What Women Want: Designing Texas Children's Pavilion for Women
It began over a breakfast meeting between two CEOs. Texas Children’s Hospital had a longstanding partnership with St. Luke’s Episcopal Hospital, a neighbor on the massive Texas Medical Center campus in Houston. In essence, Texas Children’s took care of the babies born to the female patients of St. Luke’s.
But it was during that breakfast that word came of St. Luke’s decision to get out of the obstetrics business. The immediate result: Texas Children’s was getting in to the obstetrics business.
“It presented us with a great deal of opportunity,” says Cris Daskevich, senior vice president of what today is Texas Children’s Pavilion for Women. It was agreed at the time that Texas Children’s would manage all labor and delivery plus the antepartum and postpartum units of St. Luke’s.
The timing was ideal. The hospital had been making enhancements to its Fetal Center, in which early fetal diagnostics were being conducted as well as in utero surgeries. In Daskevich’s mind, the leap from taking care of mothers to taking care of women in general is a simple one.
“It absolutely makes sense for us,” she says. “Our vision and our mission is to improve neonatal outcomes and the long-term health of our children. And the way you do that is to begin taking care of women, even before they decide to become mothers.”
Plans soon fell into place for a new women’s hospital where all of the services already offered by Texas Children’s, as well as those acquired by taking on St. Luke’s obstetrics business, could reside under one roof.
Discovering the muse
FKP Architects and general contractor WS Bellows Construction, both of Houston, were brought on board, and the Texas Children’s team began developing the project’s guiding principles.
An outside marketing research consultant was hired to conduct interviews with local obstetricians and gynecologists, mothers who had recently delivered children in the Texas Medical Center, as well as nursing staff and leadership, to begin putting together the elements of the ideal patient experience.
Once market surveys were completed, the team was in place, and the compiled data was used to educate team members and develop design goals, Texas Children’s next conducted a benchmarking exercise to assess similar facilities across the country. The team did phone interviews and made site visits to gauge not only what was working, but where the overall patient experience could be improved.
At the same time, at home, a women’s advisory council was established. “There were 14 women who were involved in this project for four years. They’re all of child-bearing age, and many have been having second or third children during this project,” Daskevich says.
The group was used to provide insight regarding all stages of their journey through pregnancy and birth, as well as to garner feedback from their husbands and other family members.
“Putting all of those pieces together offered FKP some really defined expectations and needs of the institution,” says Jill Pearsall, director of facilities, planning and development, Texas Children’s Hospital.
Setting the stage
When designing the new Pavilion for Women, FKP was charged with creating a comprehensive building where inpatient services, outpatient services, diagnostics, administrative services, food options, retail, private physicians’ offices, faculty offices, and parking could be supported, all on the extremely dense Texas Medical Center campus.
The result is a 15-story, 1.3 million-square-foot maternity hospital and parking garage, with a two-story curved bridge connecting the third and fourth floors of the Pavilion for Women with the existing Texas Children’s pediatric care facilities.
“We reached across the street physically as well as figuratively, creating a vertical stacked environment for the women’s adult area transitioning across the street to pediatrics and leaving ‘bread crumbs’ back to the original children’s hospital,” says Pearsall, noting the touches of more vibrant, childlike design elements that serve as reminders of the children’s hospital to those approaching the Pavilion for Women.
While there are elements of Texas Children’s in the new facility, this was also a new business that needed to be established separately, and FKP wanted to get the details right.
“We had great detailed input from lots of different sources. I believe it’s one of the things that make the project so special,” says Michael Shirley, AIA, LEED AP, principal at FKP Architects.
That input shaped decisions made not only on the macro scale, such as offerings of room service on-demand and the incorporation of a healing garden, but also at the micro level, such as what type of spa showerhead should be placed in the bathrooms.
The benchmarking exercise also played a significant role in FKP’s design process, inspiring several elements of the new Pavilion for Women.
