Give the children what they want
Two things that the managers of the old Alberta Children's Hospital knew for sure: The hospital was big but not nearly big enough, and it looked very much like a hospital. When the need for a replacement facility became obvious, Kasian Architecture Interior Design and Planning, Ltd., one of Canada's top design firms, was hired to help the hospital strike off in a new direction: creating a new facility through total collaboration. This meant planning and designing the new children's hospital by collaborating with patients, families, healthcare planners and providers, and the building trades. From special weekend workshops Kasian's designers got new ideas from patients and families for making the hospital kid- and family-friendly; from hospital planners and providers they learned how to maximize cost-efficiency; and from the building trades they gained ways to save time and control costs. Recently, Kasian designers Jim Ebbels, principal and head of the firm's Calgary Health Studio, and Milton Gardner, principal and head of the firm's Global Health Care Studio and partner-in-charge of the project, discussed their experiences in creating the new Alberta Children's Hospital with HEALTHCARE DESIGN Editor-in-Chief Richard L. Peck.
Creating Child/Family-Friendly Features
Gardner: With the help of Beverly Johnson, president and CEO of the Bethesda, Md.-based Institute for Family-Centered Care, who acted as moderator, and with the help of the wife of one of our partners, a school vice-principal, we had two Saturday workshops for young people aged 7 to 22 years (see sidebar). On the first Saturday we discussed building design and on the second, landscaping design. Each day we gave them a piece of paper and let them draw their “ideal hospital.” We also asked some questions and got some blunt answers.
For example, we asked the kids what they feel when they go to a hospital. Often they answered that it was “dull, dark, and boring.” In fact, one of the big questions they asked about the new facility was what would it be like at night? We weren't ready for that one. The old hospital had double rooms, no windows, and lots of noise in the hallways—not very conducive to healing or rest. After thinking about it, we decided to provide private rooms where possible, with generous-sized windows, constant circulation of fresh air, and places for parents to stay with their kids. When the new hospital opened, one of the first things we heard about it from staff was that the patients actually slept through the night
Ebbels: Keeping in mind the “boring and dark,” we also took care with the lighting of public spaces, using warm, subdued, indirect lighting, decorative neon lights around columns, and some accent-colored lighting—the patients say it's cool.
Gardner: The kids' workshops gave us other clues, as well—for example, pets are a big thing for them, so we thought, why not have a pet visitation room?
Ebbels: This is actually a vestibule within a vestibule—located between the inside of the hospital and the outside, glass-enclosed, and with negative pressure for infection control. Patients get to visit their pets, who are important members of their families, but they never leave the hospital and the pets never come in.
Gardner: The kids also told us not to be afraid of using bright colors and providing large windows—in this case, four-story-high, four-pane windows, using high-efficiency glass applied to the curtain wall. In this case, form doesn't follow function—they're just big windows, they look cool, and that's the end of it.
Ebbels: The brightly colored window frames really animate the exterior. Looking at these, some people call it the Lego building. There's also the story of the child who, being driven past the hospital by his mother, said, “I know why they call it the Lego building—because that is where they put kids back together.”
Gardner: We had sessions with the parents, as well. One major item requested was a parking structure that was enclosed, heated, and with relatively flat slabs. We had mothers telling us that they didn't enjoy pushing an infant stroller up a steep ramp in subzero weather. So, we created a 720-space “parkade” designed for comfortable walking and convenient access to the hospital. There is also a patient drop-off and pickup area inside the parkade. This has been very popular.
Ebbels: Parents also wanted private spaces for themselves—for example, a curtained-off area in the patient room with a daybed and a lamp so they could read without disturbing the child. We provided some overnight accommodation rooms for parents because they wanted places to freshen up after long drives to the hospital, since Alberta Children's serves southern Alberta, southern Saskatchewan, and southeastern British Columbia and spans the northern United States from Montana to Minnesota. Parents also wanted to be able to stay with the child in a sterile environment up to the moment of surgery, so we provided parent-accessible induction rooms between OR suites. They asked for direct access from the exterior to the ICU and oncology, so we provided a parent parking area adjacent to the inpatient wing, with card access through the staff entrance. For parents of children with potentially contagious illnesses, there is an isolated waiting area with positive pressure located outside the consult rooms
Gardner: There is also a palliative care suite with its own garden for families with children in end-of-life care.
Ebbels: Also, the southwest corner of each floor of the inpatient unit is designed as a spacious family meeting area, with great views of the Rockies and foothills and a cantilevered design so that occupants feel they're really thrust out into the view.
Gardner: Parents chipped in money to provide a major sunroom on the oncology floor so that these hospital-bound patients can have the feeling of being outside. There are a number of landscape features and themed play areas that surround the hospital.
Gardner: The lobby features a very attractive, interactive water fountain over which a theater-in-the-round stage can be lowered, complete with its own lighting and sound system. Overhead is a fantasy galaxy of cast-glass stars and a sickle moon that lights up, and they cycle through a spectrum of colors. There is also an aquarium in the lobby. The hospital also offers kids an art and music studio for various activities and therapies, and a broadcast studio that enables them to create their own programs for broadcast from the hospital.
Ebbels: In addition to the oncology unit sunroom, there are six gardens, including the Discovery Garden, the North Garden, the Suntree Garden, the Spirit Garden, The Backyard, and an apple orchard. Their respective design and landscaping features respond to individual microclimates throughout the building and to the different ambulatory needs of patients, families, and staff
The Plan and Systems
Gardner: The hospital is separated into three operational units: the Ambulatory Care area, which includes medical offices and clinics; the Inpatient Unit tower; and the Diagnostic and Treatment block. Each is structured with its own mechanical systems, which can be operated or shut down individually for maximum flexibility and efficiency, as well as for infection control during an outbreak. The simple three-area layout enables patients, families, and staff to wayfind quite easily. Large interstitial spaces over the ER, surgical, and diagnostic areas allow plenty of room for easy maintenance and future technologic change.
Ebbels: Each of the units has been designed for convenient expansion laterally.
I'd also add that one of the important infection control features of the structure is an air-handling system that allows 100% fresh air exchange every 2.4 minutes in the OR, every 4 minutes in emergency trauma, every 6.6 minutes in the ICU, and every 8.5 minutes in the inpatient unit.
Gardner: The operating rooms are not especially large—about 500 square feet—but they've been equipped with the latest in leading-edge robotic and microscopic surgery for these small patients
Ebbels: We got our contractors involved from the start. For example, our masonry contractor and glazing contractor were involved in the design of the exterior cladding, which consists of large, colorful window frames applied on a curtain wall. We had a total of seven construction managers on this project, including general, mechanical, electrical, building enclosure, doors and hardware (there are 3,500 doors), and window coverings. Our thought was that these guys know about constructability and materials availability, so let's ask them to help us address the problems of designing this. Their know-how was a big reason this project came in under budget and almost four months ahead of schedule.
Gardner: Altogether, this was an experience we definitely want to repeat. We think the collaborative approach in general will dramatically change the way healthcare facilities, especially children's hospitals, will be designed and operated in North America. HD