Christopher G. Dawes: How to build the best children’s hospital

When the administration of Lucile Packard Children’s Hospital Stanford decided in 2002 that we needed to build a 521,000-square-foot, state-of-the-art extension to our current hospital, we knew there would be significant lessons to learn along the way.

We opened in 1991 as a standalone hospital for expectant mothers and children. Over time, we were compelled to grow in size to meet increasing demand for outstanding care in our area.  We also recognized that our need to grow was rooted in our responsibility to serve the Stanford University School of Medicine’s academic mission through advancing research, education, and clinical care, and to expand access to Stanford Medicine experts. We embraced our vision and duty to enhance our facility to attract and retain top talent, and to foster participation in leading innovation in Silicon Valley, as Stanford University has always done.

As a “learning health system,” and part of Stanford Medicine’s world-class academic medical center, our goal is continuous improvement in all aspects. In December, we opened the doors of our new hospital, and we’re ready to reflect on those lessons learned.

A version of this op-ed is published in the Winter issue of Children’s Hospitals Today, the Children's Hospitals Association quarterly magazine.

Envision a future you can’t predict

Technology changes rapidly: The iPhone, for example, which debuted in 2007 and didn’t even exist when we began this project, has changed how the world connects, communicates and functions. To anticipate such leaps in progress, our management and architectural teams made flexible design a top priority. We designed shell spaces on the first and fifth floors, and are now building out those spaces. Although we designed the operating rooms and imaging suites for as much flexibility as possible, there are still challenges. Although one commonly imagines technological innovations making everything smaller, the latest MRI equipment is just six inches larger than the equipment it will replace. Those six inches could cost hundreds of thousands of dollars in renovations to accommodate.

Adapt to dramatic change in the geography of pediatric care

Like adult care, children’s care continues to shift from the inpatient to the outpatient setting. For example, in 2004, when we were one of the first hospitals to obtain FDA approval for children awaiting transplant to be supported with the Berlin Heart ventricular assist device (VAD), the device could only be used inside the hospital. Today, kids awaiting transplant can go home on supervision with a small, portable VAD.

This shift taught us that building a hospital expansion would, by necessity, also require us to develop into a multi-site pediatric and obstetric health system with new locations and partnerships to serve care needs for both inpatients and outpatients. In the last six years alone, we grew from Lucile Packard Children’s Hospital into an enterprise: Stanford Children’s Health. We simultaneously built our 80,000 square foot Sunnyvale outpatient clinic, developed seven other pediatric specialty clinics to circle the Bay Area, and developed partnerships with California Pacific Medical Center, John Muir Medical Center, Santa Clara Valley Medical Center, Sequoia and Dominican Hospitals, and others to increase our presence in San Francisco, Contra Costa County and other Bay Area locations.

Beware of budget and labor issues

Growth looks different for every hospital depending on the challenges presented by location, business model, and many other factors. Here in California, for example, we face unique challenges. While hospitals are all innately complex to construct, they are, unlike other building projects, especially expensive undertakings in our area as due to compliance with seismic performance criteria, rapidly evolving medical technology, and strict patient safety standards. We also built during a construction boom in the Bay Area. This presented a variety of challenges, one of which, for example, was a shortage of local qualified labor, especially electricians. This impacted productivity, which in turn impacted cost and schedule.

Shaping our new enterprise, while also expanding our hospital, depended on our leadership’s careful budget planning and fundraising. As a nonprofit care system, Stanford Children’s Health is committed to providing the highest quality care to children, expectant mothers, and their families, regardless of their ability to pay. To shape our growth around this commitment, we prioritized our efforts to improve operating efficiencies and optimize our providers’ ability to deliver the best care. More efficient operations ultimately lead to shorter hospital stays, which certainly impacts costs to patient families and results in fewer procedures which, in the end, will reduce overall costs for patients. 

Prepare and persist

Planning for a future you can’t see has many additional challenges. As a nonprofit hospital, we care for patients covered by Medicaid, the Children’s Health Insurance Program (CHIP) and other sources of reimbursement for low-income families. Throughout the many years of our expansion, we’ve worked through the changing tides of healthcare policy in America. In the past six months alone, multiple bills to repeal and replace the Affordable Care Act were defeated, only to have the CHIP program expire due to a lapse in federal funding. We’ve had to prepare financially for these uncertainties, and learn how to persist through these risks and changes, knowing that our business is unlike any other: children and expectant mothers rely on us for care, and the future of medicine depends on our role in fulfilling the research and education missions of the Stanford School of Medicine.

Listen to staff, faculty, patients and to adapt plans for real life excellence

As we learned the value of this process, we also learned to be as flexible as possible, as new staff, faculty, board members and others with new ideas joined our team. Clear leadership has meant balancing the need to make inevitable changes like accommodating slightly larger MRI machines, with staying confident and committed to our deeply vetted design plans from ten years ago. These include exceptional advances in family-centered care details, an award-winning environmentally sustainable “green” design, state-of-the-art surgical-diagnostic suites, and more. At this stage, we can only make changes when patient safety is a factor.

This December, we opened the doors to our new hospital, unveiling the state of the art in pediatric care. Our hope, as a learning health system, is also to share the knowledge we’ve gained across the many years of our project, and in doing so contribute to leadership considerations of other hospitals and healthcare systems as they change and adapt in our evolving industry.