Designing and Building Memorial Sloan Kettering’s First Regional Cancer Care Outpatient Center with Operatory Theatres

Steven Friedman, MSK Director of Engineering for Design + Construction and Greg Mason, MSK Monmouth Site Administrator

Steven Friedman, MSK Director of Engineering for Design + Construction and Greg Mason, MSK Monmouth Site Administrator

In December 2016, Memorial Sloan Kettering Cancer Center (MSK), the nation’s leading cancer hospital, opened its second outpatient treatment center in New Jersey and its first to feature an outpatient surgical suite outside of its central Manhattan campus. Located in Middletown NJ, 40 miles south of NYC, MSK Monmouth offers the most innovative technologies available.

Greg Mason, MSK Monmouth Site Administrator, states that a facility of this magnitude, which encompasses continuous patient care and treatment and is compounded by an outpatient surgical program, requires superior performance, reliability and support from our mechanical and electrical infrastructure. It is essential that our engineered systems provide the highest level of comfort and flexibility to support the care MSK provides.

Syska discussed the project with Steven Friedman, PE, HFDP, LEED AP, MSK Director of Engineering for Design + Construction, who is responsible for the mechanical, electrical and fire protection design of MSK’s main campus, laboratories and all the regional outpatient facilities encompassing more than 5 million square feet.

What is MSK’s vision for the new treatment center?

Our vision is to bring MSK’s world-class cancer care closer to home for our patients to reduce the stress and undue burden that comes with traveling into and out of Manhattan. MSK Monmouth provides greater access to the most advanced technologies available, specialized staffing and dedicated space for patients to get treatment, heal and recover.

With a similar mission and ideology, we’re on track to open another ambulatory care facility in Bergen County New Jersey midyear 2018. Also under construction is a new, 150,000 square foot out-of-the ground ambulatory care facility in Nassau County, Long Island, New York, anticipated to be completed in 2019 as part of MSK’s ongoing pledge to bring patient care locally.

My focus and mission is to provide the most state-of-the-art, energy efficient, sustainable and resilient facility that our facilities engineering management team can operate and maintain to support MSK’s vision of built environment patient care excellence.

What were the project’s biggest challenges?

When MSK first looked at this property—a 30-year old commercial office space—we recognized that the building and its MEP infrastructure was not conducive to support an elaborate healthcare program. MSK’s vision is to find the best geographical location to serve patients, and not be as concerned with the actual building itself. Patient care access is a high priority.

To bring this facility up to our design standards, it could potentially cost as much as building from the ground up. However, building out of the ground would have added an extensive timeline to the schedule due to the approval process by the various government agencies, which of course would have prolonged our patient care access commitment.

Within this facility, we basically gutted the interior construction and MEP infrastructure while preserving some of the finishes such as in the building’s atrium. We reconstructed within two buildings: the north building is a mission critical data center, while the south building is our clinical program.

Our role was to ensure that this facility was built around patient care functionality and the overall patient experience. We maximized the facility’s space to ensure patients can move between treatment areas as efficiently and easily as possible.

It was a very involved process to secure regulatory approval for new operatory theaters, laboratories and onsite pharmacy. We managed the construction process to ensure that the various regulatory authorities could review and sign-off on OR, pharmacy, airside pressurizations, medical gasses, etc., in a timely fashion so our project schedule wasn’t negatively impacted.

What were the keys to success?

Putting our design team together with clinical, administrative and operations staff to collaborate ensured that this facility was designed with the patient experience in mind. Treatment programmed areas were strategically placed to make it as convenient as possible, making the most efficient use of their time.

Another large factor in the success of this facility was the cooperation with local, state and federal authorities. Without their continuous support—and considering the level of complexity in this facility—the opening could have been prolonged, causing delays to patient care locally.

Once our facility opens, we cannot afford any down time to reposition or repurpose the program spaces, because it would completely disrupt the flow of patient care. We do not design the mechanical and electrical systems without our facility’s operations professionals’ being intimately involved in nearly every design meeting and actively involved during construction. This ensured that once the building was turned over to the operational staff, they were completely aware of not only the equipment and systems in place, but also how the systems are intended to perform.

To further MSK’s commitment to energy efficiency and sustainability, we partnered with New Jersey Clean Energy, rewarding us with rebate incentives for utilizing highly efficient equipment on our major energy movers, such as the magnetic bearing chillers and condensing boilers used in this facility.

What were some of the engineering solutions?

To ensure continuity of service and the ability to service and maintain our major systems, we have 100% redundancy (N+1) in all our engineered systems—chillers, boilers, domestic water heaters, pumps, electrical and medical gas systems—especially for those that support critical care areas, such as the operatory theatres and PACU spaces where patients are sedated and in recovery.

Syska was very focused on delivering a reliable, high-efficient and sustainable design. The location of the building’s system within the facility played a large role, not only for the ease of accessibility, but also to keep costs down through shorter piping main and conduit distribution.
Syska partnered with us to select and evaluate our equipment for maximum energy efficiency in securing rebates from local utilities. This contributes to MSK’s important commitment to the community in energy reduction.

What are the sustainability features?

MSK Design + Construction team designed the building’s program spaces to make the best use of natural light for the patient experience, including the infusion areas, offices where staff and patients interact, waiting areas and the implementation of the healing garden. All of our equipment is highly efficient, and standardized lighting is LED-based to further reduce our energy consumption.

Some of the biggest sustainable elements in this facility are: the adaptive reuse of the building shell, the ability to purchase green power, the utilization of recycled materials to create new products such as the “floorazzo” flooring systems in the operatory theatres, carpet tiles, exterior glass, structural steel and products with low to zero VOC’s. Natural products used at this facility include wood flooring and paneling, cork and wool wall covering. As part of our continued commitment, we made a consorted effort to purchase concrete and rebar products locally—which also kept costs low and made logistics easier.

What did you learn from this project that will inform MSK’s future plans?

The project, which took approximately three to four years from inception of design to construction completion, is a continuous learning process. We’re relentless with securing feedback from our clinical staff, building operations, and our specialized design consultants and partners in this process to ensure the highest quality and most efficient use of our systems.

The cooperation and reaction from the community has been excellent. From the community level to state, I would say that this state-of-the-art cancer care facility in central NJ was very well received. This new facility also created a lot of employment opportunities for clinical, operational and administrative staff.

Click here to download a PDF of the article, which appears in our 2017 Connections Summer magazine.