As cities grow denser worldwide, healthcare providers face the challenge of delivering patient-centered care on sites that leave little room for expansion. Unlike the broad suburban campuses many facilities enjoy, urban healthcare projects must contend with limited footprints, strict zoning, and the need to integrate multimodal access, stormwater systems, green infrastructure, and community‑oriented public space—all within compressed parcels. Meeting these demands requires design approaches that merge architecture, landscape design, engineering, and planning into a unified, coordinated effort.
Tennessee Oncology’s new flagship cancer center in Nashville, Tenn.’s Midtown medical district exemplifies how such urban pressures can become catalysts for creativity and innovation. The $120 million, 310,000-square-foot facility, designed by Gresham Smith (Nashville), opened in October 2025, consolidates cancer clinics, imaging, pharmacy services, a clinical trials research division, and an underground garage into a vertically efficient, patient-centered environment for urban cancer care delivery.
The project’s development revealed a set of design strategies essential for turning a constrained site into a resilient, welcoming, and high‑performing healthcare destination. By embedding stormwater management into the landscape and introducing green spaces that soften the urban edge while supporting patient well-being, the center demonstrates how the blend of traditional architectural and landscape planning and solutions can elevate both functionality and community experience.
These site‑responsive principles form the foundation for best practices that can guide teams working within similarly dense urban healthcare environments.
Turning urban healthcare site constraints into opportunities
A key lesson from Tennessee Oncology’s experience is that successful urban healthcare design begins by embracing, rather than resisting, the site’s limitations. Tight plots hemmed in by adjacent medical buildings, zero-lot-line conditions, strict height stipulations tied to neighborhood view corridors, and build-to lines on all sides leave little room for horizontal expansion or surface parking. To respond, the project team deliberately leveraged these constraints as design catalysts rather than barriers.
The site’s 7-foot grade change across the block complicated access and usability, forcing the building to respond to the terrain. The team reshaped arrival sequences by creating pedestrian entrances on both the upper and lower street elevations, adding an internal vehicular porte cochere and garage entry from 22nd Avenue, and widening the rear alley to allow two‑way traffic for reduced congestion and safer vehicle movements. Integrated layered landscapes were incorporated throughout the site, including street trees along the curb, recessed bioretention planters behind the sidewalk, interior planting zones at key entries, and a green roof. Together, these elements create a welcoming, efficient campus that responds sensitively to its constrained plot and varied grade conditions.
How to build an integrated project team for healthcare projects
Urban healthcare settings demand an integrated, highly interdisciplinary approach. Unlike suburban or rural sites where disciplines can operate with physical separation, urban projects require building architecture, civil engineering, landscape architecture, structural engineering, mechanical systems, and specialized clinical equipment that needs to be tightly coordinated from the outset.
At Tennessee Oncology, widening a public alley to support two-way traffic enhanced site circulation, but also required careful placement of noise- and vibration-sensitive departments such as the MRI suite. The MRI’s grade-level access needed to avoid interference from underground parking vibrations, with primary electrical service entry points designed to minimize electromagnetic disruption.
Structural elements, such as stainless-steel rebar and vibration‑damping pads, are recessed and reinforced to reduce vibration transmission. Additionally, the cryogen venting system is designed to direct gas and pressure upward and toward the alley for safe quenching.
Outlining a multitiered stormwater strategy for healthcare facilities
In urban healthcare projects sited on impermeable bedrock, managing stormwater requires layered and engineered strategies that go beyond conventional infiltration. Nashville’s limestone bedrock created a challenge by preventing subsurface absorption and creating groundwater collection around the underground garage. Traditional stormwater infiltration techniques were infeasible, pushing the team to develop a multi-tiered system.
The resulting solution combines green roof filtration that captures, detains, and pretreats rooftop runoff; distributed bioretention gardens at street level that function as public-facing amenities enhancing the pedestrian experience; and precisely routed roof-to-bioswale drainage that assigns roof catchment volumes to specific ground-level bioretention zones.
