Michael Monaldo, AIA – John Muir Health

Cancer is a frightening diagnosis, so when Michael Monaldo sat down with his team and with clinicians at John Muir Health, they developed a concept for a new treatment center environment that would uplift patients and make it easy for them to find their way to care.

The UCSF-John Muir Health Cancer Center will sit in the Tuolumne Pavilion (which is located on the campus of John Muir Health Walnut Creek Medical Center), a LEED Gold building slated to open in February 2024. Evoking a nature walk, each floor of the building corresponds to a layer of the forest: the ground floor features earth tones; the second floor’s theme is a tree canopy; and the third floor recalls the sky. There are trail markers and public art installations along the way—a piece in the lobby with perforated metal panels depicts a tree reaching up toward the heavens. And the two-story central lobby that bifurcates the building simplifies patients’ orientation, providing easy access to treatment areas.

Michael Monaldo, AIA | Senior Vice President, Development & Real Estate | John Muir Health

“Everything we do in the building is really about that patient experience, and to support the staff and physicians, whether it’s the way-finding, the artwork or access to parking,” says Monaldo, the senior vice president of development and real estate at John Muir Health. “This is hard work. Clinically, it can be exhausting; patients are having some of the biggest health challenges of their lives.”

Monaldo and his team broke ground on the 155,000-square-foot, three-story building in October 2021. John Muir is an independent, nonprofit healthcare system in the Bay Area. Its new cancer center, which is a joint venture with the University of California-San Francisco, will bring providers from 14 locations into one building.

Monaldo credits Executive Director of Oncology and Specialty Services Brenda Carlson, who partnered with Monaldo and his group, with helping them understand what patients and care providers go through. In addition to Carlson and her team of medical professionals, they also worked with the capital directors and project managers; the design team, including SmithGroup Architects; Swinerton Builders; the general contractor and the major subcontractors.

“We worked on this project through COVID-19, and during a year that was twice as wet as any year in the past decade—yet because they had so well planned the project and worked together extremely carefully, and because we worked closely with the city of Walnut Creek on the permitting and inspection side, everything has gone very smoothly,” Monaldo says.

The transition planning, likewise, is a team effort, led by Tosan Boyo, John Muir Health’s senior vice president of hospital operations. It’s been underway for over a year and has included mapping out the entire treatment process, from referral through diagnostics and treatment completion.

Comprehensive, coordinated treatment

The UCSF-John Muir Health Cancer Center will include medical oncology clinics, a radiation oncology clinic, a large infusion center, imaging and surgical specialists, as well as research facilities, genetic counseling and lab services.

“This facility will provide significant access for patients in a coordinated fashion,” Carlson says. “Without a cancer center, patients have to travel to various locations to receive high-quality care. Within the cancer center, they’ll be able to receive that care comprehensively and in one space, with all the support services that they need.”

The John Muir Health Development | Real Estate Team. Left to right: Jamie Amesbury – Administrative Assistant; Marina Reyes – Real Estate Transaction Coordinator; Jeanne Gomez – Director, Capital Projects: Planning & Design; Lisa Stackpole – Executive Assistant; Michael Monaldo – Senior Vice President, Kathy Villavicencio – Senior Project Manager; Ernie Olatunji – Project Manager; Trent Neuhausel – Director, Capital Projects: Project Delivery; Anthony Brooks – Director, Finance: Capital Projects and & Estate.

The Tuolumne Pavilion is built on a slope, and Monaldo and his team came up with a multi-level design that works with the relatively low height limit they faced. It includes linear accelerator vaults—concrete boxes with four- to six-foot thick walls that protect against radiation— on its west side. Sensitive to the risks around COVID-19 for cancer patients, who have weakened immune systems from chemotherapy, Monaldo and his team added advanced ventilation systems—including carbon filtration and UV light filtration—to Tuolumne.

To secure reliable service and backup power, they tied the building to the campus’s existing utility plant. They also added a megawatt of solar power to the parking lot and another 300 kilowatts on top of the building, in addition to other solar panels throughout the hospital campus.

Carlson says Monaldo and his team “really listened to the clinicians” in planning the project. For his part, Monaldo notes that while they solicited lots of input, their goal once they started building was to minimize changes, which drive up costs and delay the schedule; and the clinicians showed impressive discipline about sticking to the plan, he says.

Evolving facilities for more efficient care

The initial project plans had the building at 200,000 square feet. To stay within capital allocations, Monaldo and his team went back to the schematic design and got the plans down to around 150,000 square feet and a cost of $300 million.

The Tuolumne project is a major undertaking, but that’s not all Monaldo and his team have tackled. They have also been redeveloping the Concord Medical Center to modernize its campus and meet seismic requirements. They’re adding outpatient cardiac catheterization labs, expanding urgent care and moving outpatient imaging to a more appropriate setting.

To meet growth demand, John Muir Health engaged Ratcliff to transform an existing 29,500 square-foot retail facility into a new Medical Office Building to accommodate four clinics for primary care, pediatrics and specialty services.

Monaldo’s team has also been working on facilities in Pleasant Hill, where John Muir Health has expanded its primary care footprint in the community. They repurposed an abandoned retail center, turning it into a modern medical facility. Monaldo says the organization used to have small offices with two to three physicians tending to patients; it now has a new office building with 24 to 30 physicians seeing patients daily.

“These projects we’ve been working on emphasize the continued evolution of our facilities and strategic master plan to better support the rapid changes happening in healthcare, the shifts to outpatient care and the recognition that we also need to invest in acute care to serve the community,” Monaldo says.

Making the whole community healthier

Monaldo, a licensed architect, earned his B.S. and master’s degrees in architecture from the University of Maryland. He started his career in commercial and residential architecture.

“If you had told me that I’d be doing what I’m doing today, I would have said, ‘No way,’” he says. “I had no desire to be involved in healthcare, with the complexities and the long project timelines. But after the Northridge earthquake in Southern California back in 1994, I got more involved in it, and I found it to be very motivating.”

Monaldo worked for the California Governor’s Office of Emergency Services as architecture and engineering manager. Then, in 1996, he became a project director at Saint John’s Health Center in Santa Monica. That led to a stint as regional director of project development at Kaiser Permanente in 2003, where he stayed until accepting his current role in 2007.

“When you spend 10 to 12 hours a day working on something, it’s one thing to find it professionally satisfying and monetarily gratifying, but there’s something unique about working in healthcare, being mission-driven,” Monaldo says. “I think about the spaces we’re providing; people are being born there, people are getting healthy there and people are saying goodbye there. When I see the level of care that clinicians like Brenda provide to the community, there’s really nothing more satisfying than working in healthcare.”

View this feature in the Blueprint Vol. V 2023 Edition here.