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Thirty years ago, Lucile Salter Packard envisioned a warm and welcoming hospital that would transform the way children and expectant mothers receive care.

To gather ideas, Mrs. Packard, along with a team of Stanford doctors and executives, toured several of the nation’s top children’s hospitals. Curiously, she would sometimes excuse herself from the group.

“My mother would later be found speaking directly with patients, families, and their care providers so she could hear what truly made a difference to them,” remembers Susan Orr, Mrs. Packard’s daughter.

What Mrs. Packard learned from those candid conversations was the importance of nature, play, and compassion when treating children, as well as keeping families at the heart of health care decisions. She recognized that these elements, in combination with state-of-the-art medicine, would improve the way children heal and make a lasting impact in the community.

With its child-friendly amenities and access to outdoor spaces, Lucile Packard Children’s Hospital Stanford was considered ahead of its time when it opened in 1991. It remains one of the few hospitals in the country exclusively dedicated to both pediatric and obstetric care and is nationally recognized for its exceptional programs in cardiology, neonatology, cancer, and transplantation. Each year more than 4,000 babies are born at the hospital, and its expanded network through Stanford Children’s Health receives more than 500,000 patient visits.

As demand continues to grow, the hospital is responding with a $1.1 billion expansion, supported by $262 million in philanthropic gifts, that builds on the powerful foundation first established by Mrs. Packard. 

“We are building what will be the most technically advanced, family-friendly, and environmentally sustainable hospital for children and expectant mothers,” explains Christopher Dawes, president and CEO of Lucile Packard Children’s Hospital Stanford. “It is designed to treat the whole family. This means healing gardens and green space, more private rooms and spaces for families to be together during the healing process, and the ability to accommodate new technologies.” 

Scheduled to open in 2017, the project reached a major milestone in January: the “topping off” in which the final steel beam was raised, marking the completion of the structural frame for the new facility. (See "topping off" video.)

“Our vision for the future integrates many elements of the original design,” notes Michael Lane, vice president for construction of the expansion project. “In all aspects, our aim is to keep a strong connection to the past by expanding on what works well in the existing hospital.”

Orr, who is also vice-chair of the hospital’s board of directors, spoke at the topping-off ceremony to a crowd of physicians, staff, donors, construction crew members, and families. “My mother had always hoped that this hospital would be embraced by the community,” Orr said. “She would be thrilled that so many of you have participated in so many ways in making this happen and carrying out her vision now and for the future.”

Gardens and Greenery

The expanded facility mirrors the look of the original hospital but incorporates a modern sensibility focused on environmental sustainability and a design concept that integrates nature seamlessly into the overall patient experience.

“The original hospital was iconic as a health care building in the way it used natural sunlight and set nature within its framework,” says Robin Guenther, principal at Perkins+Will and lead designer of the hospital expansion. “This set a design precedent, and these elements have been incorporated into the expansion. Our challenge was to expand on what was timeless about the existing building, incorporate the components of a future hospital, and create a building that reflects its unique location and role.”

“While it needs to accommodate 21st-century medicine,” Guenther adds, “the building also needs to reflect that it is in a place that is like nowhere else in the world.”

The Bay Area’s deep sense of environmental responsibility is a driving force behind the design, which has put sustainability and “green” systems as a top priority. Almost four acres of gardens and green space will offer areas where patients, families, visitors, and staff can savor the sights, smells, and sounds of nature. The landscaping will feature native and adapted plants, including flowering shrubs and trees, that can thrive in the California climate while providing spots for quiet visits or active play. Heritage oaks and redwood trees from the original site were carefully relocated in oversized containers to be replanted when construction is complete. This environment also will provide inviting habitats for local birds.

The building site was formerly a large expanse of asphalt parking lots, which tend to raise surrounding temperatures by reflecting sunlight and subsequently increase the need for air conditioning. The expanses of green space and permeable paving can absorb storm drainage better than paved areas, since they allow rain to enter into the region’s groundwater system rather than running off into the bay, Guenther notes.

Bringing the Outdoors In

The sense of outdoors will pervade the interior of the new hospital as well. Courtyards and roof gardens will be easily accessible to patients and visitors and enable natural light to filter into the corridors. Patient room windows will feature planter boxes so that a child confined to bed will have a view of flowers, much like the current hospital building.

