Journey to transformation
Completion Date: November 2008
Owner: The Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center
Interior Design: Astorino
Photography: Dennis Marsico (exteriors), Alexander Denmarsh (interiors)
Total Area: Hospital Campus (including John G. Rangos Sr. Research Center, Plaza Building, Faculty Pavilion, Admnistrative Office Building, Central Plant and Three Parking Garages: 1.5 million sq. ft.
Total Cost: Hospital Campus: $625 million
Cost/Sq. Ft.: N/A
It started with a very simple and practical idea: Children's Hospital of Pittsburgh of UPMC wanted room to grow. Once settling on a 10-acre campus atop one of Pittsburgh's famous rugged hills for a complete replacement campus, including six buildings and three parking structures, the Board of Directors pushed things further, setting ultimate goals for the new hospital, specifically: make the new hospital the most family-friendly, sustainable, and technologically advanced children's hospital in the nation-“lofty goals, but we were unable to talk them out of it,” jokes Eric Hess, vice-president and project executive. Designing the project, the Pittsburgh-based architectural firm Astorino and its associated research design firm fathom elaborated these goals in a soulful direction.
With the consumer-oriented research process for which Astorino and fathom are becoming known in healthcare design-in this case using the ZMET (Zaltman Metaphor Elicitation Technique) market research tool developed by Harvard University-based Olson Zaltman Associates-researchers probed patients, families, staff members, and administrators alike, about what a children's hospital meant to them emotionally. In intense discussions with participants assembling collages from cut-out, drawn, and photographed images, it became clear that the chief motivating factor sought in a children's hospital was a sense of “transformation”-not necessarily transformative healing, which is often not in prospect for the long, drawn-out clinical regimens young people can face, but transformative in the sense that their emotional needs are supported throughout, moving them from an unbalanced to a balanced state. Part and parcel of this, the researchers found, are concepts of control, connection (with nature, the “outside world,” and with others), and the importance of positive energy in the healing process, as opposed to the negative draw on energy created by most traditional hospitals, as Astorino lead designer Tim Powers puts it. How was the building assembled to meet these goals and realize these aspirations? Recently, Hess and Powers offered a virtual guided tour for HEALTHCARE DESIGN Editor Richard L. Peck.
Hess: The hospital needed room to grow-that was first and foremost. And, on this 10-acre campus, we were able to integrate our medical, research, and teaching missions in ways we were never able to do before. We were also able to provide easier, more convenient access to the facility, as opposed to everyone attempting to access from the same crowded driveway.
Powers: The building, which is on a hilltop and visible from miles away, has become iconographic in Pittsburgh. Kids recognize its shape and the hospital is using a simple drawing of the building in its marketing materials.
Powers: We were looking for a way to convey to people the sense of transformation that they said was important to them in a children's hospital. The Transformation Corridor that connects the parking garage with the main lobby, and its changing floor patterns and exciting wall murals, diverts people away from any sense of discomfort upon entering the hospital. Hospitals typically drain people of their energy-they look and sound bad, they're noisy. We wanted elements that provided positive energy-an announcement that the building is here to support their emotional needs throughout the course of treatment, which might involve years, regardless of healing or not.
Hess: We, as clients, tend not to talk in terms of concepts like transformation, control, connection, or energy. We tend to talk in more practical, technical terms-the right size, easy wayfinding, a pleasant experience for patients and families. If we see a good idea, we say we like it. From a practical standpoint I was more worried about getting the hybrid cath labs right in their functionality. But ZMET and the fathom research process was important in helping Astorino understand their client's business, wishes, and desires. The concepts they discussed were important and, basically, we relied on them to get it right. And they did.
Hess: While we wanted to integrate all of our missions on one campus, at the same time we wanted to create some separation from the traditional department model of organization. In the new building we organized by service, not department, on one floor. They had their core operations but contiguous examining rooms, all designed the same so that they could be used for different services at different times, as needed. Consolidating our operations in this way has given us improved access to data and much greater flexibility in organizing things day by day. We built a hybrid cath lab to operating room standards so that some surgeries could be done there. We also have ceiling mounted X-rays in every trauma bay-a technical challenge, with the overhead space requirements, that was difficult enough to do in the new environment, and would have probably been impossible in a renovation. We've decentralized nursing, with three care stations on a typical unit of 24 beds, and have medications delivered daily to each nurse's medication cart rather than via a central medication room. Every patient room has its own supply cabinet, with supplies delivered through a pass-through window on the corridor. Besides more efficient working conditions, we've provided nurses with comfortable lounges, with plenty of space for adequate rest and relaxation, and views through outside windows.
