In California, a glimpse at the future of elite children’s hospitals
PALO ALTO, Calif. — Sunlight floods through the 20-foot windows of the sprawling lobby.
One hundred silver birds float overhead, part of a menagerie of sculptures that greets visitors in all corners of the building. Cushioned easy chairs face a green lawn just outside. Gentle piano music wafts through the air.
This, surrounded by tall trees and lavender fields on the Stanford University campus, may be the fanciest new medical center for children in the country.
Lucile Packard Children’s Hospital at Stanford is billed as the hospital of the future, but it doesn’t look much like a hospital at all. It is some hybrid of hotel, museum, and high-tech laboratory. Even the operating rooms are covered with murals.
Stanford’s new, $1.3 billion building is among the largest of numerous expansion projects at children’s hospitals across the country — including Boston Children’s Hospital, where a $1.2 billion project is in the works — as the heightened competition for patients increasingly stretches over state lines and even international borders.
The Stanford expansion was built for children with holes in their hearts, failing kidneys, brain tumors. Yet it also offers a bold look at how some elite pediatric hospitals across the country are hoping their new facilities lure not only patients, but also researchers and clinicians, and make a dent in the market shares and supremacy of hospitals like Boston’s.
In places like Houston, Chicago, and Wilmington, Del., these new hospital buildings often are fitted with the latest surgical and imaging equipment, and spacious patient rooms. And they can come with huge price tags, which can be controversial because of their potential to drive up medical costs.
“These hospitals are kind of high-tech hotels,” said Mark Wietecha, president of the national Children’s Hospital Association. “Everybody’s competing by building cooler hotels. They can do more, save more lives, all good stuff — but not cheap.”
Every year, US News & World Report publishes lists of the top children’s hospitals in the country — rankings that hospitals watch closely and use for marketing. Boston Children’s is ranked No. 1, and has been for five years running. Stanford is not in the top 10.
Could a new building, and all that it entails, change any of that?
Quickly growing hospital
Founded just 27 years ago, Stanford’s children’s hospital is young by industry standards. Two of its national competitors, Boston Children’s and Children’s Hospital of Philadelphia, each have been treating patients since the mid-1800s.
But the Stanford hospital, situated in the heart of Silicon Valley, grew quickly from a traditional community hospital to a specialty medical center offering treatment for children with congenital heart conditions, aggressive cancers, and other complex diseases.
Stanford doctors now perform dozens of transplant operations each year to treat children’s failing hearts, livers, and kidneys. They do hundreds of heart surgeries. Some young patients now travel from across the country or the world to get surgery here.
At 521,000 square feet, Stanford’s new building more than doubled the size of the existing children’s hospital and added 149 patient beds, bringing the total to 361. The facility, which opened in December, also houses expensive new technology.
Operating rooms in the new building are connected to a room with an MRI machine. During surgery to remove a brain tumor, for example, doctors can immediately scan the patient’s brain — while it is still exposed — to make sure the tumor is gone. In the past, the patient would have been taken to the ICU to recover after surgery, then taken to the MRI hours later.
One of the imaging machines is a PET/MRI, a newer technology that allows doctors to see two different types of pictures of a tumor simultaneously, and to pinpoint a tumor’s location, without exposing the patient to the radiation levels required for the more commonly used PET/CT. The $4 million machine is disguised as a big sand castle so it’s less scary to children going in for a scan.
In another imaging room, the ceiling is dotted with tiny pulsing lights arranged in constellations, to help soothe patients. Children who feel calm are more likely to stay still during their scans, so they’re less likely to need anesthesia, hospital officials said.
More complex care needed
Advances in modern medicine mean that more children today can be treated in outpatient settings, instead of having to stay overnight in the hospital. At the same time, many children who wouldn’t have survived in past decades — extremely premature babies, for example — now live long lives.
“We’ve converted cancers that would have killed children 30 years ago into chronic disease today,” said Wietecha, of the Children’s Hospital Association.
The association projects that the number of children with complex medical issues is on the rise. This creates an opportunity for certain children’s hospitals across the country that have developed reputations for treating the sickest patients. While many general hospitals have closed or downsized their pediatric units over the years, these specialty pediatric hospitals are growing.
Children’s health care also has become a national and international business. Many young patients and their families now travel great distances to get specialized medical care. And when families travel for care, they expect a certain level of privacy and comfort, Wietecha noted.