Oversized horizontal plumbing roof drain leaders are employed to accommodate proper stormwater delivery, resulting in a system that provides more than 56,000 gallons of stormwater treatment volume.
Additionally, separating storm and sanitary sewer systems reduces strain on municipal infrastructure and mitigates overflow risk during heavy rains. These measures collectively meet stringent regulatory requirements while creating a microclimate benefit—cooling urban heat islands, providing shading, improving air quality, and enhancing walkability for patients and staff.
Why it’s important to prioritize green space on urban healthcare sites
Urban healthcare architects must creatively “make” green space where natural ground-level space is scarce. The Tennessee Oncology team exceeded Nashville’s green space minimums by extending planted edges around the building, integrating landscape into urban bioretention systems, and adding green roofs.
By thinking vertically and opportunistically, every edge, terrace, and interior zone became a potential touchpoint with nature, reinforcing biophilic design principles shown to reduce stress and aid healing. Landscape architects studied circulation patterns to strategically locate greenery, stormwater elements, and outdoor gathering places that complement urban constraints while supporting restorative experiences.
For example, incorporating street-level plantings such as lacebark elms softened the pedestrian interface, while terrace planters extend greenery upward. Additionally, landscaped seating within urban bioretention systems creates shaded, comfortable outdoor rooms. These spaces provide patients, staff, and visitors with shaded respite without leaving the campus—a vital amenity for those undergoing taxing treatments.
Inside, natural light and nature-inspired art and materials carry the biophilic intent indoors. Waiting areas feature linear planters echoing plantings in the exterior urban bioretention systems, walls display calming nature scenes, and tactile flooring materials evoke a soothing natural palette. These transitional spaces blur the boundaries between inside and outdoors, enveloping visitors in tranquility from arrival onward.
How to plan a healthcare facility for resiliency and expansion
The compact, vertical orientation of urban health buildings demands infrastructure designed for long-term adaptability. The design of Tennessee Oncology anticipates future vertical expansion by constructing a robust structural core.
Architectural massing maintains harmonious proportions between the existing brick base and upper curtainwall tower through vertical mullions that mask floor height variances, making future additions visually seamless. Additionally, during the initial build phase, the infrastructure, including MEP systems and mechanical rooms, was sized to accommodate future square footage or utility‑demand expansion by incorporating valves that allow temporary mechanical systems to be extended without costly retrofits.
The site planning also reflects a forward-thinking approach with accommodations for alternative transportation, including covered bike racks within the porte-cochere and pedestrian-friendly wait areas integrated into landscaped urban bioretention systems supporting rideshare and bus stop pickup. Plans for retail amenities further embed the center within the community’s fabric, offering conveniences that reduce the need for patients and staff to leave the campus.
Use urban context to strengthen community connection in healthcare design
Urban healthcare buildings should contribute positively to their neighborhoods, reinforcing their identity and inviting public engagement. Tennessee Oncology’s project employs warm brick tones, pedestrian-scaled massing, and transparent lobbies to connect with the Midtown medical district’s architectural vernacular.
The inclusion of community-facing terraces and publicly accessible seating embedded in urban bioretention systems fosters an inviting atmosphere that extends beyond clinical functions. Daylight-filled spaces contribute to transparency and create a civic presence, strengthening connections between the health facility and its urban surroundings.
Key lessons from Tennessee Oncology’s flagship cancer center in Nashville, Tennessee
Tennessee Oncology’s flagship cancer center shows how urban healthcare design can succeed amid complex site constraints through integrated planning and design. By planning for future expansion and prioritizing welcoming, community-oriented spaces, the facility is positioned to remain resilient, adaptable, and cost-effective over time.
Urban healthcare projects demand a holistic, integrated approach that blends traditional architecture with advanced landscape architecture and engineering solutions—redefining how high-quality care is delivered in contemporary cities.
Patrick Gerhart, AIA, is an architect at Gresham Smith (Nashville, Tenn.) and can be reached at [email protected]. Rob Whitson, P.E., is a senior civil engineer at Gresham Smith (Nashville, Tenn.) and can be reached at [email protected].
