Building new Children's Hospital changes community and how patients are cared for

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Mullions of green, blue, yellow and orange frame the windows of the new Children's Hospital of Pittsburgh, all designed to flood the building and the surrounding neighborhood with light and color. Inside Children's President Roger Oxendale is explaining how the region's largest construction project came to be and how much more still needs to be done before the 1.5 million-square-foot pediatric complex can open in May 2009.

Wearing a purple hard hat and dark suit, Mr. Oxendale walks onto a wide platform jutting from the sixth floor, the space framed by copper checkerboard panels and a four-story glass atrium. This, he said, will be an outdoor garden allowing sick children and their parents to experience the sun and the open sky without leaving the building. There are no plants or benches yet, but spreading out below is a hilltop panorama of Bloomfield, Lawrenceville, the Cathedral of Learning and the largest office towers Downtown.

"It's incredible," Mr. Oxendale said of the view children will have once Children's is complete. "It's a really great site. Almost every aspect of the site, you have got ... very, very unique views."

The excitement and anticipation from hospital officials is palpable as a new home for the region's sole pediatric specialty hospital rises above the dense landscape of Pittsburgh's East End, the 10-acre site bordered by Penn Avenue and the Allegheny Cemetery.

What is missing, at least visibly, is any of the rancor, doubt and public wrangling that characterized the project at its start.

When the University of Pittsburgh Medical Center and Children's merged in 2002, they agreed to build a new structure jointly, replacing Children's cramped, warren-like headquarters in Oakland. But soon after construction began on the site of the old St. Francis Medical Center, costs began to balloon well above $400 million, and UPMC balked at the escalating price tag and scope. The dispute went public in the summer of 2004, with former Children's Chief Executive Officer Ron Violi reminding UPMC that it had pledged a "world-class, state-of-the-art" facility -- without putting a ceiling on costs.

"We want what we were promised," he told reporters.

UPMC and Children's finally agreed to cap the budget at $475 million and shifted the day-to-day construction process away from a "fast track" method that had contributed to the expense. Then Mr. Violi left the hospital amid some speculation that he had been forced out (Mr. Violi could not be reached for comment last week).

Costs about to go up again

But after Mr. Oxendale arrived, the price escalated again to $575 million ($525 million of that being paid by UPMC and $50 million by the Children's Hospital Foundation) as other features were added, including an 800-space staff parking garage, an on-site day car center, a fitness center and the outdoor garden -- now known in planning documents as the "Howard Hanna Healing Garden," thanks to a contribution from the O'Hara-based residential real estate agency of the same name.

Last week, on a tour, Mr. Oxendale disclosed that project costs were about to go up yet again -- by about $50 million -- due to a decision to build out the eighth floor of the hospital with 40 additional beds, bringing the total bed count to 296 and the total price to $625 million, an amount higher than PNC Park and Heinz Field combined. Add the $80 million contributed by Highmark Inc. to help UPMC acquire the St. Francis site and the total exceeds $700 million.

Mr. Oxendale does not appear concerned about winning support for the extra $50 million or that it will trigger another dispute, saying, "We felt and obviously UPMC and our board agreed that it made sense now to build those additional, bedrooms," and noting that the Children's Hospital Foundation would raise the additional money. A spokesman later emphasized that the boards of the foundation and UPMC still needed to sign off on the increase.

The need for an eighth-floor expansion and more beds can be attributed, Mr. Oxendale said, to surging patient volumes at Children's 263-bed facility in Oakland, where admissions and observation cases have risen 33 percent in the last five fiscal years.

"When the planning began, what you don't know is where your sense of trajectory is going," added Dr. Andy Urbach, Children's medical director for clinical excellence and service. "And ours just continues to climb. I won't say unexpectedly; but it's climbing pretty significantly and steadily."

Transformation and control

The new Children's is part of a larger health care construction boom across southwestern Pennsylvania, with 1 million square feet being added between 2006 and 2009 -- including a $109 million expansion at UPMC Passavant in Cranberry, a $31 million expansion of the Magee-Womens Research Institute in Oakland and the planned $60 million in improvements at Mercy Hospital if UPMC receives merger approval from the federal government.

The trend is a concern to some observers who worry that capital investments can mean higher premiums for health care purchasers.

But with Children's, "I think the case was made in the greater Pittsburgh area that a new, modernized and expanded facility that focused on children's health care was necessary," said Marc Volavka, executive director of the Pennsylvania Health Care Cost Containment Council.