One example is the exit strategy. In many cases, new families may have to wait in a valet line in inclement weather, with cars honking and exhaust fumes hanging in the air. “It’s a very stressful drive away, and many times it’s the last impression people have of the hospital,” Daskevich says.
The Pavilion for Women’s “Family Launch Zone” aims to alleviate that experience. Inside the parking garage, mothers and babies can wait in an air-conditioned, furnished lobby area that’s staffed with an attendant. Parking spaces and a covered driveway are right outside, so when the family is ready for exit, car seats can be installed and checked, and staff members can send everyone off in a more ceremonious, relaxed fashion.
The Pavilion for Women’s NICU was also shaped by trends identified nationally in NICU design, says Diane Osan, FAIA, ACHA, chairman of the board and chief visionary officer at FKP. “Texas Children’s decided it wanted the private-room NICU environment, so for all the babies born in that building, the moms would not be separated from them unless they need the highest level of care across the bridge,” she says.
User group interviews also informed a deep dive into programmatic elements of the NICU. For example, parents agreed that they would prefer for there to be no bathrooms inside the NICU patient rooms—after considering infection control issues, housekeeping traffic, and noise of flushing toilets. Instead, private family bathrooms are available down the hall.
Choreographing the scene
While the design of the building started with a focus on maternity, it broadened to the larger patient and family populations it would serve.
“The experience morphs. It starts as very public, supporting people of all walks of life, both men and women. Then, as you move up vertically to the birthing rooms, the antepartum rooms, and the NICU, those spaces needed to feel more like bedrooms; they needed to be more intimate and comfortable. And the aesthetics shift a little in terms of some of the material selections,” Osan says.
The building shifts in terms of flow, as well. For example, FKP designed the Pavilion for Women with a two-story bridge to provide both on-stage and off-stage traffic paths: a public connection to the third floor and a private connection to the fourth floor, which is used for discreet transportation, such as wh
isking a critically ill newborn to Texas Children’s adjacent pediatric hospital for surgery.
Also considered in the design was Texas Children’s in vitro fertilization and reproductive endocrinology programs. “We had to locate that particular center in a part of the building where you could have ease of wayfinding, but also be discreet enough to provide women and families with a sense of dignity and privacy,” says Chris Cortes, AIA, vice president at FKP.
“There’s a choreography of movement throughout the building that was very carefully studied,” Osan adds.
The movement of staff throughout the building is another part of the dance. The opening of the Pavilion for Women was postponed by three weeks to allow for a full-scale orientation in the massive facility, in which staff practiced procedures by taking turns serving as patients, tested the more than 90 pieces of new technology, and simulated emergency scenarios to stress the system.
Actors were also brought in to simulate worst-case scenarios, such as a brain bleed-out and OR gases failing during an emergency C-section. “We truly did a full-blown, integrated high-fidelity simulation. And that made a big difference for everybody,” Pearsall says.
Since its opening in March 2012, the Pavilion for Women has seen success, with facility tours filling up and plenty of preregistrations for deliveries. Daskevich says she’s thrilled to be seeing the fruits of their own labor.
“I feel very proud to be a part of the design itself. It really was designed by women, for women, and that is exemplified across the facility,” she says.
For more on this topic at the HEALTHCARE DESIGN Conference being held Nov. 3-6 at the Phoenix Convention Center, check out the session “Should Women Be Patients in Children’s Hospitals?” being held from 1:15 to 2:15 p.m. on Sunday, Nov. 4. The panel of experts includes Annie Coull, AIA, ACHA, vice president, healthcare practice leader, Stantec Architecture Inc.; Jan Freitas-Nichols, MN, PNP, director of Women + Children's Services, Doernbecher Children's Hospital at Oregon Health & Science University; Elena Gates, MD, professor & vice chair, University of California San Francisco; and Judith Smith, MHA, principal, Smith Hager Bajo Inc.