1.
Planning a Better Cancer Center:
10 Critical Steps to Success
A great responsibility has fallen on your shoulders: you’re in charge of developing
a new cancer center or perhaps expanding the existing facility. You’re an expert at
keeping your cancer center running smoothly but you’re not sure where to start
with this new challenge. A myriad of questions are running through your mind
like:
Unfortunately, a cure How much will it cost? How much space do we need? Could we expand our
for cancer has yet to existing clinic? What about the Certificate of Need? Who can help me?
be found. However,
treatments continue Of course, everybody’s first question is “How much will the new facility cost?” but
to evolve and improve. there is a great deal of work to be done before that question can be answered. In
Doctors and hospitals this paper we provide you with a basic outline of the design and construction
will need new facilities process to ensure that your project is smooth and successful. The specifics of
to help them your project may require additional steps, but when this fundamental process is
administer the latest omitted or not followed it is inevitable that you will experience delays, cost
therapies and overruns and your expectations may not be met.
ultimately provide
patient care in the We’ll focus on the aspects directly related to the design and development of the
best way possible. physical facility and leave the questions of market analysis, business
development, practice management and other concerns to the specialized
consultants. The cancer center construction process includes the following 10
critical steps:
1. Assemble your Core Team
2. Develop the Project Scope and Budget
3. Select the Equipment
4. Conduct Site Selection and Analysis
5. Assess the Certificate of Need Process
6. Select a Construction Delivery Method
7. Begin the Design Phase
8. Finalize Permitting and Construction Cost
9. Begin Construction
10. Occupy your new building
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2. Step 1: Assemble your Core Team
Before you go too far, assemble a team of experienced professionals who are
familiar with your project type and who will become a tremendous asset to help
you move through the process. In healthcare, it takes a team of specialists to
ensure the patient receives the best treatment. The development of your new
facility is no different. Just as doctors specialize, so do architects, contractors and
Just as doctors consultants. You do not want your project to be an apprenticeship where your
specialize, so do team members are learning about a new project type.
architects, contractors
and consultants. Common team members in a cancer center construction:
 Owners Representative: This could be your role and the reason that you are
reading this article. If so, it is important to realize that this is one of the most
critical roles for the success of your project.
 Architect and Design Team: Your architect should be like a conductor leading
a symphony of engineers and other members of the design team as they
convert your needs into a buildable design.
 General Contractor: All of the work that you, your architect and others have
put into this project will lie in the hands of the General Contractor (GC) to put
all the pieces together.
 Equipment Vendors: The vendors for your major pieces of equipment (linear
accelerators, CT and PET/CT, etc.) are a great resource. They should be
engaged early and utilized as a resource for their expertise and experience.
 Physicist: A physicist will be needed to design the shielding requirements for
linear accelerators, HDR rooms and imaging areas of the facility.
 Specialty Consultants: Depending on the size, complexity and even location
of your project, there may be a variety of other consultants involved at
Whether you’re
different phases. Specialists might include CON experts, business consultants,
building a new facility
real estate professionals, land surveyors and geotechnical engineers.
or completing a
 Project Manager: With larger projects, it is common for the Owner to hire an
renovation, several
outside consultant to manage the design, construction and eventual
questions need to be
occupancy of the space.
addressed early in the
process before design
Step 2: Develop the Project Scope and Budget
can begin.
This step is the most important when determining the long‐term success of your
project. It is where your architect helps to translate your needs into building
area and other project requirements. This is when spatial requirements such as
the number of exam rooms, treatment spaces, offices and even storage and
housekeeping requirements need to be determined. To be successful, you will
need to communicate detailed information to your design team so they can
understand how you intend to operate within your facility. You should have
meaningful involvement from all stakeholders during this process.
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3. Step 3: Select the Equipment
If your project includes radiation oncology, then there are several design factors
which are reliant on the selection of the linear accelerator and other treatment
equipment. If your cancer center is limited to medical oncology, this step is not as
Keep in mind that if critical. Due to the unique nature of each piece of equipment, it is critical for you
major changes occur and your design team to understand the requirements and constraints imposed
late in the design by the selection of one piece of equipment versus another. Criteria such as
process, this could energy level, ceiling height, shielding thickness, power requirements, cooling
have a great impact requirements, control console size and accessory storage varies between
on the project manufacturers.
schedule and cost.
