© Robert Canfield

Maybe buffalo didn't roam there, but horses and cattle did for a hundred years. And through that time ranchers and their families gathered around a sprouting oak tree to tell stories and enjoy respite from the Texas heat. In August 2008 something new was added: a modern children's hospital blending in with the site, including the old tree, and offering children and families all the health-giving amenities documented by evidence-based research. The new facility has not only established a Dallas-based children's hospital in a fast-growing suburb, the extension has achieved Press-Ganey stardom as the number one children's hospital in the nation for across-the-board patient satisfaction. Recently Vice-President and Administrator David Biggerstaff and architects Doss Mabe, FAIA, Design Partner of ZGF Architects LLP, Los Angeles; Josh Theodore, ACHE, Planning; and Robert Doane, AIA, ACHA, Project Director for PageSoutherlandPage, LLP, Dallas, discussed with HEALTHCARE DESIGN Contributing Editor Richard L. Peck how they took advantage of the opportunities offered by the suburban Plano site and the emerging concepts of healthcare design.

© ROBERT CANFIELD
© ROBERT CANFIELD

© ROBERT CANFIELD
© ROBERT CANFIELD

David Biggerstaff: Children's Medical Center of Dallas has been offering children's health services for over 90 years, including tertiary and quaternary services and serving as a Level One trauma center. We wanted to expand into a new geographic area in the Dallas suburbs, where the pediatric population is growing eight times faster than the national average-more than 600,000 children in a five-county area already. This is a 140-acre site and we've built on the first 56, with the concept of creating a welcoming facility that brings nature in, including lots of natural light, uses natural materials, offers healing gardens, a lake and nearby creek, and the old oak we call the Story Tree, which dates back 100 years.

Doss Mabe, FAIA: It really is a wonderful site and we had to think about the building in relation to it. The stone we used for the exterior is regional stone that the owner pushed for because it gives people an instant association with the site while giving the building a look that blends in with the neighborhood. But the building has a split personality so that, while having a familiar look, the use of glass and Rimex panels expresses the competence of a modern, high-tech facility.

Robert Doane, AIA, ACHA: Yes, the design is a combined high-tech, high-touch approach. In terms of its exterior appearance, we were cognizant of the need for a children's hospital to provide positive distractions and an appeal to all the senses. The stone offers a rough texture that kids can feel, while the Rimex has an iridescence that changes color throughout the day. It's a dynamic structure, not a static one.

© ROBERT CANFIELD
© ROBERT CANFIELD

Josh Theodore, ACHE: The “split personality” that Doss talks about acknowledges that the healthcare team includes the parents. The building has that warm residential aspect, but it also reassures parents of this facility's great capabilities.

Biggerstaff: The family who lived on this property for decades called the old oak tree the Story Tree; they would gather around it to tell stories and get respite from the heat. The design for this provides a sort of amphitheater around the tree for that purpose.

Doane: We designed a pathway from the hospital to the tree, which then circles the tree, as does an 18-inch high stone wall where people can sit. As a backdrop to this there is a large lake and several healing gardens on the property. What's really interesting is that there are still horses nearby, just like in previous years, and David Biggerstaff wants to bring them back for a sort of pet therapy, under safe conditions with parents accompanying the kids.

Mabe: That's probably the most wonderful thing about the site-it was a working pasture for years. When we were out there working on our plans, horses would come up to us to pick our pockets for carrots and apples and the like. The site provides such a great variety of features: the Story Tree, pathways, gardens, as well as the lake and creek. Not many children's hospitals offer that sort of respite setting for parents or patients.

Biggerstaff: In keeping with our goal of bringing nature in, we went with a “finger” design for the patient towers. They're U-shaped extensions into the property so that there is natural light and a view of the site for every patient room. Offering all-private rooms was not a challenge for us nor even a matter of debate-it's the direction design is going now. We are committed to the family experience and wanting them to feel comfortable here. The rooms have refrigerators, fold-out couches, hidden medical gases in the headwall cabinetry, and a computer that swivels out of a fold-up cabinet just inside the room so that the clinician can work on the computer while still facing and talking with the child and parents.

© ROBERT CANFIELD
© ROBERT CANFIELD

© PETE ECKERT
© PETE ECKERT

Doane: We designed the patient room from the inside out, with same-handed concepts and mock-ups of staff work areas to get those right. We have inboard toilets and large bay windows, with the angle and distance to the patient bed carefully calculated to maximize the view.

