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Care at the Castle
by Beth Leibson
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The dedicated Imaging Center at Miller Children's Hospital, Long Beach, Calif., contains two radiography (x-ray) rooms, two radiography and fluoroscopy rooms, and two ultrasound rooms. |
The easy part of planning and building the $150 million, 124,000 sq.ft. expansion at Miller Children’s Hospital in Long Beach, California was meeting the staff’s tangible and technological needs. The hospital needed dedicated operating rooms, an imaging center, expanded neonatal intensive care units, and additional beds.
The greater challenge rested in addressing community desires, focusing on sustainability, and accommodating depleted funding due to the economic recession.
As a nonprofit pediatric teaching hospital, Miller Children’s cares for infants through young adults, and provides maternal care for expectant mothers. Miller’s Children is one of eight standalone children’s hospitals in the state of California. The facility treats more than 8,000 children and delivers more than 6,000 babies a year. It serves more than 100,000 patients between the emergency room and clinics. And many of these, says Mel. Marks, MD, Executive Vice President of Miller Children's Hospital, are high risk and special needs children. “We don’t turn away any child or woman in labor,” he explains.
Unfortunately, over the past decade, the state of California has lost nearly 800 pediatric beds. And the need isn’t shrinking – it is growing exponentially. So Miller Children’s Hospital wants to expand services in the southern part of the state.
Identifying Needs
In the fall of 2003, Miller Children’s Hospital enlisted the help of TAYLOR, a Newport Beach, California-based architectural firm. TAYLOR was assisted by Turner Construction for pre-construction and construction services. Together, the organizations conducted a needs assessment with more than 30 hospital user groups.
But that was not enough. They also wanted to be sure the new building would meet the social and emotional needs of child patients and their families. The last thing the hospital wanted was an intimidating space that screamed injections, surgeries, and painful procedures. To that end, they held a “visioning fair.”
Between the current inpatients and outpatients and former patients, the hospital gathered more than 200 children to its visioning fair, with a wide range of ages. “In the end, we had five-year-olds all the way up to young teens,” says Rick Savely, Principal-In-Charge for the Miller project, TAYLOR.
At booths representing a variety of countries – including Italy, Mexico, Israel, Greece, Egypt, Norway, and Japan – children answered questions, put keywords on a board, and eventually voted for the most important ideas. “We realized that Long Beach is one of the most culturally diverse areas of the country, so we decided to speak to that with our visioning session,” says Savely.
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Architect TAYLOR designed a four-story,124,000 sq.ft. inpatient addition for Miller Children's Hospital in Long Beach, California.
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Ultimately, hospital administrators realized that children needed an “anti-hospital” designed with an emphasis on distraction. The theme, the Hero’s Journey and the Castle Refuge, emerged. The hospital, said the community, needs to embody the narrative of a hero journeying from illness into health.
“It was one of the most exciting days I’ve sever spent as an architect,” says Savely. “It was fun but it also had a purpose.”
Sustainability
Standing on a former landfill, Miller Children's Hospital, Long Beach, Calif., required excavation of nearly 45,000 tons of soil.
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Along with pediatric health, hospital designers focused on taking care of the planet. To this end, Miller Children’s Hospital emphasized several areas.
Miller’s Children was the first non-profit hospital to receive brownfields grants from the U.S. Environmental Protection Agency for its green efforts. The first step was soil remediation.
In the 1920s and 1930s, the area had been littered with oil derricks, which dripped oil and other debris into the soil. So, before Miller Children’s could even break ground, it had to remove more than 45,000 tons of tainted soil, which was then thermally cleaned. Then the hospital brought in new soil to lay a basis for the facility.
Recycling was also very important, particularly during the construction process. The hospital recycled 75% of its construction waste, which amounted to more than 2.5 million pounds.
And energy is a challenge in the land of perpetual sunshine. Miller Children’s uses a high-efficiency control plant and air-conditioning system. And the hospital opted to paint the roof white, to reflect some of those California rays and reduce the “heat island” effect. Abundant natural light, combined with a high efficiency lighting system and motion detectors, lowers electricity use. |
Meeting Economic Challenges
The economic challenges that started with Hurricane Katrina – elevating the cost of materials – were exacerbated by new state-mandated hospital improvements. Then, to create a perfect storm of financial obstacles, the recession dealt a major blow. “We didn’t see it coming,” says Savely. “So we had to make changes.”
“If we had kept going with the original project,” Marks explains, “we would have had a 20% overrun.” And that simply wasn’t an option for a nonprofit institution. “So, we addressed it through value engineering.”
Many of the esthetics were toned down. “We had to take out some of the cool effects,” says Savely. No more waterfalls, no more seaside boardwalk, no more moat monster. But those changes weren’t enough. “We made a lot of hard decisions,” says Savely.
The hospital decided to create a phased construction project. “The plan is to complete the shelled-in sections within the next two to three years,” says Marks. “Probably the biggest example is that we were going to have an eight-story inpatient tower, but we scaled it back to four stories, with one and a half stories shelled in,” says Marks.
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The first level, designed to be reminiscent of a beach, contains the entrance lobby,
family spaces, a cafeteria area, and the imaging center. |
Unfortunately, that was not the only change the hospital had to make. In the neonatal intensive care unit, for instance, half of the beds (24out of 48) were shelled in. The original plan had called for all of these NICU beds to be private spaces; the hospital compromised such that one in six spaces would be isolated behind sliding glass doors and the remaining spaces would be separated only by curtains.
Hard Choices Help LA
While it is telling to think about the compromises that Miller Children’s had to make, it is equally critical to think about the new facilities it offers to Southern California. The new pavilion, opened in December, offers a family resource center, playrooms, and a conference space. It also encompasses:
- A pediatric surgical center with seven state-of-the-art operating rooms.
- An easily accessible pediatric imaging center with X-ray rooms, radiography and fluoroscopy rooms, ultrasound rooms, and dressing rooms with baby changing tables.
- A neonatal intensive care unit designed to remind infants of the quiet, comforting environment of the womb in mind, with three-walled bays to reduce noise levels. The unit also has overnight family sleep rooms and a Family Lounge.
These new spaces meet the current needs of the community. And if the hospital can complete the rest of the spaces within two or three years, as planned, it should be able to grow with its patient base.
The fundraising efforts are paying off. So far this year, a fashion show has raised $78,000 to benefit the general pediatrics unit and a dance competition fundraiser brought in a quarter of a million dollars for the pediatric surgical facilities. Just last month, a bike race raised $60,000 for the hospital.
The hospital is comfortable with its choices. “It will be easier to finish the shelled-in spaces than if we just ‘downscaled’ the project,” Marks explains. “We have the structure and infrastructure installed – and we have the plans and permits in place,” says Marks. “That will save us time.”
The hard choices that Miller Children’s Hospital has made are a useful model for healthcare construction in the current economic environment. “It is a 100% success,” says Marks. “Not only are we proud of it, but the community is thrilled.” |
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The surgical area, reminiscent of an underwater scene, is designed to allow family to stay with the patient as long as possible. Patients asked that there be no water fountains in the surgical area because patients cannot eat or drink before procedures. Architect TAYLOR listened.
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