At Stanford’s children’s hospital last year, 14 percent of patients came from outside the San Francisco Bay Area. That’s up from 11 percent in 2012.
At Boston Children’s, the number of out-of-state patients also continues to climb. And the number of international patients from countries such as United Arab Emirates and Kuwait, among others, grew 37 percent from 2014 to 2018, hospital officials said.
The patients who travel for care tend to need complicated treatments, for which hospitals charge many thousands, sometimes even millions, of dollars. Most of these costs are typically covered by insurers.
Many patients stay in the hospital for weeks, or months, awaiting and recovering from intricate surgeries.
Healing power of nature
The design of Stanford’s hospital is rooted in the ideals of its founding donor, the late Lucile Salter Packard, who was known for her belief in the healing power of nature.
The building is bathed in earth tones. Each floor is themed for a different California ecosystem — shores, forests, valleys, deserts, foothills, and mountains. The elevators are nestled inside what looks like the trunk of a giant tree, constructed with reclaimed redwood.
Perhaps more striking than the building itself is what’s just outside: the lush gardens. A spacious courtyard, the centerpiece of more than 3 acres of green spaces here, is a mix of trees, shrubs, benches, and winding paths. There is room for children to roam and explore statues of bears, dinosaurs, and other creatures.
The hospital has high-tech play areas, too. There’s a space where children can wiggle and jump and watch their bodies move on an interactive screen.
All of this is designed to attract and comfort patients and their families.
“It’s not sterile expanses of white walls,” said Dr. Mary Leonard, physician-in-chief. “We’re trying in every way we can to not have it feel like a hospital.”
For the parents of 2-year-old Calvin Buck, the look and feel of Stanford’s new building made the very stressful experience of having a sick child somewhat bearable.
Calvin has been to many hospitals in his short life. He has a condition called tetralogy of Fallot, which caused severe problems with his heart and blood vessels and required surgery soon after he was born.
When Calvin needed another complicated surgery this year, his parents went looking for doctors who know his condition well. They were referred to Dr. Frank Hanley, a cardiothoracic surgeon at Stanford.
In May, Calvin was sedated while doctors operated on his 19-pound body for 15 hours, his parents said. He spent 33 days in the hospital recovering before he was discharged. His parents stayed at a nearby Ronald McDonald House, a charity that houses families who travel for medical care.
The family is from Lexington, Ky., and had never been to California before. Calvin’s parents said they battled Medicaid insurers to get his out-of-state procedure covered.
While Calvin was in the hospital, hooked to tubes and monitors, his parents sometimes took shifts. One stayed in the room with him, while the other went for a walk.
“If you need to go wander,” said his mother, Chyenne Buck, “there’s plenty of places to just go and stare at something that’s not beeping.”
Several weeks after his surgery, the color has returned to Calvin’s cheeks. He has more energy now. He’s running. He goes to the park to play.
‘More privacy between everyone’
The patient rooms at Stanford have three distinct areas. The patient is in the middle. On one side, by the windows, is space for the parents. On the other side is a station for nurses and other caregivers, who can type on the computer almost unnoticed.
Parents staying overnight with their children can sleep on a pull-out bed big enough for two. They have their own TV, and outlets to charge phones and laptops. They can pull a curtain for some privacy.
These are big improvements from the original building, said Eileen Cueto, who lives about 40 miles away in Dublin, Calif. Cueto has spent many days and nights at the hospital with her 5-year-old son, Rocket, who is being treated for leukemia and a severe fungal infection that grew while he was on chemotherapy.
“The rooms are larger, so it doesn’t feel as crowded,” Cueto said as her son, dressed in Spider-Man pajamas, burrowed into his bed with an iPad. “There’s more privacy between everyone.”
The hallways and common areas are also larger, so people inside the building are more dispersed. On an afternoon in late June, the new building was nearly full, but it was quiet. It connects to the original hospital building, which remains in use.
“When you go to the old [building], it’s a roundabout, and there’s a million people walking around,” Cueto said. “Here, you go in, it’s like you’re the only person. You go into the elevator, you go into the unit, and it’s still kind of quiet the whole way through. I like that part.”
Work underway in Boston
Other top-tier pediatric hospitals are following a blueprint similar to Stanford’s, building additions that marry aesthetics with the latest medical technology.