Mabe: This is all possible because, as David said, we designed the patient towers in the form of a U, with 12-bed pods folding back on themselves, rather than the alternative of providing wrap-around exterior windows around a core or arranged in a straight line or L-shape. Nesting between the fingers are family rooms and child life areas serving those bed pods. It's a very unusual plan and there's been a lot of interest from people, including [Professor of Architecture and Research Fellow at Texas A&M University] Dr. Roger Ulrich wanting to study how this works administratively and from a healthcare standpoint.

Biggerstaff: Near the entrance to the patient towers we have great rooms for families, where they have flat-screen TVs and laptop connections. These are situated next to play rooms for kids, with toys, games, computers, as well as a child life specialist to interact with the kids using patient education and therapy approaches. These are nested adjacent to patient rooms for easy access, and they're wide open-kids can take laptops and video game consoles into their rooms and bring them back when done. At the end of the units there are lounges for families, with an area for coffee and food.

© ROBERT CANFIELD
© ROBERT CANFIELD

© ROBERT CANFIELD
© ROBERT CANFIELD

© ROBERT CANFIELD
© ROBERT CANFIELD

© PETE ECKERT
© PETE ECKERT

Mabe: We've tried to “domesticate” the design, in the sense of making it comfortable, with lots of amenities and plenty of windows taking advantage of the views of the site. It offers a real hierarchy of places for people to go during the day-places to socialize and interact with people, and places to be alone for a while when they need quiet time.

Theodore: The child life areas are subdivided so that kids of different ages can be comfortable associating with kids their own age-computer stations and Xbox 360s for the teens and near-teens, and toys and games in the toddler areas. Our rule in general was to make it child-like, not childish-no cartoon characters going out of style in a few years!

Doane: The lobby features a maple plank ceiling; the planks are two-and-three-quarter inches wide and pinned together. This provides noise abatement, especially with the terrazzo floor there, without sacrificing aesthetics. It also met our goal of using natural materials wherever possible.

Mabe: Sitting there is like sitting under a grape arbor or lattice-again, domesticating the design and keeping people's minds off the clinical aspect of things.

Biggerstaff: In our MRI suite we're using the Phillips Ambient system, which allows kids to control the colors, imagery, and music provided as they're undergoing an MRI. Not only is a sense of control important to kids, this can reduce the necessity of sedating them, an important goal for us.

Doane: This was only the company's third installation of this system, and the first in the United States. The idea of reducing sedation was an important motivator. We've provided some flexibility in the emergency department, so that adjacent spaces can be used for conscious sedation during the day but flexed at night to serve the extended treatment phase of a critical care pathway, if necessary.

© PETE ECKERT
© PETE ECKERT

Biggerstaff: We now have 36 beds occupied and plan to open another 12 in the fall, along with a Level Two pediatric intensive care unit. There are also plans to relocate the Children's Medical Center's eating disorders program from downtown to this facility. The growth of this facility's utilization has been considerable since it opened in August 2008: 25,000 ED visits a year, 4,500 surgeries a year, and an inpatient census close to 30 patients a day. With the initially planned 72 beds rapidly filling up, we do have to plan for the future. To accommodate growth to an eventual 240 beds, we can expand vertically by adding two patient floors, and horizontally, with two more patient tower “fingers.” If there is anything I've learned from this project and subsequent growth, it's that the more flexibility you can build into your plans in terms of space utilization, the better.

Mabe: I've learned that it is a great experience working with a partner willing to push the envelope and use evidence-based design to the fullest. This was one of the most fun and exciting projects I worked on in my 30 years as an architect.

Doane: I've seen the importance of going into a project with an open mind, being ready to take advantage of all the opportunities you can within the budgetary and other constraints we all work with, to find the edge and push the project ahead.

Theodore: For me, it was an exciting experience to interact with a client who had such clearly defined goals and vision, and to work with that client to drive the project home to the finish line. HD

© ROBERT CANFIELD
© ROBERT CANFIELD

© ROBERT CANFIELD
© ROBERT CANFIELD

For further information, visit http://www.childrens.com

Healthcare Design 2010 March;10(3):60-67