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See inside a hospital designed by patients

The new children’s ward at the Medical University of South Carolina in Charleston was designed for, and by, patients and their families.

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It’s a unique challenge to design a place where no one wants to end up. When the Medical University of South Carolina in Charleston started making plans several years ago to redesign its new children’s building—a facility where premature babies get ventilated in the intensive care unit and children with cancer endure the slow trauma of a life in treatment—its leaders decided early on that the new building needed a design that was as empathetic as possible to patients and families who would rather be anywhere else.

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“This is not an environment that is on anybody’s life plan when they’re building a family,” says Dr. Mark Scheurer, a pediatric cardiologist and chief of children’s and women’s services at MUSC Health. “So how do you take that, say it out loud, think about it, and create an environment that actually makes them feel warm and that adjusts to the fact that this is their new normal? How do you do that thoughtfully?”

[Photo: Halkin Mason]
The way, Scheurer and others decided, was to put patients and families at the center of the design process, along with hospital staff and doctors, to guide the development of the new building—even before an architect had been hired. “We hijacked the process of designing the building unapologetically,” Scheurer says.

[Photo: James Steinkamp]
The result is a new 10-story, 250-bed facility that opened earlier this year, just before the onset of the coronavirus pandemic. It has been nearly a decade in the works, and started with the hospital’s administration reaching out to the families of patients to set up a kind of design steering committee called the Patient Family Advisory Council.

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One of the first people they contacted was Kelly Loyd, a woman who had spent a lot of time at the previous facility. When she was 42, Loyd gave birth to twin girls more than 11 weeks premature. Months of treatments, surgeries, ventilation, and ICU care ensued, and though Loyd’s two daughters eventually emerged from the hospital healthy, the experience gave her some insight into the hospital’s design shortcomings, from the awkward location of its bathrooms to the lack of privacy between ICU bays that often held dying children and grieving parents. “It’s a really difficult place,” she says.

[Photo: Halkin Mason]
But Loyd was also grateful for the care the hospital provided her daughters and wanted to give back. When MUSC reached out, she quickly volunteered and ended up as the head of the advisory council. The group of patients’ family members would be involved in the entire design process, not just as a rubber stamp in the final stages.

“They didn’t know what they were getting, because I really took that responsibility to heart,” she says. She recruited 26 other family members of previous patients to volunteer. They helped in selecting the architect for the project, the global design firm Perkins&Will in collaboration with McMillan Pazdan Smith Architecture, and were embedded with design teams focused on the various clinical departments, from the neonatal ICU to long-term care rooms to spaces designed for children on the autism spectrum.

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“There’s not a clinical space that did not have family involvement when the building was designed,” Loyd says. “We wanted to keep the architects and the care team members always focused on the fact that the patient is at the center of everything.”

[Photo: Halkin Mason]
The architects say this feedback was instrumental in guiding the ultimate design, including details both big and small. One parent’s devastating experience watching her child die in an open ICU bay led to the decision that the hospital would have only private rooms. The doctors’ experiences working with overstimulated children on the autism spectrum guided color and lighting choices.

“Color is something that can really affect positively and negatively the children within this hospital. So we worked carefully to have the color be something subtle and natural,” says Manuel Cadrecha, architecture design principal at Perkins&Will. They tried to avoid imposing what he calls “an adult’s interpretation of what a child’s world would be like”—all gaudy colors and cartoon characters.

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The design instead emphasizes natural light and access to outdoor spaces overlooking the Ashley River and Charleston Harbor, including a large balcony midway up the tower and a rooftop garden and play space. “It is possible to create beauty and delight and an uplifting space without knocking somebody over the head with visual clutter and noise and stimulus,” says Carolyn BaRoss, healthcare interiors design director for Perkins&Will.

[Photo: Halkin Mason]
Scheurer says that not every single part of the hospital turned out perfectly, and though it’s a $385 million project, the budget didn’t allow for everyone’s desires to be fully met. But he says any trade-offs that had to happen were made with the experience and well-being of patients in mind. The design decisions, he says, were patient-centric: “When I walk around the building that’s what I see.”

[Photo: Halkin Mason]
Perkins&Will got a small grant to do a post-occupancy evaluation of the building, and the architects are hoping to see how it’s experienced by both patients and care providers in the months ahead. “We will continue to look, understand, and learn from it,” BaRoss says. “And I think there’s no substitute for speaking to the patients themselves in understanding the challenges they experience and talking with the families about how they experience the space.”

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[Photo: Halkin Mason]
Scheurer says the participatory design process undoubtedly helped make the hospital a better place for patients, and it may even be helping to make him and his colleagues better caregivers. “Clinical care helped inform the design process, but this whole process has made me rethink about why we deliver care in the way we do,” he says. “It forced me to think about that. It forced all of us to think about that. . . . You can be both pragmatic and innovative. And it’s reminded me also to live up to the ideals of what we designed.”

Though Loyd’s experience with her premature twins is now more than 13 years in the past, she says the experience of advising the design of the new hospital was deeply rewarding. She was there on opening day and was one of a handful of people to walk the first baby in from the old facility.

“The day we moved in was extraordinarily emotional,” Loyd says. Based on what she went through, she knew that the baby and the baby’s family were heading into a place they never wanted to be. But with the new design she helped guide, she says, the experience would be as good as it could be. “To be able to create an environment, both an aesthetic design as well as a feeling, a sense of home, a sense of belonging, a sense of care that can surround you when you are in that place you really don’t want to be,” she says, “it’s kind of the least that we can do.”