Inside the development of the Arthur M. Blank Hospital

David Caravello

IIt’s one of the most technologically advanced healthcare facilities in the world: a 19-story hospital featuring state-of-the-art operating rooms, special care areas for infectious disease patients, a 30-foot-wide digital wall in the lobby and even a fleet of 90 robos with their own dedicated elevators. But Children’s Healthcare of Atlanta (Children’s) new Arthur M. Blank Hospital began life very differently—as a series of conversations with families and patients.

Early in the facility’s design process—almost seven years ago, Chris Chelette, senior vice president of facilities services at Children’s, said—Children’s asked patients and families what they would want in a new hospital. Answers included outdoor spaces for playing, patient rooms large enough to accommodate parents, places for parents to work and do laundry. Those ideas and many more were incorporated into the immense amount of engineering that went into designing and building Arthur M. Blank Hospital, a two-million-square-foot facility a decade in the making that welcomed its first patients Sept. 29.

“It is a fairly sophisticated building, even down to the big interactive wall in the main lobby that engages kids as they jump and create their own little caricatures. There are things like that all throughout the building,” said Douglas Lacy, senior vice president at the engineering services firm WSP, which was involved in the hospital’s master planning and design. “So I do think it is certainly at the high end of technology for any of the buildings we’ve designed, especially for healthcare.”

Lacy would know, given that he’s been involved with previous pediatric projects not just in Atlanta, but also in Dallas, Iowa, Ohio and Kuwait. The new Arthur M. Blank Hospital—named for the Atlanta philanthropist, whose foundation donated $200 million to the project—has multiple screens in each room, including a second television for parents. There are built-in, pan-tilt-zoom cameras— which automatically face away from patients when not in use—to provide remote interpretive services and future use cases such as remote clinical services. Each room also includes a digital whiteboard that shows patients’ daily schedules and care team members.

And that’s all on top of medical advances like the Marcus Center for Cellular Therapy, an in-house lab that manufactures cells for use in cutting-edge treatments and therapies. The hospital has 69 emergency exam rooms and 446 patient beds. Arthur M. Blank Hospital is also the only dedicated Level 1 pediatric trauma care center in Georgia.

“At Arthur M. Blank Hospital, we worked to incorporate technologies that would maximize impact,” said Chris Chelette, senior vice president of facilities services at Children’s, who holds engineering degrees from the University of Tennessee and Georgia Tech.

For instance: the new hospital uses real-time location systems (RTLS) to streamline workflows and enhance safety, which improves the patient experience by reducing clinical response times. The screens within the patient room integrate with that system so that when a clinician enters, they’re identified by a pop-up message appearing on the screens. “Staff members can review which clinicians have been with patients,” Chelette said, “which helps us improve staff coordination and patient care.”

WELCOME TO CARDBOARD CITY

The first patient transferred to Arthur M. Blank Hospital was 8-year-old Brithany Morales. She was one of 202 patients moved from Egleston Hospital and the Aflac Cancer and Blood Disorders Center at Scottish Rite Hospital to the new North Druid Hills facility on Sept. 29, a 10-hour process that involved 65 ambulances, coordination with more than 15 state and local agencies, and the help of over 1,000 support staff volunteers.

But well before the new hospital could begin accepting patients, it was “Cardboard City”—10,000 square feet of cardboard panels, taped together and moved around to determine the ideal layouts for workflow and patient care. “When we were designing Arthur M. Blank Hospital, we tried to think through every part of a patient’s journey from the moment they arrive at the hospital,” Chelette said. “To ensure that our staff would be best positioned to deliver lifesaving care for our patients, we knew we needed to stress test our 2-D plans through real-world simulations.”

The Cardboard City exercise was critical, Lacy said. It allowed engineers to assemble a space, watch actual healthcare professionals move through it, and then modify it to improve efficiency and fine-tune those spaces to best fit the needs of their occupants.

“A lot of it is moving big cardboard walls, but eventually you get into asking questions of, ‘OK, so tell me why you're doing that?’ And that informs where things need to be placed in the room as well—where different pieces of technology or utilities need to be,” said Lacy, who is based in metro Kansas City. “As it progressed, eventually it got to the point of, ‘OK, this is where we want computers on the wall, and this is where we want the gasses and things like that.’ And we were doing that in a paper mock-up state before anyone drew it.”

The Cardboard City project involved repurposing an empty 114,000-square-foot warehouse, Chelette said, and building full-scale mockups of various floors, rooms, and stations entirely out of cardboard. From there, more than 400 frontline staff, clinical leaders and patient families were brought in to test detailed scenarios throughout the cardboard hospital.

“We checked and rechecked everything, from the distance between operating rooms and the Emergency Department to the materials in patient room cabinets,” he said. “The result is Arthur M. Blank Hospital—a facility that has been optimally designed to meet our patients’ needs.”

