And a Little Child Shall Lead Them

What if the best hospital designers are the patients themselves? At the brand new Children’s Hospital of Pittsburgh, the architects gave the patients and their families seats at the drafting table.

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“Let’s face it, many hospitals are pretty terrible places,” says architect Tim Powers, the senior vice president for the health care studio of Astorino, a design and architecture firm based in Pittsburgh. With more than a billion dollars of health care build in their portfolio, Powers is in a position to issue his grim diagnosis. “Hospitals are traditionally bad buildings. They look bad, they function poorly. They smell bad. And people don’t want to be there.” And as medicine has become more cutting edge, the construction challenge has been to keep up with the new technologies that the public demands. “We’re designing for technology that doesn’t’ exist yet,” says Powers. “Generally architects are recognizing this. But we wanted to deliver something that was more than the sum of its parts.”


The new Children’s Hospital of Pittsburgh, a 1.9-million-square-foot facility and campus, opened its doors on May 2, 2009 and marks Astorino’s best thinking to date on patient centered design. Normally the design process involves in-depth interviews with the client–“how many beds, how many surgeries, how many emergency department visits–the deep numerical analysis that tells you how a building will be used,” says Powers. “But we knew that we were building a house with a highly specialized group of people.”

The used something they call the Fathom Survey, a methodology created by firm designer Christine Astorino, and daughter of the company founder. (Fathom is now a separate subsidiary of the architecture firm.) She conducted a four month study of hospital patients, their family and the staff, to better understand how a patient actually feels during their hospital experience and how to better address their anxiety–and facilitate healing–through design. Think focus grouping with a huge side of cultural anthropology and some good, old-fashioned listening. “Ethnography, sensory exploration, collage work, creative brainstorming, color analysis, one on one interviews with patients, family and staff, and observing people in their environment,” says Astorino. “It’s all in there.”


The final product is an insight journal that is as much a philosopher’s notebook as a design guide, (see this pdf for a partial look) was delivered to the team early in the process. It triggered some heavy thinking. “I know it sounds lofty, but it became clear that the primary deep meaning for this building is transformation– people that come to this building are expecting that their lives are going to be transformed from an unbalanced state to a balanced state,” says Powers. “Even when the outcome is death. We wanted to build a building that would support all the emotional processes.” More at

They sweated the small stuff: the hospital now has individual patient rooms with individual temperature controls, places for both parents to sleep, and beds offering adjustable heights because kids reported feeling more vulnerable when adults loomed over them. Fun artwork and beautiful colors abound. And the transformation theme starts early–the first thing kids see when they arrive is a “transformation corridor,” linking the garage to the hospital, with murals on the floor representing the change of the seasons, and butterflies transforming on the walls. (One element that got nixed were shadow boxes that kids could decorate outside of their rooms, sort of like the hospital version of decorating your own locker.)

But some of the bigger adjustments are on the inside. Most of the traditionally patient-oriented areas like lounges and chapels are typically placed near the lobby of a hospital, making them more marketing features than anything else. “Patients felt exposed,” says Astorino. “Those are ‘wow factor’ items that don’t help the healing process.” Instead, the team created a town square/atrium on the sixth floor, where patients and staff can gather, play, even watch movies from a 40 foot projection screen, rolling up in wheelchairs to the railing if they need to. No one from the public is mixed in. Adjacent to the atrium is a healing garden, a rooftop where both patients and staff can easily “leave the hospital” safely to decompress and reflect.


The response has been overwhelmingly positive, but the team is eager to link design to healing rates and better outcomes–the first round of data is expected in August. They are cautiously optimistic. “One patient’s mother told the hospital CEO that she got the best night sleep she’d had in years,” says Powers. “That’s got to be a good sign.”