Assignment: Plan a patient tower for children’s services. It must have seamless access to many of the main hospital’s medical and support services. Design it within a tight footprint on the medical center’s property. Work within budget restrictions. Develop a new vision and identity focused on the Southwest Florida community. Actively involve more than 100 stakeholders—clinicians, physicians, parents, community representatives, and hospital system leadership—in the process.

Lee Memorial Health Systems, a provider of healthcare in Southwest Florida, chose the HKS master planning team to consolidate The Children’s Hospital of Southwest Florida (TCH) in a new patient tower in 2010. Through its planning process, the HKS/TCH team set a new standard for collaborative planning and programming. 

Kathy Bridge-Liles, vice president, Women’s and Children’s Services at TCH, says, “When we chose HKS, we believed they were knowledgeable and down-to-earth. HKS listened. If someone expressed concerns at a meeting, those concerns were addressed and often clarified at future meetings. All opinions were respected and considered. HKS helped us create an environment that was very transparent. That is why we were able to accomplish such great results.”   

So what was the difference? Rachel Saucier, vice president with HKS, sums it up: “In a traditional master planning process, we usually don’t have the opportunity to really get to know the end users. As a result, we may make assumptions on square footages and adjacencies, based on industry standards. At TCH, we were able to spend time with a representative cross section of the staff and were able to address issues that wouldn’t have come up without their involvement.”


Planning the planning

The master plan process involved seven months; eight rounds of meetings; 80 staff members, clinicians, and physicians; and 22 family representatives. 

Setting schedules and agendas. Months in advance, HKS and TCH facilities’ staff researched calendar availabilities for planning team members, and sent emails for workshops and smaller group meetings for the seven-month process. Agendas, action items, and timeframes for each workshop and meeting were planned in advance.

Jennie Evans, vice president, Clinical Solutions & Research Group with HKS, says, “The hospital placed the right people on the steering committee: health system representatives, philanthropists, medical and nursing staff, board members, and family focus and community representatives. The hospital’s facilities person—a dedicated coordinator with significant ownership in the process—was totally engaged.”

Creating a master plan space. HKS set up one room for small group sessions of eight to 10 people, so that doctors, nurses, and parents could meet in the same space and see posted on the walls the comments and priorities of the other groups.

Touring/shadowing staff. HKS architects and clinical research team members toured every pediatric department. Observations identified critical issues that affected master planning, design, and programming for the hospital and set the stage for discussion workshops and group meetings.


Workshop sessions

In addition to small group meetings of eight to 10 people working on process and specific issues, the team planned larger workshops for various team members. Information gleaned from observations set the stage for discussion.

Visioning workshops included three sessions: an overall project session that included administrators, physicians, and board members; a clinical process session that involved nurses and clinical staff; and a family focus session that worked with parents to capture their unique perspectives.

 Saucier describes one outcome from the visioning workshop: “The overall concept was for TCH to be a hospital within a hospital. The new tower represented the opportunity to have nearly all pediatric services under one roof, but the original space assumptions did not allow for future growth. By listening to the users’ concerns, the team was able to determine which areas needed expansion capability. The NICU, for instance, originally programmed for 20 new beds, will now have the ability to move 64 beds into the children’s hospital, allowing for standardization of patient and family spaces, and a more efficient workflow for the staff.”

Bridge-Liles says, “At the end of our first visionary meeting with 43 participants, we had determined our priorities and they were actually posted on the walls. We walked out knowing our guiding principles.”

The clinical town hall with nursing staff reviewed cross-functional teams for medication delivery, supply process, equipment process, environmental services (linen and trash) processes, and patient care workflow.

The family focus workshop involved family representatives, the family council, and clinical staff. The group discussed the existing facility and brainstormed perfect faculties to meet family needs, as well as how to empower the child and support the family through space and design.

A checkup workshop was held to review information, discuss issues, and make sure everyone was on task and working toward the same goal. Named “addvisioning,” stakeholders, including staff, clinicians, administration, and families, were brought together to review spreadsheets that incorporated all comments and suggestions. Additional ideas were added.

The families returned when the spreadsheets were 95% complete to ensure full compatibility with their needs and demonstrate TCH’s commitment to create what’s best in children’s hospitals.

Process mock-ups provided the ultimate hands-on experience for hospital staff. Betsy Berg, HKS associate principal and assistant vice president for the Clinical Solutions & Research group, says, “For mock-ups, we don’t start with tape on the floor. We come to the meeting with tape, equipment, and furniture. We watch carefully while they work everything out.”

The architects and hospital facilities team brought in multiple furniture samples, so staff could lay out the size of the room and test arrangements. There were three sessions for three decisions: room size, stacking influences, and inboard/outboard services (medical, surgical, and intensive care).

Individual mock-ups were held to look at a typical emergency exam room, pediatric sedation room, prep/recovery room, and hematology/oncology room. In the course of these meetings, similarities in size and layout were identified and additional tweaks were made, ultimately creating TCH-specific standardized room designs, something usually not addressed until the design process. Groups were also brought together for rooms that needed to be similar for stacking purposes, such as patient rooms on the perimeter.

“Mock-ups helped make the process more tangible. Our clients were able to connect spaces with drawings. We learned each other’s languages—they were understanding us, and we were understanding them,” Evans says.

Blocking and stacking provided an interactive experience for physicians and directors to address stacking and key adjacencies. Participants reached a common understanding with complete transparency. In a block planning exercise, challenges involved with the existing facility, operating room utilization, NICU future growth, and emergency department access were addressed.

Berg says, “There were numerous challenges with the project and creating adjacencies with the existing hospital. For example, we needed to
create a seamless flow between birthing and NICU. We had to traffic staff to radiology, main supply room, and other services.”

One particular challenge was Florida’s hurricane-specific building code requirement that emergency rooms be located on the second floor. “The feedback was firm. They didn’t want to transport patients in an elevator to the ED and wanted parents to have the fewest number of turns when coming to emergency,” Berg says. The solution involved a sloping approach to the second level emergency room entrance.

In a closing review with the teams, HKS went over the final plan with all stakeholders. The master plan gained unanimous consensus. TCH leadership and the board of directors later approved it. Survey results from all participants gave the process—and the team—a resounding thumbs up.

The collaborative planning process will shave six months off the project schedule when construction begins. Fundraising efforts are well underway, with the hope that construction will begin in 2012. HCD

Jeffrey Stouffer, AIA, is Principal/Academic and Pediatric Practice Leader for HKS. He can be reached at 214.969.5599 or