Lake Fong, Post-Gazette
Roger Oxendale, Children's Hospital President and CEO, tours the hospital's construction site in Lawrenceville.
Click photo for larger image. Video: Children's Hospital Construction
Locator map: Site of UPMC Children's Hospital under construction

It is clear from a tour of the Children's construction site last week that doctors, administrators and faculty feel they have one chance to get it right and that a new Children's should reflect the best interests not only of doctors and nurses, but patients and families, as well. The architect, Downtown-based Astorino, based its recommendations on a "deep-design filter process" that involved patients, families and staff members in a round of in-depth interviews, observation, storytelling and journaling, collages, sensory analysis, color theory and spatial and form analysis.

Two main themes emerged: the need for patients to feel transformed and for patients and staff to have greater control over their surroundings.

The bold strokes of purple and green and orange and yellow and blue that dot and bisect the exterior -- perhaps the hospital's signature architectural feature -- are the most visible indications of the transformative feeling Children's officials hope to create inside.

"The parents are apprehensive, the kids are apprehensive when they are coming to the hospital," Mr. Oxendale said. "If there is something right away that can catch their attention and make it feel like, 'Hey, this is a cool place we are going to,' that is what we wanted to accomplish."

'Let us feel uplifted'

The new visual angles -- a contrast to the windowless spaces in Oakland -- and the multitude of natural light also play to the need for a distraction from illness and the emotional challenges that accompany any prolonged hospital stay. A four-story Eat n' Park Atrium launches upward on the sixth floor, anchoring a part of the building officials refer to as a "Children's Town Square." Here will be a chapel, a library, a business center for working parents -- all leading outside to the garden and a sprawling city vista.

"We wanted families who were really stressed and under tension to come here and feel uplifted, hence the views and the light," said Dr. Urbach of Children's. "We also wanted ... the wow factor. You walk in and you go, 'Wow!' It truly distracts you from what you are here for."

The long hallways leading from a parking garage to the main lobby will be known as the "Transformation Corridor," and illustrations lining the terrazzo floor will chronicle the changing of seasons from winter to summer to spring to fall, perhaps with cocoon-to-butterfly iconography on the walls and in the main lobby.

"Butterflies are about as good a metaphor for transformation as anyone can come up with," said Dr. Urbach, who stops in the hallway and points out the spaciousness and light that exists amid the piles of construction materials, beams and dust. "That is what patients and families have been telling us over and over and over again. 'Don't close us in; let us see the community; let us see the light; let us feel uplifted.' "

Another architectural effect emphasized by hospital officials is the layout of patient rooms. The 300-square-foot spaces will be 1 1/2 times larger than the rooms in Oakland and completely private (one child per room), with overnight couch and pull-out bed for parents. A nearby nursing work station and "pass-through" cabinets will allow the hospital to stock the room from the hallway and clear soiled linen or food trays without entering the room -- a system Children's predicts will keep infection rates down. Rooms in the 36-bed intensive care unit will feature breakaway glass doors in case of emergency and alarms that are passed to nurses via wireless phones -- meaning no more noisy bells and alarms at the bedside.

"We are really pushing to get everything set up the way we want it," said Dr. Urbach.

'A neighborhood to be part of'

Completing Children's by May 2009 and moving everyone from Oakland will mark one of the most challenging city construction projects in recent memory -- on the outside as well as inside. In all, five buildings from the old St. Francis were demolished and five new ones will have been built. Some of the old hospital was kept intact, including the operating rooms and intensive care units, and construction workers are blending old and new by matching floor and ceiling heights.

The 12-story, 900,000-square-foot hospital will sit closest to Penn, albeit set back from the road a bit, and surrounding it will be a 10-story research tower, a 130,000-square-foot faculty building, a 75,000-square-foot administration building, a family housing/day care building and three garages with 1,400 spaces -- the maximum amount allowed by the city. Children's also is purchasing another 13-acre site near 55th and Butler streets to provide an additional 557 parking spaces.

The hospital expects to have about 2,700 employees when it opens in May 2009, but not all will be descending on the site at the same time since people work in shifts seven days a week, 24 hours a day. To help with the flow of traffic in Lawrenceville and Bloomfield, Children's widened sections of 44th and 45th streets, Penn Avenue and Garwood Way and added turning lanes and new traffic signals, storm pipe, manholes, pavement markings, sidewalks and curbs.

"We have a neighborhood to be a part of," said Eric Hess, assistant to the CEO at Children's, "and we wanted to respect that."


Staff writer Joe Fahy contributed to this story. Dan Fitzpatrick can be reached at dfitzpatrick@post-gazette.com or 412-263-1752.


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