fb-pixelChildren’s ‘cardboard city’ aids in design of clinical tower - The Boston Globe Skip to main content

Children’s ‘cardboard city’ aids in design of clinical tower

Mock-ups of key facilities are helping the hospital see the plans for an 11-story clinical tower in lifelike 3-D

A team of doctors and nurses in scrubs and surgical masks crowd over the small patient and work feverishly to control his bleeding heart.

It looks like a real operation. But the “patient” is a toddler-size mannequin, and the operating room a makeshift space of brown cardboard.

The setting was a 40,000-square-foot “cardboard city,” a mock-up of a new building that Boston Children’s Hospital is planning for its Longwood Medical Area campus. The simulated surgery was part of an exercise by hospital executives and architects to test the most efficient use of space.

At 11 stories and a half-million square feet, the new building will be the largest expansion in the hospital’s history: 150 patient beds, a dozen operating rooms, a pediatric heart center, and a bigger intensive care unit for newborns.


The expansion plan includes renovating other Longwood properties and adding hospital beds to the outpatient clinic in Waltham. Executives said patient growth is strong enough to justify the $1.5 billion expansion.

“Twenty years from now, we don’t want to be in the same position we are in today, which is not enough space,” said Melissa Burke, director of operations for the simulator program. “We’re doing this to make sure we make good decisions about how to design these spaces, make optimal use of the real estate, and have very efficient workflow.”

One of the big challenges of constructing a hospital building in Boston is the shortage of land.

“Real estate is so expensive,” Burke said. “The standard hospital room can be much bigger in a place like Texas. Here, every inch of space is critical.”

The cardboard setup allows clinicians to move doorways, walls, and equipment around while they consider how big the doors should be, for example, which way patients should be facing, and where to place the many trays of surgical tools. Such details are critical, clinicians say, during complex medical procedures, which require that both personnel and tools be optimally placed.


Shepley Bulfinch, the Boston firm designing the building, has created cardboard hospital mock-ups before, but not one where doctors and nurses ran simulations of medical scenarios.

“This will be really helpful in the design process,” said Andre Kamili, an architect at Shepley Bulfinch. “If you just do a paper design, you will find something doesn’t work. Doing it this way is actually cost-saving.”

Children’s spent more than $75,000 to build the cardboard city and run three days of simulations. The hospital said the cost was small, compared to the benefits of an efficient space, such as the potential for fewer medical complications.

The simulations this week began with briefings of doctors, nurses, and other clinicians, who then went quickly to their stations in the cardboard operating rooms as if responding to a real medical situation. They stopped after each mock procedure to discuss the experience.

“How does this room feel?” Dr. Catherine Allan, clinical director of the simulator program, asked a member of the surgical team. After several minutes of back-and- forth, the team moved the cardboard walls and equipment around to see if another configuration felt more comfortable.

“It’s extremely important we do this as we build a facility for the next 30, 40 years,” said Dr. Aditya “A.K.” Kaza, a cardiac surgeon who participated in the exercises.

“Things look great on paper until you bring the patient in and see maybe there’s a better way.”


Clinicians reposition sections of the “cardboard city” to find the optimum operating room layout during a mock exercise. Pat Greenhouse/Globe Staff

Priyanka Dayal McCluskey
can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal.