The challenge of building the children's hospital of the future.

Hospitals, like Childrens Hospital Los Angeles, must sustain and grow its patient care, teaching and research mission in an increasing difficult economic climate.

The State's budget deficit threatens reimbursement for services by hospitals and physicians. Urban and children's hospitals are particularly vulnerable because of the large number of poor and severely iii children they treat. There also continues to be serious erosion of the "... safety net ..." in Los Angeles County, resulting in fewer providers willing and able to provide services to Medi-Cal and uninsured patients.

Federal funding priorities are shifting away from domestic spending, especially for Medicare recipients, while more unfunded government mandates and regulations--such as seismic upgrades and minimum nurse staffing ratios--are escalating costs for hospitals. Meanwhile, private payers are resisting payment rate increases.

These challenges, coupled with an increasingly sophisticated and expensive medical environment--nanotechnology, genomics, robotics, new drugs and devices and computer controlled diagnostic imaging and interventions--as well as the significant and growing shortages of healthcare professionals--only intensify the importance of private philanthropy from individuals, foundations and corporations and the vital role it provides in sustaining the level of service the hospital provides the residents of Southern California. (Most of the children admitted to Childrens Hospital Los Angeles come from Los Angeles County; others from Kern, Orange, Riverside, San Bernardino, San Luis Obispo, Santa Barbara and Ventura counties--and throughout the United States and around the world.)

On April 12, 2003, Childrens Hospital Los Angeles announced the most ambitious fundraising campaign in its history--$500 million for new facilities as well as for endowment, program and annual support. More than $371.4 million has been raised toward the $500 million goal, as of March 31, 2004.

Already operational at Childrens Hospital is the $65 million Marion and John E. Anderson Building and Burtie Green Bettingen Surgery Center, providing state-of-the-art, child-friendly facilities that set the stage and the standard for pediatric surgical care.

On June 29, 2003, the Childrens Hospital Los Angeles Research Institute was rededicated as The Saban Research Institute of Childrens Hospital Los Angeles--and its new 88,500 square-foot state-of-the-art research laboratory facilities as the Saban Research Building--in recognition of Cheryl and Haim Saban's "... commitment to the children and families of Los Angeles and children everywhere."

Next will be the construction of a $300 million New Hospital that has been in the planning stages for more than two years and represents the creative perspective of patients and families, health care professionals, administrators, hospital trustees, community members, and health care architects and engineers. The project architect for the New Hospital is Zimmer Gunsul Frasca Partnership.

Vice President for Patient Care Services and Chief Nursing Officer Mary Dee Hacker has been the executive-in-charge of the design and planning of the new facility at Childrens Hospital that some in healthcare believe will be the finest medical and surgical environment for seriously iii and injured children anywhere in the United States. The following is an interview regarding her perspective on the pediatric hospital of the future.

Q. How has the delivery of pediatric care changed over the years?

Mary Dee Hacker: When our existing hospital building was dedicated in 1968, it provided truly visionary facilities that supported the standard of care in common practice at that time; that is, children were admitted to the hospital, treated, healed and discharged to the care of their families. But, medical care has evolved over the past 35 years; we now encourage our parents to participate as an integral part of the healing process. If we support the parents by providing facilities for them to be close to their children--an environment in which children and their families can heal and learn together--help them learn about the challenges of the particular illness or injury and make it easier to manage their lives, we empower them to be better caregivers, better parents.

Q. Why is a home-like environment so important?

MDH: Pediatric illness and injury can have a devastating impact on the entire family, and we consider the family--those who love and care for their child--to be integral members of the health care team. A home-like environment offers a great deal of comfort to our families, and a relaxed, friendly atmosphere can help give parents a sense of well-being and security that they pass on to their child. Research has shown that children respond better, and recover faster, when their families participate in their care.

Q. What will make this facility truly unique?

MDH: Our New Hospital will feature spacious private rooms, designed with three distinct areas: a clinical area, just inside the door, will house sophisticated medical equipment; a family area, opposite the clinical area, that will include space for parents to stay overnight, along with workspace equipped for telephones and computers; and a patient area in the middle of the room that will feature lighting and designs to help make children feel at home, including ceilings decorated with cheerful images. Semiprivate rooms will be available for children who can benefit from social contact, often so important for children with chronic disease.

Q. How about amenities for the children, parents and families?

MDH: Children will be able to visit Chase Place playrooms on each unit for therapeutic play. Working with a child life specialist, younger children will learn about their treatment through the use of doll models, while older children and their families can talk with child life specialists prior to medical procedures. Teenagers will have a lounge that will include a media center and a kitchenette, as well as space for computer games, arts and crafts, and more. Each floor will include separate staff and family lounges, with spaces for quiet and reflection. Dining facilities on the ground floor will open onto spacious gardens, and a convenience store will offer basic supplies that families may need during an extended stay.

Q. Are there other resources for parents to learn about their child's illness or disease?

MDH: A state-of-the-art Family Resource Center will provide information for parents about their child's health care needs so that they can participate more fully in care giving. It will include Internet access, multilingual print and video reference materials and referrals to support groups.

When our children and their families leave here, we want them to feel empowered; we want them to feel that they have mastered their disease or injury.

Q. What will be included in the New Hospital? MDH: When the 460,000-square-foot facility opens in 2008, it will include an Emergency Department; imaging facilities; a Cancer Day Hospital, with a 61-bed acute care Hematology/Oncology unit and a 14-bed Bone Marrow Transplant (BMT) unit; a 24-bed Cardiothoracic Intensive Care Unit (CTICU) and a 21-bed acute inpatient medical heart unit; a 24-bed Pediatric Intensive Care Unit (PICU); and a 40-bed Neonatal Intensive Care Unit (NICU).

There will be 96 additional medical and surgical acute care beds. The New Hospital has been designed to encourage and support multidisciplinary care and enable caregivers to respond with flexibility to dramatic advances in pediatric medicine and technology.

Q. How about seismic performance?

MDH: The New Hospital will improve seismic performance to not only withstand a major earthquake, but be fully operational after a major seismic event to meet the 2030 standard mandated by law.

Information for this article was provided by Children's Hospital Los Angeles.