Your design/build team should have a good understanding of your type of
practice and an established relationship with physicist and equipment
manufacturers. Linear accelerator manufacturers can be a good resource for
finding qualified consultants whom they have worked with in the past.
Step 4: Conduct Site Selection and Analysis
Whether you’re planning an addition, renovation or a new freestanding center, it
is important for your design team to survey and analyze the site conditions.
Depending on your type of project the concerns and due diligence will vary.
Below is a listing of typical concerns that need to be addressed early, before
design can truly begin.
For a New Facility:
 What are the local zoning requirements (such as
allowed uses, building setback lines, building size)?
 How much property is needed to build this facility?
 Can future expansion be accommodated on the
same property? Are there adequate utilities
available?
 Will the terrain or other features of the land cause
you to incur more site development cost?
For Addition and Renovation Projects:
 Is there adequate space available?
 How can this be accomplished with minimal
interruption to occupied spaces?
 Is the existing vault large enough?
 Is the existing shielding adequate?
 Is there adequate power, air conditioning and
chilled water?
 How will the new equipment be rigged into the
space?
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4. Step 5: Assess the Certificate of Need Process
The first step in evaluating the regulatory climate for development of your project
is to determine if Certificate of Need (CON) regulations apply. Sometimes this is
a simple analysis and in other states the regulations may be quite complex.
“The complexity of the CON
process as well as potential
for competing applications
or contentious opposition
often adds delays to the
development or expansion
of a cancer center.
Identifying an experienced
consultant as part of the
team early in the process
will help you navigate this
course.”
‐Kathryn M. T. Platt, M.B.A.
President, Platt HMC, Inc.,
Depending on limitations of CON regulations in your state, the potential for
Atlanta, GA
approval of the CON should be assessed before spending a significant amount on
development of the project scope, equipment selection and site selection. If there
is little likelihood of CON approval under current conditions, the project may need
to be delayed—or in some instances postponed indefinitely.
To successfully navigate the CON process, you want to be familiar with three
things:
1. Knowing when to use CON Professionals: A specialized consultant will help to
determine the likelihood of approval and any limitations created by the CON
process. You will want to find a consultant who has experience with CON
applications for cancer services generally and for radiation therapy specifically
(in many states, there are special CON rules just for radiation therapy). A
consultant with this experience will be able to best position the CON
application for approval, particularly in a competitive CON filing process. The
budget may need to encompass CON consulting and legal fees should the
project encounter opposition or appeal. A CON consultant or attorney can
also help navigate any post‐approval reporting requirements that are typical
in most states.
2. Knowledge of your state’s CON Process:
The CON process in your state may impact not only the project costs but also
the project timeline. The timing can dictate the schedule in the initial
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5. planning phases. Also, many states limit the time period in which CON
applications for various services may be submitted. Certain elements of the
scope, budget, design, equipment selection and site selection must be
completed for submission with the CON (the specifics of which vary by state).
In order to be ready for CON filing at the appropriate time, specific steps must
be completed prior to the filing deadline.
3. Impact on project timeline: The CON process and potential appeal can set the
time frame for all remaining aspects of the project. Time for the CON review
must be built into the project schedule in regulated states. If there is a
possibility for protracted CON litigation, additional delay must be built into
the project time frame.
Step 6: Select a Construction Delivery Method
The most common types of project delivery and execution methods are Design‐
Build or Design‐Bid‐Build. The majority of projects used to be built under the
For highly technical
traditional Design‐Bid‐Build method. Just as the name suggests, the Owner first
and specialized
contracts with an architect to develop the complete design and contract
projects such as
documents (drawings and specifications) and then the project is sent to
radiation oncology,
numerous general contractors to bid. After bids are received and evaluated, a
our experience has
general contractor (GC) is selected and contracted by the Owner to build the
shown the team‐
project.