Powers: Blocking and stacking acute care, ambulatory care, level I trauma, cardiac, neonatal, and pediatric intensive care in one vertical building was a giant 3-D puzzle. As it stands, we have the lobby and emergency department on the first floor, imaging on the second, ambulatory care on the third floor, ORs and same-day surgeries on the fourth floor, pediatric intensive care on the fifth, and acute inpatient on floors six through nine. The intensive care areas are organized as individual rooms, with staff connected by wireless communications, rather than as open bays. Because of the new building, the clients discovered that they could reframe their operational model and do a lot of things they had never done before. The building is also more convenient for patients and visitors. It is organized so that there is direct access from the first floor to each of these services. This resulted from a vertical transportation study calling for a highly complex elevator setup. Parking areas are also divided according to ambulatory or acute care, giving everyone only a relatively short walk from parking to the appropriate elevator. Considerable effort, too, went into separating the patient areas from the materials management areas, with a real front stage and back stage. They've even been color-coded to make sure people stay in the right areas.
Powers: We consolidated the Family Resource Center as a 20,000-square-foot community square and located it not next to the lobby, as is usually the case with these spaces, but on the sixth floor, to allow easy private access for patients wearing gowns. It includes a 28′ x 28′ square movie screen and a 4,000-square-foot healing garden just to the outside.
Hess: We're very happy with the Family Resource Center, which has a large movie screen, a four-story atrium, a 24-hour playroom, a chapel, a music therapy room, and classrooms where teachers from the Pittsburgh school system conduct classes. It's true that people have been a little slow in getting used to visiting the center during its first few months, but we were recently able to show a Pittsburgh Penguins world championship hockey game on the big screen and had people gathering at every level of the atrium to see it. So it may be that we'll have to do some more active programming to encourage use of this space.
Powers: The rooms are designed to be kid-friendly and give patients lots of control over lighting and media. And there's plenty of space for families to spend time with them.
Hess: Each room has two sleeping surfaces for family members, a dedicated family pantry, free laptops, connection with a Lodgenet entertainment center-mainly for its gaming component-and free movies on-demand. Families have been very enthusiastic about these amenities from day one.
Powers: We did a lot of research on the color options throughout the facility. We wanted a sophisticated scheme, not just simple primary colors, because children are not unsophisticated. We also wanted to avoid theming with well-known cartoon characters and the like. Themes get old very fast, and can be especially tiresome for staff. In color selection, we looked into some international color research that predicts popular colors, to make sure that our colors would be coming in, not going out, and I think our choices were accurate. Like many children's hospitals, our colors are quite loud, but in this case not primary. Their names-“Daffodil,” “Sunrise,” “Willow Herb”-give some idea of the direction we were moving.
Powers: We wanted a building that was bigger and better than the sum of its parts. We wanted to discover what the deep meaning of this building was, from an emotional standpoint, and to achieve this through design. Some architects will say, “We know what you need,” but we didn't want to do that. We didn't want to trust our own intuition in such a big project. What we discovered during the research was compiled into a journal of 3,000 pages, which we boiled down into something that was portable and easily reproducible. We used this to communicate these insights with everyone-some 200 people were involved, at one point-from administrators, to draftsmen and constructors, and more. That communication was the key to getting this done successfully.
Hess: We hit our completion date and our budget number with this project, and I don't know too many people who can say that with a straight face. Although it sounds like a cliché, we did this by surrounding ourselves with the right people, with experts who could deliver and were performing at a very high level. This included designers, financial consultants, equipment planners, everyone across the board. I learned from this project that, if you communicate consistently, and confront problems and concerns as they come up day by day, people will understand what you are trying to do and, for the most part, will want to do the right thing. HD