Boston Children’s Hospital’s facilities were considered state-of-the-art when they opened decades ago. But they’re not designed for the growing number of critically ill patients who are treated there today, hospital officials said.
“The need for us to update our facilities became paramount,” said Dr. Kevin Churchwell, the hospital’s chief operating officer.
After years of planning, work is underway to build an 11-story tower and revamp the hospital campus in Boston’s congested Longwood Medical Area.
The new building, scheduled to open by 2022, will include new operating rooms, a heart center, a larger newborn intensive care unit, and dozens of new patient rooms, bringing the capacity from 404 beds to 475.
One big change: Virtually all the patient rooms will be private. Boston Children’s, like a lot of hospitals with older buildings, still has many shared rooms, which can be crowded and uncomfortable for families, and allow germs to spread more easily.
The new private rooms will more than double the space for patients and their families. As at Stanford, each room will have areas for the patient, parents, and hospital staff.
The new building will have bright colors, windows with sweeping city views, interactive play areas, and perhaps an aquarium, hospital officials said. The project also includes new gardens.
In Houston, Texas Children’s Hospital is finishing work on a 25-story tower, with 640,000-square feet of additional space, which also includes larger patient rooms and new operating rooms and imaging machines. Major expansion projects are underway or were completed in recent years at Children’s Hospital of Philadelphia, Lurie Children’s in Chicago, Nemours in Wilmington, Del., and others.
“All those hospitals have to create regional centers,” said Churchwell. “They’ve made the decision that ‘We have to create a new facility for the types of patients we’re seeing and the number of kids that are coming.’ ”
Advertising for patients
Stanford officials have advertised their new facility across the country — ads that have reached Boston — in podcasts and print and digital outlets. Since the building opened, they have seen a 3 percent uptick in patient volume compared to the previous year, even though portions of the building remain unfinished.
“We would like people all over the country to know that we are a high-quality children’s hospital, and that we’ve been able to build this phenomenal new facility,” said Dr. Dennis Lund, chief medical officer and interim chief executive of the Stanford hospital. Lund previously worked at several other pediatric hospitals, including Boston Children’s.
Hospital buildings are more complicated than most. They require large footprints and need ample supplies of water and power. The rooms must be built to comply with safety and infection control guidelines, and fitted with bulky monitors and medical equipment. In California, hospitals must be built to withstand earthquakes.
The largest hospital construction projects in pricey coastal areas can cost hundreds of millions, or more than $1 billion, like the projects in Palo Alto and Boston. Nonprofit hospitals raise money from wealthy donors to help cover the costs. But ultimately, experts said, building projects are part of the costs of doing business. Those costs become part of the prices that hospitals charge insurers, and insurers pass the costs along to premium-paying employers and consumers.
When hospitals expand, they are under pressure to fill their new buildings and collect more revenue. This can drive overuse of expensive medical care, said Dr. R. Adams Dudley, director of the Center for Healthcare Value at University of California San Francisco.
“Across the nation, we’re building much more than we need,” Dudley said. “It makes sense for the most sophisticated places to focus on specialized care. The question is how much should be invested in amenities? How much should be spent on doing the next CT scan, compared to other potential uses for that [money]?”
When Boston Children’s was seeking approval to expand its campus two years ago, hospital officials ran into such concerns. Opponents questioned the need for a new building, arguing that it would pull patients from more affordable hospitals, cement the market clout of Boston Children’s, and raise health care costs.
Officials at Boston Children’s said they won’t pass the high costs of their new building on to patients. If they do, they risk penalties from the state Department of Public Health, which conditionally approved the project in 2016.
At Stanford, officials argue that their new facility will allow them to deliver care more efficiently, leading to safer and shorter hospital stays, which will help to contain costs and improve outcomes.
Ultimately, a gleaming new building by itself is not enough for patients and their families. They come looking for answers, and solutions.
Lui Sio and his 14-year-old son, Gary, left their home in Hawaii and came to Stanford because Gary needed a new kidney. Gary is on the list for a transplant, but his name hasn’t been called yet.
They have been living in the Ronald McDonald House near Stanford for more than two years. Gary is attending public school, except for the days he feels too sick to sit through class.
The father and son have been to the new hospital building many times. It is nice, Lui Sio acknowledged. But he is really focused on just one thing.
“We’ve been waiting for this kidney for a long time,” the father said. “I don’t want to miss that chance.”