with more than 160 stakeholders—including Winship’s leadership, its patients, clinicians, volunteers, hospital staff, and the construction team—a wide assemblage of voices became a creative engine to determine how to organize a medical facility from the perspective of the patient’s experience. Using a set of scaled cardboard models, easily reconfigurable to represent various clinics and services, SOM created a new concept: a medical facility arranged not around equipment and departments, but instead broken down into “care communities,” each focused on a specific type of cancer.

This model is particularly suited to cancer treatment. Unlike most patients in a general hospital, patients with cancer make frequent visits. The care communities create smaller, more efficient, and supportive units focused on patients’ needs. Every “care community” functions like a miniature hospital-within-a-hospital. They each bring together an inpatient unit, outpatient clinic, infusion, diagnostics, and even some procedural spaces, all connected by two-story communal lobbies. By contrast, many typical urban medical facilities follow a “blocking and stacking” arrangement: inpatient departments stacked atop diagnostic services, which are stacked above outpatient departments at the base. While this may seem like a simple change, it’s a complete reinvention of the building type. Winship at Emory Midtown’s communities unite fellow patients and families enduring the same experiences—to make sure no one feels like they’re alone—and allows specialists to visit both inpatients and outpatients without ever leaving the two floors.

To determine the layout of each individual space, SOM and May Architecture imagined a way to compose the care communities to best serve patients’ needs. That led to the next breakthrough moment—to turn the typical hospital floor plan inside out. Normally, outpatient exam floors follow a familiar formula: grids of windowless exam rooms, with clinical offices segregated in the back. Instead, the design team inverted this layout, placing gracious, light-filled corridors along the perimeter, with exam rooms and clinical space in the center of the floor. The daylit spaces and generous common areas are like nothing typically seen in a medical facility. That goes for the workspaces as well—clinicians benefit from an efficient, centralized layout that encourages collaboration. These spaces, which are also used for clinical research, help build and sustain the Winship Cancer Institute’s distinctive oncology programs through recruitment, retention, engagement, and the development of faculty, staff, and trainees.

The research spaces and care communities are housed in a rectangular tower. The duplex care communities informed the design of the structure’s exterior, which is expressed in two-story facade increments that give the facility an approachable scale on Atlanta’s iconic Peachtree Street. The two-story lobbies that bracket the ends of each care community are designed with wooden ceilings and floors that extend to the outside, juxtaposing the building’s taut, high-performance glass and steel facade with natural materials.

A two-level pedestrian bridge connects the new cancer care center to the existing Emory hospital complex. The bridge is supported by a steel truss with an innovative geometry that was optimized using SOM developed finding 

tools. The structure was prefabricated on the ground and installed over the street in just a single weekend. Emory Hospital is the first client to benefit from this innovative truss design.

Reflecting Emory’s commitment to a new level of civic engagement, the base of the tower meets the street with a transparent storefront. The visitor experience begins with a dignified, valet-serviced porte cochere—a grand outdoor room sheltered by a dramatic roof with an oculus that opens views to the sky and creates dramatic sun and shadow at the building’s front door. Pulled off from the street, this drop-off creates a calming and welcoming space within the busy heart of Midtown Atlanta, while providing patients easy access to the building and parking. Taking cues from hospitality design, the porte cochere leads into the main lobby, a double-height space finished in a warming marble and wood and through which every space in the building is accessible. The lobby connects patients and visitors to a seamless, centralized registration reminiscent of a hotel arrival and check-in. Each destination is visible from any point in the lobby, making the user orientation elegant and intuitive.

Amenities throughout the building reflect a holistic and expanded approach to patient care—including a retail boutique and pharmacy, a wellness center, a cafe, and multipurpose spaces for yoga, music, education, and art. Many of the new amenities provide patients, staff, and visitors with areas for relaxation within the dense urban setting. Informal lounge spaces are sprinkled throughout the entire building, and designed with natural materials to evoke a sense of warmth. The lower roof hosts an elevated garden, a calming, biophilic urban sanctuary for respite that can be used for dining and events.

Through a holistic approach to energy-efficient design, the building will expend almost 40 percent less energy annually than the average hospital in Atlanta. The project is on track for a predicted Energy Use Intensity (pEUI) of 136 kBtu per square foot per year, a 32% improvement from typical hospitals in the United States, which expend 220 kBtu per square foot per year on average. The high-performance facade optimizes glazing and window-to-wall ratios, and the building features energy-efficient recovery mechanical equipment with chilled beams and direct-outside air units. Water usage is reduced through the collection of all stormwater for reuse in irrigation and chiller plants. Within the building, daylight, views, and thermal comfort create an environment that supports recovery. The use of low VOC materials further contribute to a high-quality indoor environment. The project is targeting LEED Silver certification.

Now complete, the building offers a very new kind of healthcare experience. As a center for wellness, it reconsiders how an urban medical center relates to its neighborhood. Its care communities serve patients throughout the region with holistic treatment that spans from education and screening to survivorship—all at one-stop destinations tailored to the experience of each patient. The building helps Emory Healthcare remain at the vanguard of cancer care, and it could raise the bar for how we design our medical facilities in the future.

Architecture and Design Talking Points:

●  Winship at Emory Midtown reimagines the role of architecture in health care, serving as a new paradigm for hospital design. The architecture rethinks the typical organization of floors that routinely move patients throughout a hospital building.
●  The new 17-story facility brings more than 450,000 square feet of inpatient, outpatient, and research facilities to the existing Emory University Hospital Midtown campus and Winship Cancer Institute.

Layout:
●  The layout is arranged not around equipment and departments, but instead broken down into “care communities,” each focused on a specific type of cancer. These “care communities” each bring together an inpatient unit, outpatient clinic, infusion, diagnostics, and even some procedural spaces, all connected by two-story communal lobbies.
●  The design team inverted the traditional outpatient exam floors layout, which is typically a grid of windowless exam rooms, with clinical offices segregated in the back. Instead, the new facility places gracious, light-filled corridors along the perimeter, with exam rooms and clinical space in the center of the floor. The centralized layout encourages collaboration, improves daylight, and creates generous common areas.

Lobby and Drop-Off Area:
● The visitor experience begins with a dignified, valet-serviced drop-off—a grand outdoor room sheltered by a dramatic roof with an oculus that opens views to the sky. 

●  The oculus is a long span, fabric-covered canopy structure that frames the drop-off zone, provides shelter, and creates a dramatic sun and shadow at the hospital’s front door.
●  Like a hotel, this drop-off leads into the main lobby, a double-height space finished in marble and wood, and through which every space in the building is accessible.
●  The lobby connects patients and visitors to a seamless, centralized registration reminiscent of a hotel arrival and check-in. Each destination is visible from any point in the lobby, making the user orientation elegant and intuitive.

Sustainability:
● Sustainability was an important consideration in the design. The project is targeting LEED Silver certification. Sustainable design features put the building on track for a high Indoor Environmental Quality (IEQ) and an ambitious 130 Energy Use Intensity (EUI). As a result, the building will expend almost 40 percent less energy annually than the average hospital in Atlanta.