Over the next several years, hundreds of millions of dollars will be spent on creating new children's hospitals around the world. The reasons are many but include the realization that most older facilities were not designed to encourage the involvement of families in the child's care, as well as the unique “power of philanthropy” that children's hospitals bring to the financing picture. Equally interesting is that most of these new facilities will be “state of the art” and provide a healing environment, but only a few will be considered benchmarks for the industry, or truly “world-class.”

When studying many of the “great” new facilities around the world, there appears to be a series of principles that the best of them share. Here is a discussion of 10 that might provide some insight into what it takes to be a world-class children's hospital.

1. Vision. The leadership involved in creating a new children's hospital can come from many different sources: a grateful parent, a passionate physician, a well-respected philanthropist, or the administration of an existing facility. Most important, nevertheless, is to establish the vision at the beginning of the process. Ideally, this vision should be to create a children's hospital unlike any other, rather than copying those that have gone before. This vision must be shared and embraced by all involved to maximize the project's potential.

2. Family-centered care. From the kickoff retreat to move-in day, a successful project will involve interested parents and, ideally, every committee in every phase of the project. What better way to exceed your customers' expectations than by having them involved in defining what they expect? The process does not end with the design and construction. Parents and families must be considered partners in the care of their children in the facility, and in everything from the mission statement to employee job descriptions, to clearly reinforce this approach.

3. A team approach. A successful project must be a team effort. The greater the numbers of people involved, the greater the chances for success. While it may seem difficult to include hundreds of individuals in project planning, with good leadership, the appropriate facilitation skills, delegation of responsibilities, and excellent communication, the project will benefit greatly.

4. The “wow” factor. From the minute a family drives up to a great children's hospital, they realize that it is a special building that does not look institutional (Figure 1). Once they're inside, the lobby should create for them a sense of surprise and should provide a diversion. Whether this is accomplished with a dramatic sculpture or a unique water feature, the goal is to help the family forget why they are there, even if only for a moment. The use of unexpected elements, such as a donated railroad engine (Figure 2), fire truck, or helicopter, can also create diversion, without adding expense to the project.

Maria Fareri Children's Hospital, Valhalla, New York, is an example of a hospital that does not look institutional

This railroad engine serves as a pleasant diversion for patients and their families

5. Communicate, communicate, communicate. You cannot overcommunicate when it comes to building a new hospital. Use every opportunity to reach not only the teams involved, but also the entire hospital and the community.

6. Community involvement. Not many facilities impact a community more than a new children's hospital. It is likely, at one time or another, to affect almost everyone, whether as a parent, child, grandparent, niece, or nephew. One key to a successful project is to seek out the community's involvement for more than just fund-raising. Engage them in the design process and incorporate themes taken from the community into the design scheme. For example, Hasbro Children's Hospital in Providence, Rhode Island, has a 36-foot sailboat on the roof (Figure 3), reflecting its location at the mouth of Narragansett Bay and the importance of the marine industry to the local economy. It also features the Rodger Williams Zoo satellite (Figure 4).

Hasbro Children's Hospital, Providence, Rhode Island

The Rodger Williams Zoo satellite, Hasbro Children's Hospital

7. Engaging schools. Creating a relationship with the local schools provides a great benefit, both to the hospital and the schools. More and more schools recognize the importance of celebrating values such as “giving back” to the community. By encouraging schools to do walkathons, readathons, bake sales, and other fund-raising events, not only do you generate financial support for the project, you create an opportunity for students to tour the facility and realize that it does not have to be a “scary place.” Ideally, an educational component is incorporated into the design of the hospital and all the schools are encouraged to tour the public areas as part of their required curriculum.

8. Recognizing art's impact. There is probably no healthcare building in which art is more important than a children's hospital (Figures 5 and 6). People are at the heights and depths of their emotions, and the impact of art can be most powerful. If the installation of art is approached as an additional opportunity for the community to become involved with the project, it does not have to add cost to the budget, yet it can create significant value. It is also important to consider incorporating the therapeutic value of art in-to ongoing patient care programs by creating an in-house art studio or artist-in-residence program.

Tile project by Rhode Island schoolchildren, Hasbro Children's Hospital

“The Pup,” by artist Nara, will become part of the healing garden/miniature golf course at Maria Fareri Children's Hospital

9. Harnessing the power of philanthropy. As noted in the introduction, few projects benefit more from philanthropy than a children's hospital. Not only does it enhance the project's potential for success, it also allows for the possibility to fund elements that make a children's hospital special, such as the 13,000-gallon water feature in the Maria Fareri Children's Hospital in Valhalla, New York. This generous gift was funded by a family who would not have typically given to a “bricks and mortar” campaign.

10. Celebrate your success. Few experiences in healthcare today are more invigorating and uplifting than the opening of a world-class children's hospital. Take full advantage of the impact this project has on the morale and pride of both the institution and the community, and be sure to celebrate every step in the process. Once the project is complete, share the experience with others who are about to start their own exciting journey to world-class children's care. HD

Bruce King Komiske, FACHE, is a hospital administrator who has had the opportunity to plan, open, and operate five new facilities during his career. Hasbro Children's Hospital in Providence, Rhode Island, and the Maria Fareri Children's Hospital in Valhalla, New York (opening in June 2004), are two of his most current projects that have received significant attention. He also serves as a consultant to hospitals around the world, is a frequent speaker on creating healing environments, and is the author of Family Partnerships in Care and Designing the World's Best Children's Hospitals. He is currently working on his newest book, in conjunction with the National Association of Children's Hospitals: Children's Hospitals-The Future of Healing Environments, which will be published in late 2004.

For more information, e-mail komiskeb@wcmc.com.

Healthcare Design 2003 May;3(2):39-42