Strategic Innovation: The Children's Hospital at Montefiore

And yet, as successful as the mobile units are, Redlener never saw them as the answer to children's health care. "Children really deserve to be in neighborhood-based, fixed-place primary health-care environments," he says. "The mobile units are really a stopgap measure."

Redlener's real dream is on display on the sixth floor of the adolescent inpatient unit at CHAM. Take the elevator up, and the doors open to a beautiful tile mosaic of the night sky over the Bronx. A young person in silhouette sits in the corner, gazing up at the city lights sparkling like constellations. Just below, the words of Carl Sagan offer a gentle push: "Dreams are maps. We make the world significant by the courage of our questions and the depth of our answers."

Sagan, a longtime friend of the Redleners who died in 1996, provided both the challenge and the beginning of a response. While in the process of drafting his dream brief for CHAM, Redlener called Sagan's widow, Ann Druyan, to discuss the idea of memorializing Sagan. Was there a way to build on Sagan's sense of science to create a hospital that was as much about discovery as about recovery? The two then called on another mutual friend, then-vice president Al Gore. Gore put together a group of top-flight scientists and thinkers -- Stephen Jay Gould, Harvard professor and author; Daniel S. Goldin, former administrator of NASA; and Neil Tyson, director of the Hayden Planetarium -- for months of White House brainstorming.

Sagan's own ideas about using science and discovery to unlock the future for children became Redlener's map. "He believed that the process of finding out where you fit into the universe and the inspiration that comes from learning something about your world can be a gateway to a whole set of possibilities for children who have otherwise been contained in a very limited worldview," Redlener says. Transforming that cosmic blueprint into a meaningful experience required another set of unlikely collaborators.

"We Are Star Stuff": Making Important Connections

Redlener had his map. Now he needed an architect to help him turn it into working drawings. He turned to David Rockwell and his team at Rockwell Group. The firm's lavish spectacles, such as Cirque du Soleil's headquarters in Orlando and sets for theatrical productions of The Rocky Horror Show Live and Hairspray, seem a world away from the serious business of designing a hospital for sick children. But Rockwell and Redlener share a commitment to creating layered experiences that unfold and capture visitors' imaginations in diverse ways.

"For us, every project begins with reimagining everything about a space," says Rockwell. "The more time we spend tilting at windmills and pushing at dreams before we get to form or color or texture, the more profound the effect. The best projects, like Montefiore, start with pure ideas rather than ideas about design."

Redlener presented Rockwell with two animating ideas. The first was Sagan's principle, which stressed the interconnectedness of the universe and the joys of learning. The second was a radical change in perspective about medical services: "family-centered care." Family-centered care shifts nearly every dimension of traditional health-care facilities. It calls on hospitals to go from being doctorcentric, information-scarce, intimidating institutions to being places that focus on responding to the needs and comfort of families, sharing information, and enlisting parents as partners in their children's health care.

In the hands of Rockwell Group, these ideas became an organizing theme: "Children are explorers on a journey to health." The idea was to uncover "all of those moments in your experience as a child in a hospital that are terrifying, dehumanizing, and lacking in information and to use those as interventions to provide information, insight, and a sense of wonder and delight," says Rockwell.

To that end, Rockwell Group wove the Carl Sagan Discovery Program into the hospital's design at every level. Each of the hospital's seven patient floors has a unique theme and design palette. The elevator lobby on each floor is an entry into a richly conceived corner of the cosmos. Step off the elevator on the third-floor unit for ambulatory and outpatient procedures, and Sagan's idea that "we are star stuff" connected by our common origin in the Big Bang is rendered in a colorful etched-glass mural of sea worms, snowflakes, and stars. Travel to the fifth-floor unit dedicated to subspecialties involving illnesses of perception (craniofacial disorders, speech, and sight conditions), and you're in an interactive playground dedicated to exploring nonvisual senses.