Completion Date: Phased opening (January through June 2011)
Owner: Phoenix Children's Hospital
Architecture, Interior Design, and Structural
Engineering: HKS, Inc.
Construction Manager: Kitchell Contractors
Civil Engineering: Evans Kuhn & Associates
MEP Engineering: ccrd partners
Programming: Blue Cottage Consulting
Landscaping: Site Design Group/Talley Associates
Food Service Consulting: Systems Design International
Lighting Design: Scott Oldner Lighting Design
Photography: Blake Marvin/HKS, Inc. Total Building Area (sq. ft.): 770,000
Total Construction Cost: $270 million
Cost/Sq. Ft.: $340
As seen in the September 2003 issue of HEALTHCARE DESIGN, Phoenix Children's Hospital was remodeled and renovated in 2002. Featuring a design from Karlsberger Companies, the hospital was built upon the framework of a former adult general hospital campus, and successfully so—HEALTHCARE DESIGN even awarded the project a Citation of Merit in the 2003 Architectural Showcase. But even the best laid plans will only work for so long in an ever-expanding healthcare world. A few years later, a new campus master plan was established, incorporating new parking garages, a new central energy plant, and a new front door-the distinctive new patient tower, designed and executed by HKS, Inc. The tower, designed to emulate a night-blooming desert flower, is the cornerstone of the new campus plan, but far from the last step in its reinvention. HEALTHCARE DESIGN Editor-in-Chief Todd Hutlock spoke with three members of the HKS design team-Principal-in-Charge Jeffrey Stouffer, AIA; Senior Construction Administrator Sidney Smith, AIA; and Interior Designer Sandra Miller, IIDA, LEED AP-about this latest addition to a forward-thinking pediatric campus.
The master plan
Jeffrey Stouffer, AIA: This was a very complex project that required an integrated team to deliver it, and we had that integrated team from the inception. We set forth re-master planning the campus, and the master plan had some challenges in phasing. We quickly studied more than 12 options and came up with a solution to accomplish the project.
The first phase of the project was a new employee parking garage, followed by a replacement of the existing central energy plant for the whole campus, which we placed a half-block away and connected with a tunnel. From a patient-safety standpoint, we really wanted to keep all the large trucks out of the way of the children and their families.
This is not a replacement facility; the existing building will remain, although the master plan was designed so that the next expansion will allow for the existing hospital to be torn down eventually, but that will take a number of years.
In the original master plan, the ambulatory building and the bed tower were 1,000 feet apart. All we could think about were all of those families, mom and dad with a sick child and pushing a stroller with two other kids, walking 1,000 feet back and forth-and then there's the doctors and the supplies as well. We came up with the tower and tunnel plan and the relocation of the central utility plant to establish more efficient movement of the public, patients, materials, and staff.
Sidney Smith, AIA: The tower basement through the third floor is complete and in control of the owner; we are currently finishing out the patient units, and there is also shelled space. The CEP and employee garage started around spring 2008 and they were completed in early 2009. The tower project broke ground in October 2008, so there was a little bit of overlap there.
There were certainly challenges with coordinating the construction. The central energy plant was built simultaneously with the employee garage, which is actually across the street and south of the patient tower. The challenge there was in part due to building inside a live and active community; we had to block road access to build the tunnel that connects the CEP to the new tower. At that time, the employee parking sat where the current patient tower is located today, so coordinating parking along with construction was a significant challenge early on. The site was also confined by the community on the south and west sides, while being confined by the existing facility on the east side, which presented a challenge as well.
All in all, the coordination effort was tremendous. Bear in mind that at the peak of construction, we had around 1,400 workers on site. Once the new employee parking and the CEP were completed, the challenge then was how to get the services from the new CEP adjacent to the underground tunnel and through the new tower to backfeed the new hospital while construction of the main tower structure was ongoing. We actually had the public parking garage being built almost simultaneously with the tower, so we had to flip-flop who was using what parking garage while the tower construction was ongoing. Getting med gases and chilled water lines and the like through the basement of the tower while the steel was being erected so that the timing could hit properly was also a major challenge.
Stouffer: Another challenge has been keeping everything operational during construction of the tower, as well as integrating some of the departments that will remain in the existing building and renovating a few other areas of the campus when the tower project is 100% complete. That connectivity has been key-coordinating the onstage/offstage circulation and the wayfinding of both the new and existing sections.
A walk through the new tower
Stouffer: The new tower really gave Phoenix Children's a strengthened presence in the community. You can now see the hospital from all over the valley-you can see it when you land at the Phoenix airport; from Scottsdale, Arizona; from Camelback Mountain.
Conversely, we designed the patient units to capture the views of the natural beauty of the valley. Every patient room window has an amazing view of downtown, the airport, or the mountains. These views create positive distractions for the patients and their families.
The clinics are located directly below, and so from a wayfinding standpoint, there is one unified entrance. We looked to the hospitality industry in our master planning of the movement of the families. As families enter the campus, our goal was to create that feeling of welcome. The parking garage is just steps away from the new main entrance, and that entrance opens up to a phenomenal three-story lobby. Families are met by greeters, register, and then go wherever they need to go, just a quick elevator ride away.
