November 13, 1998

Space the first, not final, frontier for Children’s Hospital design team

Space the first, not final, frontier for Children's Hospital design team

The stars were the limit when the Vanderbilt Children's Hospital "Design Team" gathered for a one-day retreat to launch the detailed planning process for a new, free-standing Children's Hospital to be built on the Vanderbilt University Medical Center campus.

The theme of the Oct. 29 retreat was space, which was especially appropriate given that while the nearly 200 participants worked at tables decorated with confetti stars and Milky Way bars, Sen. John Glenn was making his successful return to space. The physicians, nurses and other caregivers, administrators, VCH parents and representatives of the architectural team divided into smaller work groups called Galaxy, Space Aliens and the like.

The retreat was designed as the "launchpad" for designing the new hospital ‹ to dream about what it will look like and what it will include. More importantly, it was a day to think about how the philosophy of "family-centered care" will shape the design of the hospital as well as how care will be delivered.

"We wanted to get everyone excited about this, and to make sure we are all starting on the same page," said Terrell Smith, administrative director for Children's Hospital. "Over the next month to six weeks, the Design Team will be making such basic decisions as how big the new hospital will be, what it will include and what areas should be situated next to or near each other. Then, 27 separate committees will get down to the nitty-gritty details, right down to where light switches and electrical outlets are located."

Beverley H. Johnston, president and chief executive officer of the Institute for Family-Centered Care, moderated the retreat. She praised VCH's start toward the new facility, especially building a strong foundation of community involvement and bringing parents and families into the process at its inception. She also cautioned the group that they will need a lot of patience not only during the design and construction of the new hospital but during that first year of adjustment once the new hospital opens.

Johnston and others who have recently participated in the building of family-friendly children's hospitals reminded the group that family-centered care is grounded in the fact that families ‹ not health care providers ‹ are the constant in patients' lives. Family-centered care is an approach that involves families as full partners in the decision-making, delivery and evaluation of health care.

"You're the visitor in your patients' and their families' lives; they are not visitors in yours," said Dr. Curt Steinhart, professor of Pediatrics, Surgery and Anesthesiology at the Medical College of Georgia, which has just built a new children's hospital in Augusta, Ga.

Steinhart said that becoming a family-centered care provider is "kind of Zen," something that evolves with time and practice. "It's not something you work at for two years, and then you're a family-centered care provider," he said. "It's a journey, not a goal. I'm not there yet. I'm always, constantly becoming a better family-centered care provider."

Delivering family-centered care takes time, knowledge and commitment, he said, but the pay-offs are tremendous. "It is energizing taking medical knowledge and making it valuable for the family and patient," he said. "Family-centered care is better care because it makes you a better, more knowledgeable decision-maker."

The commitment to family-centered care must extend beyond the individual caregiver to the institutional level, said Juliette Schlucter, a parent consultant at Children's Hospital of Philadelphia (CHOPS).

Schlucter told the group about the day in 1991 when she and her husband learned that their infant son had cystic fibrosis and, through genetic testing, that the daughter she was then carrying also had the disease. The news was broken during a walk down a busy hallway, under harsh lighting and interrupted by noise from nearby staff and ringing telephones.

"I can't tell you what I fixed for dinner last night, but I can still recall the sounds, the feel and the taste of that moment," Schlucter said. "That experience would have been so different if we had been in a quiet room, softly lit, with privacy and a box of Kleenex on the table."

Schlucter then described how CHOPS ‹ with the integral participation of Schlucter and other parents ‹ has recreated itself as a family-friendly hospital, complete with a 4,000-square-foot Family Resource Center. The center includes a kitchen where families can eat together, six private rooms where parents can stay overnight at the most critical times of their child's care, and quiet rooms where caregivers can deliver tough news.

"And I can tell you, there's a box of Kleenex on the table," Schlucter said.

A new Children's Hospital, built from the ground up with children's and families' needs in mind, can go a long way toward fostering family-centered care, but it's more than just the building, Johnston said.

"It's changing patterns of care, it's information sharing, it's empowerment," she said. "The key is to have a clear mission, vision and philosophyŠ Family-centered care is based on family-identified needs, not professional assumptions."

The retreat ended with participants brainstorming "beyond-their-wildest-dreams" ideas to spark the creative process. Just a few of the suggestions included:

o elevators that move vertically and horizontally to deliver you to a precise location;

o individual environmental controls to allow setting of temperature, noise and lighting levels on a room-by-room basis;

o use of holographic technology to conduct "virtual patient exams;"

o palm print- or retina-activated security systems to provide a safe environment that would still be easy for parents and families to navigate;

o a playground with equipment accessible to all children, even those who use wheelchairs;

o a high-tech business center where parents can telecommute to work from the hospital.

William S. Mead, a principal with design consultant Shepley Bulfinch Richardson and Abbott, said that the design of the new Vanderbilt Children's Hospital is a true team process that will be assisted by his firm and the architect Earl Swennson and Associates.

"We are really excited about this because it really has the potential to break all the old paradigms," Mead said. "We will not design this building. You will do it, and we'll help you. And when we leave, this will not be our Children's Hospital, it will be your Children's Hospital.