building approach of
Design‐Build to be
A few decades ago, the Design‐Build delivery method was introduced. In 1985, it
best suited for these
was the method used in 5% of all construction projects. In 2008 that number
projects.
grew to more than 40 percent, according to the Design Build Institute of America
(DBIA). The DBIA predicts that by 2010, the Design‐Build method will outpace
other methods of construction. With Design‐Build, the architect and contractor
work together as a team under a single contract with the Owner. This allows the
architect and contractor to develop the project with a better understanding of
how design decisions will affect the construction cost. This process eliminates
the competitive bid between general contractors but still allows competitive
pricing of the sub‐contractors. Design‐Build is used to minimize the project risk
for an Owner and to reduce the delivery schedule by overlapping the design
phase and construction phase of a
project.
Step 7: Begin the Design Phase
Now that you have determined your
needs, established the budget and
received CON approval, you have the
green light to move forward with the
design of your new facility. The
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6. design team will develop the construction documents in stages from general to
more specific. The design process will progress from schematic design to design
development to construction documents. Depending on the size and scope of
your project, this could take anywhere from one to six months (or even more with
extremely large projects). At the end of each stage there should be opportunities
for the Owner to review, comment and make adjustments to the design.
Step 8: Finalize Permitting and Construction Cost
Once construction documents are complete, submittals will then be made to the
“As a construction local building department and other authorities for review, comment and
company, we want to approval of the design. During this process there may be a few revisions required
hit the ground running by the building authority before a permit can be issued. This may take as little as a
and we can do that in couple of weeks to several months depending on the process and workload at the
a Design‐Build project. municipality.
If we’re depending on
an architect not During this same time, construction documents can be sent to the bidders or the
experienced in cancer selected General Contractor for pricing. Again, this may take a couple of weeks
centers, so many but generally never more than four weeks to get the final construction cost. At
changes come into the end of this step you should have a building permit in hand and a contract for
play when the design the construction of your facility.
isn’t done right.”
‐Mark Van Tilburg, Step 9: Begin Construction
General Contractor, Finally! This is where everything
Advanced Shielding starts to come together and
Technologies you will eventually see physical
West Point, KY evidence of all your effort. But
be prepared: construction is the
longest and often the most
frustrating part of the process.
Depending on the size and
complexity of your cancer
center, the construction phase
will last from just a few months
to more than a year. It’s inevitable that you, your boss and your coworkers will
see things during construction that are not quite as you imagined. If there are any
questions, it is far better to bring them up early; once materials have been
ordered, concrete has put in place or walls have been covered up with gypsum
board, it is going to be much more expensive to make a change.
The architect and contractor should invite your participation in periodic site visits
and meetings to keep you abreast of the process and allow your input as needed.
You need to stay involved as there are bound to be additional details that need to
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7. be worked out as your facility is built. If you and your team have done a good job
defining your needs and being sure the design documents reflect those needs,
then these should be relatively minor issues.
Step 10: Occupy your New Building
All of your hard work has paid off and everybody is excited to move into your new
space. The majority of construction is complete but it may take several weeks for
the equipment to be fully installed and tested.
Summary
The process of building
a cancer center can be
overwhelming. It’s
important to hire the
right team with the
right experience. If you
follow these 10 critical
steps, you can move
forward confidently
and ensure your
project will be a
success.
Do you have questions about your specific cancer center or want to find out
more? HPA Architects has more than 30 years of combined experience building
cancer centers. Call us today at 770‐419‐8337 or email David at david@hpa‐
arch.com. For more information visit us online at www.hpa‐arch.com.
HPA Architects
2040 Arbor Forest Dr.
Marietta, GA 30064
Office: (770) 419‐8337
Email: david@hpa‐arch.com
www.hpa‐arch.com
HPA would like to thank the following individuals for their contribution to this white paper:
Kathryn Platt Mark Van Tilburg
Platt HMC, Inc. Advanced Shielding Technologies, Inc.
881 Piedmont Ave. NE 23355 L&N turnpike
Atlanta, GA 30309 West Point, KY 40177
(404) 728‐1974 (502) 922‐3009 7
www.platthmc.com www.advancedshieldingtech.com