“From the very beginning, we knew that the new building would be highly sustainable and that thematically it would be all about nature,” Guenther says. “As a way-finding guide for families who come from all over the state, the building is themed around the ecoregions of California, from the Rocky Shore to the Sierra Nevada Mountains.”

Each floor theme highlights a specific ecosystem that includes native animals and plants, both to help visitors find their way around the building and to serve as an educational experience for young patients. The hospital’s child life staff and the design team polled patients and their families to determine favorite plants and animals, and engaged Stanford University ecology faculty to ensure accuracy. The fourth floor, for example, is themed to the California foothills with their indigenous cottontail rabbits, burrowing owls, and California poppies; the desert theme on the third floor will showcase bighorn sheep, valley quail, and saguaro cacti.

Water Wise

No potable water will be used for landscaping, Guenther says, which will save more than 684,000 gallons of water per year.

Rainwater will be harvested for landscape irrigation, and condensate water — water collected from dehumidifying indoor air — will be used to irrigate the gardens. All collected water is gathered in two 55,000-gallon underground cisterns. Harvested water will be used by a highly efficient drip irrigation system.

Water-cooled pumps and air compressors will be eliminated to reduce water usage. Dishwashers and sterilizers are projected to use about 80 percent less water than their standard counterparts, and low-flow bathroom fixtures along with a system of sensors and controls will reduce potable water usage in the new building by as much as 40 percent.

Energy Efficiency

Hospitals by their very nature are energy-intensive facilities, operating around the clock, and using complex medical systems and equipment critical to patient care. They also include heating and cooling systems that require a lot of energy, as do specialty support services such as laundry, sterilization services, food service, and complex computer centers. Lane and his team have been working closely with the architects and contractors to identify ways to make these systems energy efficient and to reduce waste.

An extensive external solar shading system will minimize direct sunlight, and window configurations in each direction can be altered to accommodate the sun’s orientation over the year, Guenther says. 

Instead of overhead air conditioning, the new hospital will incorporate a highly efficient displacement ventilation system that introduces air at the floor level. “Air naturally rises as it gets warmer from equipment and people, so it takes less fan energy to deliver it to the space,” she says, adding that the system uses 55 to 60 percent less thermal energy than a standard hospital cooling system.

The goal is to qualify for LEED gold status, says Michele Charles, a project engineer for the expansion project. LEED (Leadership in Energy & Environmental Design) is a national certification program that recognizes sustainable building strategies and practices. An energy dashboard in the main lobby will display how much energy is being used — and saved — at any time.

Full Circle

Lane says that the building’s construction also adheres to the highest standards of environmentally sensitive practices. On site, a quarter of the vehicles and equipment are powered by electric or alternative fuel. Thanks to diligent recycling practices, more than 1,200 tons of scrap metal, paper, and construction material have been sorted and diverted from local landfills. More than 70 percent of the steel used in the building comes from recycled sources.

And, in an ultimate measure of using recycled or reclaimed materials, the main elevator tower will be paneled in redwood slats harvested from the recently demolished roof infrastructure of the zeppelin hangar at Moffett Field in Mountain View. “The elevator tower will look and feel like being inside a redwood tree,” Guenther explains.

Next Steps

The expansion project remains on schedule for a summer 2017 opening, says Lane. By mid-May of this year, the metal decks and concrete floors will be in place, and the steel framework will be coated with fireproofing. The prefabricated components that make up the exterior skin are being installed throughout this spring and summer.

By mid-fall the hospital will look more like a building than a construction site, he adds, and interior walls will start going up floor by floor. By the end of 2015 the overhead utilities, water pipes, electrical conduits, and basic infrastructure will be in place.

Finally, by late 2016 construction will be completed as equipment and staff are brought on board to prepare for patients.

In the meantime, the planning team attends ongoing safety meetings with the construction crew. “Some of our crew members’ own children were born at our hospital,” says Charles. “It’s an ongoing reminder of the positive impact this hospital makes on people’s lives.”

As one parent of a current patient says, “2017 can’t come soon enough. It’s so critically important to help advance the healing for children.” 

This article first appeared in the Spring 2015 issue of the Lucile Packard Children's News.