There was one more step after Cardboard City: Mission Center. Or actually, a former small warehouse location on the new hospital site where contractors and engineers built detailed, full-scale mock-ups of actual rooms—like patient rooms, emergency department rooms, and operating rooms. The walls of the mock-ups quickly became covered in sticky notes—some bearing comments that required a change to the full-scale model, others with smaller tweaks that could be addressed in the drawings.

The idea was, “let’s look at one of them before we build 19, 200 or 400 of them,” Lacy said. “You try to get all the kinks worked out, basically like a prototyping phase. If there was one small thing that would be better if we changed it, it would be better to figure that out before we released thousands of workers onto the construction site and repeated that one thing 1,000 times.”

POWER OF PREFABRICATION

Construction of Arthur M. Blank Hospital, whose size and scope rival those of a professional sports stadium, was a massive undertaking that required well over one thousand workers on site at a time. To facilitate the process, general contractor Brasfield and Gorrie relied heavily on prefabrication—meaning that components like bathroom pods, exterior curtain walls and overhead MEP (mechanical, electrical and plumbing) utility racks were assembled by skilled workers off-site, then delivered to the North Druid Hills job location.

“You are delivering pre-assembled components to the jobsite and hoisting them into place,” said Darrin Roby, project director at Brasfield and Gorrie. “Once they are attached to the building structure, what would have required weeks’ worth of effort sequenced across several different trade partners is essentially complete.”

Prefabrication helped limit the number of personnel on the job site, and allowed workers to assemble items like MEP racks off-site in a place where they didn’t even need to wear a hard hat. The new hospital’s countless MEP utility racks were outfitted at an Inglett and Stubbs location about 10 miles from the job site, arriving in 20-foot sections. “By moving things into conditioned environments where people are working not on ladders but at bench-top height, and building things inside a controlled condition, we increase the safety for everybody,” Lacy said. “And of course it also speeds it up, so you can have multiple trades working in almost a factory environment, at a warehouse, putting those components together.”

Construction of one pre- and post-operative area, for instance, required the assembly and installation of roughly 90 medical headwalls—walls that combine electrical and medical gas functions, and house their requisite piping. For Arthur M. Blank Hospital, all those headwalls were prefabricated offsite. “You can imagine the manpower of skilled labor that the trades would have to have out here to get all 90 of these done,” David Hajjar, operations manager at Brasfield and Gorrie, said in a video the company produced during the hospital’s construction.

From an engineering perspective, WSP separated the hospital’s main tower into three sections, powered by respective substations on three different floors. The HVAC system is divided up the same way, out of necessity. “You basically break a giant budling building down into three or four smaller buildings, to make it manageable for a lot of different reasons,” Lacy said. “Obviously, we couldn’t have one giant air handler that fed the whole two million square feet, so we have to break it down into components that are shippable and manufacturable.”

HELPFUL ROBOS

Wrapped in colorful cartoon exteriors that show cute dogs or kids riding in red wagons, the 90 robos traversing the hallways of the new Arthur M. Blank Hospital are designed to make life easier for their human colleagues and ensure healthcare personnel can focus their attention on caring for patients.

“While planning for Arthur M. Blank Hospital, we were focused on ensuring our clinical teams could spend as much time as possible with patients,” Chelette said. “Our robos play a huge role in helping us accomplish that goal.”

About one-third of the devices are patient-facing, he added, performing tasks like delivering meals, transporting medications, and picking up labs from patients. The hospital also has a fleet of back-of-house robos which operate behind the scenes, hauling heavy linens and trash through the hospital’s back halls. There are even twelve elevators in the hospital dedicated for robo use. The robos are one of many ways in which Arthur M. Blank Hospital stands out.

“We also wanted to make the space as welcoming as possible for children of all ages,” Chelette said. “Elements like wall murals and digital installations throughout the hospital bring a sense of playfulness to the space, helping engage patients and families from the moment they walk through our doors.”

Designing a children’s hospital is unique, Lacy added, because architects and engineers have more than patients to consider—there have to be places for siblings to play, areas for parents to work or rest, accommodations for visiting aunts, uncles, and grandparents. Those needs are evident within Arthur M. Blank Hospital, where bright colors, open spaces and numerous play areas foster a welcoming and healing environment.

“We still want kids to be kids, so you have to be able to design a patient room, but also a playroom. You have to be able to design an operating room, but also a family care center that has some place for mom or dad to do a little bit of work, to keep paying the bills, maybe to do a little bit of laundry,” Lacy said. “There are lots of amenity spaces in a children's hospital that you wouldn't necessarily find in your adult care facilities. And so it's always top of mind who this building is for.”

Cardboard models, full-scale mock-ups, prefabricated parts and pieces—they all combined to create the state-of-the-art facility now standing off North Druid Hills Road. It’s a hospital unlike any Atlanta has seen before, one that promises to provide transformative care to children for generations to come.

“It’s been amazing to see the new hospital come to life since the end of September,” Chelette said. “After a decade of planning, there was obviously a huge amount of excitement and anticipation leading up to Move Day on Sept. 29, both from our patients and staff and the larger Georgia community. Now that we’re officially open, we’re able to focus on what we do best: delivering exceptional care to kids and families.”