Ranked No. 8 according to Child magazine’s latest assessment of the nation’s best pediatric hospitals, Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, TN, is not only visually stunning – but is a cutting-edge facility that promotes the organization’s purpose: to give children a place to hope and heal.
Formerly located in a 3-floor unit within adult hospital space, Vanderbilt determined more than 5 years ago that a separate children’s facility was essential in order to serve its 8,000-plus yearly admissions. With the aspiration of becoming a national model for family-centered care, Vanderbilt had specific guiding principles that were adhered to throughout the project – the building’s design was to be viewed “from the eyes of a child,” enhance patient and family access, establish clear lines of sight between patients and staff, create spaces with flexible use, and incorporate a Tennessee theme encompassing nature and water.
A total of 28 committees met to deliberate on wishes from physicians, former patients, current patients, donors, staff, and parents before facility design and construction began. “It started at the top, but it was very democratic and made its way through all the users – all the way down to the end-users,” explains Molly Alspaugh, interior designer, Earl Swensson Associates Inc., Nashville, TN. “It took extra time and commitment, but we firmly believe that it created a better outcome.”
These committee meetings resulted in an 8-story, 206-inpatient-bed children’s hospital as part of Vanderbilt University Medical Center’s campus. Fitting this 660,000-plus-square-foot building onto its designated 2-acre site wasn’t an easy undertaking: With certain services requiring location on the ground floor (such as the emergency room and main entrance), and other services needing to build off of those particular points (i.e. the imaging center next to the emergency room), “arrangement and placement of the various departments was a real challenge,” says Richard L. Miller, president, Earl Swensson Associates Inc. “Having the proper relationships and fitting those on a tight site was one of our first challenges.”
Vanderbilt uses this children’s healthcare facility to convey its dedication to the well-being and comfort of not only its patients, but to family members, physicians, and staff as well.
Designed for Children
The sense of “a hospital that doesn’t feel like a hospital” was vital to make children feel at ease in an unfamiliar place. Both the exterior and interior of the building were designed to welcome children instead of causing anxiety. To provide children a sense of the hospital being “their own place,” the facility is constructed of granite instead of brick like the other buildings in Vanderbilt’s medical complex, and also displays its fanciful paper-doll logo. “It’s a sophisticated, whimsical approach ... but without creating a ‘circus’ atmosphere for a child. The goal was for the children to be able to relate to the building, both on the outside and the inside,” explains Miller. Public areas of the hospital feature cheerful, interactive art (acrylic butterflies that can be set to flight, an operable train village, and playful sculptures). Bathroom fixtures, window sills, and countertops are all presented at a child’s level to allow patients to see what’s going on around them.
Wayfinding systems had to be established so that even children who aren’t old enough to read could navigate through patient corridors without getting lost. Each floor has its own theme, and the creation of “neighborhoods” within each of these floors allows children to follow colors and distinctive animal/nature signage to make their way through the space. “The graphics and signage for this building are definitely pediatric-friendly. We set up a whole genre of design standards for the wayfinding of this building, which is different from any other project. We feel like we were successful enough with that process that we’ve actually hired the graphic designer to come in and look at the entire medical complex and help us with our global wayfinding system throughout the entire medical complex. There were some good, positive things that came out of the children’s hospital that we are pursuing, even beyond the completion of this project,” says John Sparks, architect and project manager at Vanderbilt University Medical Center’s Office of Space and Facilities Planning.
Centered on evidence-based design, the facility offers patients exposure to nature (via rooftop gardens, natural light, and outdoor scenery); positive distractions (interactive art displays and access to music, poetry, and live readings via a performance stage); and environmental control (allowing patients to manage lighting, sound, wayfinding, and air quality). An emphasis was also placed on life safety, cleanability, and durability: “Vanderbilt directed us from the very beginning that they needed materials they were familiar with; things that they could keep up with. We wanted to make sure, visually, that we were addressing what children see, and what can give them joy down at that level; and then we considered the textures and safety of the materials that are around them,” says Alspaugh.
But as Alspaugh also points out, designing a pediatric facility doesn’t mean just designing for toddlers. “We did want to address the space through the eyes of a child, but we also had users of the space that go all the way up to age 18 or older. Because of the nature of certain illnesses, children may continue to come to Vanderbilt until they’re 20, 21, or 22 years of age. So, we had to include imagery at many different physical levels, and also imagery that was joy-giving but did not alienate the older kids.”
Designed for Family
Knowing that families are crucial to the continuum of treatment, Vanderbilt allocated a considerable amount of its total square footage to family-centered space. This includes sleeping accommodations both within private patient rooms and in hospitality quarters, laundry facilities and common kitchen areas, and family lounges.
In order to offer family members the best environment in which to support and comfort children and work with physicians to make necessary decisions, there are “communal support” areas especially for families. These areas include a chapel; a resource center providing materials for learning, and a room for children filled with information to explain illnesses; supervised play areas for patients and siblings; a fully equipped business center with computers, fax machines, and telephones; and an outpatient pharmacy and gift shop.
“Hospitals are often so concerned about not having to spend a lot of money on the upkeep or the running of space that is technically ‘soft space,’ such as family-centered space, but it makes all the difference in the world in terms of the ways a patient feels,” says Alspaugh, “and probably the quickness with which they can return to their home setting as it relates to how family can support them in their environment.”
Designed for Physicians and Staff
The same pressures facing patients and their family members also transfer to hospital physicians and staff members; Vanderbilt knew it was important to provide space for employees to decompress (such as a rooftop garden, located on the fourth floor). The design of the facility also allows natural light to infiltrate the core of the hospital, providing daylight to staff that otherwise may not see natural light during the day.
The latest advances in technology are also available to physicians and staff, including ceiling architecture in surgery suites allowing for robotics. Nurses’ stations, workrooms, and control centers all have clear lines of sight into patient rooms via design configurations and open or glass enclosures, making observation less time-consuming. Trauma/critical-care patient areas surround staff work areas, giving personnel a full view of all rooms. Screens viewing individual patient rooms hang from the ceiling above nurses’ control centers, providing additional monitoring capabilities. In addition, each private patient room has a “staff zone” that provides space for personnel to do charting and other paperwork.
Space flexibility in the hospital also makes for a less hectic environment for employees. Considering that the number of critical-care cases may increase, all general medical/surgical patient rooms were designed with the required square footage to be converted into critical patient care rooms if necessary.
Vanderbilt’s Sparks says, “After working on the project, one of the highlights for me was to walk through the building the first night after we moved the patients in, and seeing the building being used for its intended purpose – knowing that the kids were actually able to take advantage of all the planning that had gone on in the project, and that the staff were able to be in a new facility that was not just comfortable, but easy to work in. That was a very high point … a very gratifying point.”
Leah B. Garris (firstname.lastname@example.org) is associate editor at Buildings magazine.
A total of 28 committees met to deliberate on wishes from physicians, former patients, current patients, donors, staff, and parents before facility design and construction began. As a result, the hospital is centered on evidence-based design, and offers patients exposure to nature, positive distractions, and environmental control. An emphasis was also placed on life safety, cleanability, and durability.