The lower level contains the lab, pharmacy, and information technology departments, as well as the “central garage” for equipment. The first floor contains the new diagnostic imaging department, patient registry, outpatient pharmacy, the kitchen and restaurant, as well as a 24-hour café, which was a request from both staff and family members-they wanted something to eat at night besides fare from vending machines. There is also some shelled space and administrative space on that floor.
The second floor contains the ambulatory clinics. The plan is to move as many of the multispecialty clinics as possible to the new tower from the original building, collocating them together in a shared clinic module. The third floor houses support functions-mechanical, electrical, and central sterile-as well as some family amenities and some shelled space.
The fourth level is the inpatient procedure floor, so there are operating rooms, interventional radiology, and the like. All
the floors above are patient bed floors.
Obviously, this is a huge building, and to fit the number of beds in it that were required would normally have meant a basic racetrack-style building. The client did not want a simple rectangle, so we curved the plan and divided it into three parts, creating a “blooming flower,” accented with colors and kinetic lights, creating a beacon, even at night.
Interior design elements
Stouffer: We established a color concept for the new tower, as opposed to something more thematic or explicitly childlike. The floor is very colorful, with specific colors that come from nature in the area-flowers, animals, birds, and plants. Everything is color-matched to an actual living thing. Each floor has an animal that “sponsors” it; there are sculptures on every floor of animals, which serves as an aid to wayfinding, as well as a positive distraction. The furniture is also very colorful. The goal was to showcase the beauty of the desert.
Sandra Miller, IIDA, LEED AP: One of our directives was to avoid looking childish, which is one of the major challenges in a pediatric facility. The children treated here range in age from newborns to 20 years old, so it doesn't make sense to only target the 5-to-8 year olds. We established the look of the tower through color and artwork, and incorporating interactive positive distractions within the building; it was important to provide something for the children and their families to do, whether they were waiting or if they were stressed out and needing a break. To incorporate the entire accent color palette, we used dichroic glass, which reflects the entire color spectrum as you walk past.
Stouffer: We also incorporated a Theater of Light in the far corner of the atrium, adjacent to the dining room. The idea was to bring a waterfall into the atrium without water-a waterfall of light that we took one step further. Scott Oldner Lighting Design was instrumental in achieving this.
There are also LED lights incorporated into the terrazzo floor in the atrium. The kids can jump from one light to the other, and the lights will change color. Something like that is interesting for children of all ages.
Stouffer: The patient rooms are approximately 280 square feet, and are universally sized, acuity-adaptable rooms, from acute up to intensive care. Each floor is arranged with two groups of 24 beds each for a total of 48 beds per floor. They are all single occupancy mirrored rooms with an outboard toilet on the outside wall and standardized headwalls, and a wonderful family space that allows two family members to sleep over.
All the rooms also have amazing views, which are maximized by the use of energy-efficient glass in the large windows that allows for shading techniques while still allowing lots of daylight. We did computer energy modeling as we were designing to figure the best way to angle and shape the building to respond to the sun, which of course can get very hot and uncomfortable in Phoenix. The building is curved and angled with the sun patterns.
Miller: The interior finishes were selected to provide a warm and neutral envelope for the majority of the spaces, and in support of the eight-accent-color palette that was used to highlight certain areas and destinations, as well as to provide interest throughout the building. Each floor and each clinic has its own distinctive four-color palette, taken from the original eight accent colors, which gives each floor and clinic its own identity, as well as aids in wayfinding. There are magnetic marker boards to allow the children to express themselves with their own artwork. We also provided each patient with an area outside of the room to display the patient's own individualized artwork, allowing them to personalize their own space. The goal was to make each patient room like their own individual “front door” into their world.
Nurses' stations are decentralized on each inpatient unit. There are charting stations appearing between every two patient rooms that allow the staff to maintain visibility of the patients while they are charting. There are larger stations called “touchdown” stations that are not for permanent residence for any member of staff, but have computers and other equipment necessary for nurses to get their jobs done. These resemble the more traditional nurses' stations you would expect to see in a hospital corridor.
During design, the staff requested a closed work area to provide privacy for functions like charting or patient care discussions, so we created enclosed team workstations. There are two such workstations per wing, for a total of four per floor. Each workstation is accompanied by two touchdown stations. We were able to provide staff privacy in the team workstations without compromising their need to maintain visibility of the patients and families by installing perforated photographic images on the walls and windows. The perforated images on the windows are similar to what you see on buses, which allows the people inside to see out, but obscures the visibility into the bus, or workstation, in this scenario. These photographic images also provide interest and help with wayfinding on the units.
The unit coordinators are located immediately off of the patient elevator lobby, allowing the coordinator to direct visitors to the proper unit. Every public elevator lobby has exterior views, its own distinctive four-color palette, a bronze animal sculpture, and a digital photographic wallcovering of a plant or nature scene, all of which really helps with wayfinding.
Design goals and conclusions
Stouffer: The number one goal was to create a design that would allow families to feel a sense of normalcy; in our research, that has been the number one request from family advisory groups, and so we tried to create many different places for families to go. For instance, we installed a covered garden on the third-floor roof where parents, family members, or even staff can go outside and relax and re-energize.
There's also a beautifully landscaped garden outside the dining area to provide an area of escape. Eventually, there will also be a fountain installed there.
The whole building, from the main entry court in, was designed to create a welcoming space, to really make visitors feel they are entering somewhere special. HCD
For further information, visit www.phoenixchildrens.com.
Healthcare Design 2011 March;11(3):52-59